Zusammenfassung
Hintergrund: Die visuelle Analogskala (VAS) ist eines von verschiedenen Instrumenten zur Messung subjektiver Empfindungen wie der Schmerzintensität. Sie findet in der Physiotherapie zunehmend Verbreitung.
Ziel: Analyse der Gütekriterien Validität, Reliabilität (mit Objektivität) und Empfindlichkeit für klinisch relevante Veränderungen der VAS; Beschreibung des Skalenniveaus der VAS für die zu wählenden statistischen Tests.
Methode: Literatursuche in 3 Datenbanken und Referenzlisten.
Ergebnisse: Die VAS erscheint valide, reliabel sowie objektiv und erfasst mit hoher Sensitivität Änderungen der Schmerzempfindung. Die klinisch relevante Reduktion der VAS-Werte beginnt bei kleinen Eingangswerten schon ab 5 – 10 / 100 mm, während bei Eingangswerten von über 40 / 100 mm eine Mindestveränderung von 20 mm oder 30 % angegeben wird. Bei der Berechnung sind die Verbesserungen in Prozent denen in absoluten Zahlenwerten vorzuziehen. Die VAS-Werte besitzen die Eigenschaften einer Rationalskala und erlauben bei vorausgesetzter Normalverteilung die Anwendung parametrischer Tests zur statistischen Berechnung. Die Fehlerquote beim Ausfüllen der VAS ist mit 4 – 11 % gering. Da sie bei älteren und desorientierten Patienten höher liegt, bevorzugen diese häufig eine verbale Ratingskala.
Schlussfolgerung: Die VAS scheint die wissenschaftlichen Gütekriterien zu erfüllen und eignet sich zur Messung subjektiver Empfindungen wie der Schmerzäußerung in der Physiotherapie.
Abstract
Background: The visual analogue scale (VAS) is one of various instruments to measure subjective sensations like pain intensity. It is more and more used in physiotherapy.
Objective: Analysis of the quality criteria validity, reliability (with objectivity) and responsiveness to clinical relevant change of VAS; description of the VAS scale level for the correct selection of statistic tests.
Method: Literature search in 3 databases and reference lists.
Results: The VAS seems to be valid, reliable and objective, and is highly sensitive to detect changes in pain sensation. In the case of low baseline VAS scores the clinical relevant reduction in VAS values starts at 5 – 10 / 100 mm whereas with baseline VAS scores above 40 / 100 mm a minimal change of 20 mm or 30 % is indicated. In analysis improvements in percentage are preferred to absolute value quotations. The VAS scores hold the attributes of a ratio scale and assuming normal distribution allow the application of parametric tests for statistical analysis. With 4 – 11 % the error rate of VAS application is low. As the score is higher in elderly and disoriented patients, they often prefer a verbal rating scale.
Conclusion: The VAS seems to meet the scientific quality criteria and is suitable for measurements of subjective sensations like pain manifestation in physiotherapy.
Schlüsselwörter
visuelle Analogskala - numerische Ratingskala - verbale Ratingskala - Validität - Reliabilität - Empfindlichkeit für Veränderungen - Statistik
Key words
visual analogue scale - numeric rating scale - verbal rating scale - validity - reliability - responsiveness to change - statistics
Literatur
-
1
Abrams D, Davidson M, Harrick J. et al .
Monitoring the change: Current trends in outcome measure usage in physiotherapy.
Manual Therapy.
2006;
11
46-53
-
2
Breivik E K, Bjornsson G A, Skovlund E.
A comparison of pain rating scales by sampling from clinical trial data.
Clinical Journal of Pain.
2000;
16
22-28
-
3
Briggs M, Closs J S.
A descriptive study of the use of visual analogue scales and verbal rating scales for the assessment of postoperative pain in orthopaedic patients.
Journal of Pain and Symptom Management.
1999;
18
438-446
-
4
Carlsson A M.
Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale.
Pain.
1983;
16
87-101
-
5
Collins S L, Moore R A, McQuay H J.
The visual analogue pain intensity scale: what is moderate pain in millimetres?.
Pain.
1997;
72
95-97
-
6 Cutler P. Problem Solving in Clinical Medicine. From Data to Diagnosis. Philadelphia; Lippincott Williams & Wilkins 1998
-
7
De Leon S P, Lara-Muñoz C, Einstein A. et al .
A Comparison of three rating scales for measuring subjective phenomena in clinical research. II. Use of experimentally controlled visual stimuli.
Archives of Medical Research.
2004;
35
157-162
-
8
DeLoach L J, Higgins M S, Caplan A B. et al .
The visual analog scale in the immediate postoperative period: intrasubject variability and correlation with a numeric scale.
Anesthesia and Analgesia.
1998;
86
102-106
-
9
Dexter F, Chestnut D H.
Analysis of statistical tests to compare visual analog scale measurements among groups.
Anesthesiology.
1995;
82
896-902
-
10 Domholdt E. Rehabilitation Research, Principles and Applications. St. Louis; Elsevier Saunders 2005
-
11
Duncan G H, Bushnell M C, Lavigne G J.
Comparison of verbal rating scales and visual analogue scales for measuring the intensity and unpleasantness of experimental pain.
Pain.
1989;
37
295-303
-
12
Dworkin S F, Von Korff M, Whitney C W. et al .
Measurement of characteristic pain intensity in field research.
Pain.
1990;
Suppl 5
290
-
13
Farrar J T, Portenoy R K, Berlin J A. et al .
Defining the clinically important difference in pain outcome measures.
Pain.
2000;
88
287-294
-
14
Farrar J T, Young J P, LaMoreaux Jr L. et al .
Clinical importance of changes in chronic pain intensity measured on an 11-point numerical pain rating scale.
Pain.
2001;
94
149-158
-
15 Gäbel H. Photogrammetrische Verfahren zur Erfassung von menschlichen Körperoberflächen [Dissertation]. München; Bayerische Akademie der Wissenschaften 1993
-
16
Gridley L, Dolder P A.
The percentage improvement in pain scale as a measure of physiotherapy treatment effects.
Australian Journal of Physiotherapy.
2001;
47
133-138
-
17
Haas van den M, Groupp E, Panzer D. et al .
Efficacy of cervical endplay assessment as an indicator for spinal manipulation.
Spine.
2003;
28
1091-1096
-
18 Harms V. Biomathematik, Statistik und Dokumentation. Kiel; Harms 1992
-
19
Hartrick C T, Kovan J P, Shapiro S.
The numeric rating scale for clinical pain measurement: a ratio measure?.
Pain Practice.
2003;
3
310-316
-
20 Huber H, Winter E. Checkliste Schmerztherapie. Stuttgart; Thieme 2006
-
21 Hüsler J, Zimmermann H. Statistische Prinzipien für medizinische Projekte. Bern; Huber 2006
-
22
Jensen M P, Karoly P, Braver S.
The measurement of clinical pain intensity: a comparison of six methods.
Pain.
1986;
27
117-126
-
23
Jensen M P, McFarland C A.
Increasing the reliability and validity of pain intensity measurement in chronic pain patients.
Pain.
1993;
55
195-203
-
24
Jensen M P, Turner J A, Romano J M.
What is the maximum number of levels needed in pain intensity measurement?.
Pain.
1994;
58
387-392
-
25
Jensen M P, Turner J A, Romano J M. et al .
Comparative reliability and validity of chronic pain intensity measures.
Pain.
1999;
83
157-162
-
26 Kool J. Messen bei Befunderhebung und Ergebniskontrolle. Hüter-Becker A, Dölken M Beruf, Recht, wissenschaftliches Arbeiten Stuttgart; Thieme 2004
-
27
Kropmans T JB, Dijkstra P U, Stegenga B. et al .
Smallest detectable difference in outcome variables related to painful restriction of the temporomandibular joint.
Journal of Dental Research.
1999;
78
784-789
-
28
Lara-Muñoz C, Leon S P, Einstein de A. et al .
A comparison of three rating scales for measuring subjective phenomena in clinical research. I. Use of experimentally controlled auditori stimuli.
Archives of Medical Research.
2004;
35
43-48
-
29
Lund I, Lundeberg T, Sandberg L. et al .
Lack of interchangeability between visual analogue and verbal rating pain scales: a cross sectional description of pain etiology groups.
BioMedCentral (BMC) Medical Research Methodology.
2005;
5
31
-
30
Marquié L, Raufaste E, Lauque D. et al .
Pain rating by patients and physicians: evidence of systemic pain miscalibration.
Pain.
2003;
102
289-296
-
31
Myles P S, Troedel S, Boquest M. et al .
The pain visual analog scale: Is it linear or nonlinear?.
Anesthesia and Analgesia.
1999;
89
1517-1520
-
32
Ogon M, Krismer M, Sollner W. et al .
Chronic low back pain measurement with visual analogue scales in different settings.
Pain.
1996;
64
425-428
-
33
Ohnhaus E E, Adler R.
MethodologicaI problems in the measurement of pain: a comparison between the verbal rating scale and the visual analogue scale.
Pain.
1975;
1
379-384
-
34
Price D D, McGrath P A, Rafii A. et al .
The validation of visual analogue scales as ratio scale measures for chronic and experimental pain.
Pain.
1983;
17
45-56
-
35
Price D D, Bush F M, Long S. et al .
A comparison of pain measurement characteristics of mechanical visual analogue and simple numerical rating scales.
Pain.
1994;
56
217-226
-
36
Rosier E M, Iadarola M J, Coghill R C.
Reproducibility of pain measurement and pain perception.
Pain.
2002;
98
205-216
-
37
Rowbotham M C.
What is a “clinically meaningful” reduction in pain?.
Pain.
2001;
94
131-132
-
38
Scott J, Huskisson E C.
Graphic representation of pain.
Pain.
1976;
2
175-184
-
39
Scudds R A, Fisbain D A, Scudds R J.
Concurrent validity of an electronic descriptive pain scale.
Clinical Rehabilitation.
2003;
17
206-208
-
40
Summers S.
Evidence-based practice. Part 2: Reliability and validity of selected acute pain instruments.
Journal of PeriAnesthesia Nursing.
2001;
16
35-40
-
41
Williams A C, Davies H TO, Chadury Y.
Simple pain rating scales hide complex idiosyncratic meanings.
Pain.
2000;
85
457-463
-
42
Williamson A, Hoggart B.
Pain: A review of three commonly used pain rating scales.
Journal of Clinical Nursing.
2005;
14
798-804
Jochen Schomacher
PT, PT-OMT, MCMK (F), DPT (USA), B. Sc. Phys., M. Sc. Phys. (D)
Dorfstr. 24
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Schweiz
eMail: Jochen-Schomacher@web.de
