Is the Pain Visual Analogue Scale Linear and Responsive to Change? An Exploration Using Rasch Analysis
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{"title"=>"Is the pain visual analogue scale linear and responsive to change? An exploration using rasch analysis", "type"=>"journal", "authors"=>[{"first_name"=>"Paula", "last_name"=>"Kersten", "scopus_author_id"=>"7007160123"}, {"first_name"=>"Peter J.", "last_name"=>"White", "scopus_author_id"=>"8677587200"}, {"first_name"=>"Alan", "last_name"=>"Tennant", "scopus_author_id"=>"7006183251"}], "year"=>2014, "source"=>"PLoS ONE", "identifiers"=>{"issn"=>"19326203", "scopus"=>"2-s2.0-84903388703", "pui"=>"373399121", "doi"=>"10.1371/journal.pone.0099485", "isbn"=>"1932-6203 (Electronic)\\r1932-6203 (Linking)", "sgr"=>"84903388703", "pmid"=>"24921952"}, "id"=>"b5ca68c7-8083-33b3-ba92-a58d8270792f", "abstract"=>"OBJECTIVES Pain visual analogue scales (VAS) are commonly used in clinical trials and are often treated as an interval level scale without evidence that this is appropriate. This paper examines the internal construct validity and responsiveness of the pain VAS using Rasch analysis. METHODS Patients (n = 221, mean age 67, 58% female) with chronic stable joint pain (hip 40% or knee 60%) of mechanical origin waiting for joint replacement were included. Pain was scored on seven daily VASs. Rasch analysis was used to examine fit to the Rasch model. Responsiveness (Standardized Response Means, SRM) was examined on the raw ordinal data and the interval data generated from the Rasch analysis. RESULTS Baseline pain VAS scores fitted the Rasch model, although 15 aberrant cases impacted on unidimensionality. There was some local dependency between items but this did not significantly affect the person estimates of pain. Daily pain (item difficulty) was stable, suggesting that single measures can be used. Overall, the SRMs derived from ordinal data overestimated the true responsiveness by 59%. Changes over time at the lower and higher end of the scale were represented by large jumps in interval equivalent data points; in the middle of the scale the reverse was seen. CONCLUSIONS The pain VAS is a valid tool for measuring pain at one point in time. However, the pain VAS does not behave linearly and SRMs vary along the trait of pain. Consequently, Minimum Clinically Important Differences using raw data, or change scores in general, are invalid as these will either under- or overestimate true change; raw pain VAS data should not be used as a primary outcome measure or to inform parametric-based Randomised Controlled Trial power calculations in research studies; and Rasch analysis should be used to convert ordinal data to interval data prior to data interpretation.", "link"=>"http://www.mendeley.com/research/pain-visual-analogue-scale-linear-responsive-change-exploration-using-rasch-analysis", "reader_count"=>119, "reader_count_by_academic_status"=>{"Unspecified"=>6, "Professor > Associate Professor"=>2, "Researcher"=>11, "Student > Doctoral Student"=>7, "Student > Ph. D. Student"=>19, "Student > Postgraduate"=>13, "Student > Master"=>20, "Other"=>6, "Student > Bachelor"=>25, "Lecturer"=>3, "Lecturer > Senior Lecturer"=>1, "Professor"=>5}, "reader_count_by_user_role"=>{"Unspecified"=>6, "Professor > Associate Professor"=>2, "Researcher"=>11, "Student > Doctoral Student"=>7, "Student > Ph. D. Student"=>19, "Student > Postgraduate"=>13, "Student > Master"=>20, "Other"=>6, "Student > Bachelor"=>25, "Lecturer"=>3, "Lecturer > Senior Lecturer"=>1, "Professor"=>5}, "reader_count_by_subject_area"=>{"Unspecified"=>14, "Agricultural and Biological Sciences"=>6, "Arts and Humanities"=>1, "Business, Management and Accounting"=>1, "Computer Science"=>1, "Economics, Econometrics and Finance"=>1, "Engineering"=>4, "Nursing and Health Professions"=>12, "Materials Science"=>1, "Mathematics"=>1, "Medicine and Dentistry"=>52, "Neuroscience"=>4, "Sports and Recreations"=>7, "Pharmacology, Toxicology and Pharmaceutical Science"=>3, "Psychology"=>7, "Social Sciences"=>3}, "reader_count_by_subdiscipline"=>{"Materials Science"=>{"Materials Science"=>1}, "Medicine and Dentistry"=>{"Medicine and Dentistry"=>52}, "Social Sciences"=>{"Social Sciences"=>3}, "Sports and Recreations"=>{"Sports and Recreations"=>7}, "Psychology"=>{"Psychology"=>7}, "Mathematics"=>{"Mathematics"=>1}, "Unspecified"=>{"Unspecified"=>14}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>3}, "Arts and Humanities"=>{"Arts and Humanities"=>1}, "Engineering"=>{"Engineering"=>4}, "Neuroscience"=>{"Neuroscience"=>4}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>6}, "Computer Science"=>{"Computer Science"=>1}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>12}}, "reader_count_by_country"=>{"Canada"=>1, "Netherlands"=>1, "Belgium"=>1, "Egypt"=>1, "Brazil"=>1, "United Kingdom"=>2, "Indonesia"=>1}, "group_count"=>5}

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/1533107"], "description"=>"<p>The graph displays the person-item threshold distribution map with the x-axes displaying location or difficulty of item thresholds (lower half) and location or level of pain reported on the VAS by participants (upper half). The y-axes display the frequencies of item thresholds (lower half) and participants (upper half). Thresholds of seven items are shown and it can be seen that the thresholds spread over 1½ logits only.</p>", "links"=>[], "tags"=>["neuroscience", "Cognitive neuroscience", "anesthesiology", "epidemiology", "health care", "physiotherapy", "neurology", "Pain management", "pain", "mathematics", "Statistics (mathematics)", "Statistical methods", "research design", "Survey research", "Survey methods", "Clinical research design", "vas"], "article_id"=>1056038, "categories"=>["Biological Sciences"], "users"=>["Paula Kersten", "Peter J. White", "Alan Tennant"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0099485.g003", "stats"=>{"downloads"=>2, "page_views"=>41, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Person_Item_Threshold_distribution_Pre_VAS_data_/1056038", "title"=>"Person Item Threshold distribution (Pre VAS data).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-06-12 03:27:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1533092"], "description"=>"<p>Data distribution baseline pain VAS scores (average over 7 days).</p>", "links"=>[], "tags"=>["neuroscience", "Cognitive neuroscience", "anesthesiology", "epidemiology", "health care", "physiotherapy", "neurology", "Pain management", "pain", "mathematics", "Statistics (mathematics)", "Statistical methods", "research design", "Survey research", "Survey methods", "Clinical research design", "baseline", "vas", "scores"], "article_id"=>1056023, "categories"=>["Biological Sciences"], "users"=>["Paula Kersten", "Peter J. White", "Alan Tennant"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0099485.g001", "stats"=>{"downloads"=>0, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Data_distribution_baseline_pain_VAS_scores_average_over_7_days_/1056023", "title"=>"Data distribution baseline pain VAS scores (average over 7 days).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-06-12 03:27:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1533122"], "description"=>"<p>The Item Response Curve displays the expected raw score on the y-axis and the interval transformed log score on the x-axis.</p>", "links"=>[], "tags"=>["neuroscience", "Cognitive neuroscience", "anesthesiology", "epidemiology", "health care", "physiotherapy", "neurology", "Pain management", "pain", "mathematics", "Statistics (mathematics)", "Statistical methods", "research design", "Survey research", "Survey methods", "Clinical research design", "vas"], "article_id"=>1056048, "categories"=>["Biological Sciences"], "users"=>["Paula Kersten", "Peter J. White", "Alan Tennant"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0099485.g004", "stats"=>{"downloads"=>10, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Item_Response_Curve_for_one_VAS_item_/1056048", "title"=>"Item Response Curve for one VAS item.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-06-12 03:27:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1533126"], "description"=>"<p>Inclusion criteria into the study included a minimum score on a single pain VAS of 30; although on the seven daily VAS measures some scored below 30 mm, these numbers were small. Standardised Response Means (SRM) data for those with daily measurs below 30 mm have therefore been combined into one group.</p>", "links"=>[], "tags"=>["neuroscience", "Cognitive neuroscience", "anesthesiology", "epidemiology", "health care", "physiotherapy", "neurology", "Pain management", "pain", "mathematics", "Statistics (mathematics)", "Statistical methods", "research design", "Survey research", "Survey methods", "Clinical research design", "means", "displayed", "baseline", "vas"], "article_id"=>1056052, "categories"=>["Biological Sciences"], "users"=>["Paula Kersten", "Peter J. White", "Alan Tennant"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0099485.g005", "stats"=>{"downloads"=>0, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Standardised_Response_Means_displayed_by_baseline_raw_pain_VAS_score_/1056052", "title"=>"Standardised Response Means displayed by baseline raw pain VAS score.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-06-12 03:27:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1533127"], "description"=>"<p>* The range is from 0 to 50 as VAS scores have been halved, thus scores range from 0–50.</p>", "links"=>[], "tags"=>["neuroscience", "Cognitive neuroscience", "anesthesiology", "epidemiology", "health care", "physiotherapy", "neurology", "Pain management", "pain", "mathematics", "Statistics (mathematics)", "Statistical methods", "research design", "Survey research", "Survey methods", "Clinical research design"], "article_id"=>1056054, "categories"=>["Biological Sciences"], "users"=>["Paula Kersten", "Peter J. White", "Alan Tennant"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0099485.t004", "stats"=>{"downloads"=>0, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Vas_conversion_of_raw_ordinal_data_to_interval_data_item_4_/1056054", "title"=>"Vas conversion of raw (ordinal) data to interval data (item 4).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-06-12 03:27:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1533129"], "description"=>"<p>* The minimum baseline score is a little lower than 30 mm at screening, which took place a week before the commencement of the study.</p>", "links"=>[], "tags"=>["neuroscience", "Cognitive neuroscience", "anesthesiology", "epidemiology", "health care", "physiotherapy", "neurology", "Pain management", "pain", "mathematics", "Statistics (mathematics)", "Statistical methods", "research design", "Survey research", "Survey methods", "Clinical research design", "analogue", "baseline", "follow-up"], "article_id"=>1056055, "categories"=>["Biological Sciences"], "users"=>["Paula Kersten", "Peter J. White", "Alan Tennant"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0099485.t001", "stats"=>{"downloads"=>0, "page_views"=>4, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Visual_analogue_scale_distribution_at_baseline_and_follow_up_averaged_over_7_days_/1056055", "title"=>"Visual analogue scale distribution at baseline and follow-up (averaged over 7 days).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-06-12 03:27:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1533130"], "description"=>"<p>* The location represents the item difficulty in the Rasch model.</p>", "links"=>[], "tags"=>["neuroscience", "Cognitive neuroscience", "anesthesiology", "epidemiology", "health care", "physiotherapy", "neurology", "Pain management", "pain", "mathematics", "Statistics (mathematics)", "Statistical methods", "research design", "Survey research", "Survey methods", "Clinical research design", "analogue"], "article_id"=>1056056, "categories"=>["Biological Sciences"], "users"=>["Paula Kersten", "Peter J. White", "Alan Tennant"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0099485.t003", "stats"=>{"downloads"=>1, "page_views"=>6, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Visual_analogue_scale_item_difficulty_pre_data_/1056056", "title"=>"Visual analogue scale item difficulty (pre-data).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-06-12 03:27:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1533094"], "description"=>"<p>Data distribution follow-up pain VAS scores (average over 7 days).</p>", "links"=>[], "tags"=>["neuroscience", "Cognitive neuroscience", "anesthesiology", "epidemiology", "health care", "physiotherapy", "neurology", "Pain management", "pain", "mathematics", "Statistics (mathematics)", "Statistical methods", "research design", "Survey research", "Survey methods", "Clinical research design", "follow-up", "vas", "scores"], "article_id"=>1056025, "categories"=>["Biological Sciences"], "users"=>["Paula Kersten", "Peter J. White", "Alan Tennant"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0099485.g002", "stats"=>{"downloads"=>0, "page_views"=>12, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Data_distribution_follow_up_pain_VAS_scores_average_over_7_days_/1056025", "title"=>"Data distribution follow-up pain VAS scores (average over 7 days).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-06-12 03:27:06"}
  • {"files"=>["https://ndownloader.figshare.com/files/1533131"], "description"=>"<p>* Baseline pain: seven daily measures of pain on a VAS before the commencement of the trial, all cases included in the data set.</p>∞<p>Baseline pain: seven daily measures of pain on a VAS before the commencement of the trial, 15 misfitting cases have been excluded.</p>†<p>Post pain contains seven daily measures of pain on a VAS after the completion of the trial, item threshold shave been anchored to baseline item thresholds, 15 misfitting cases have been excluded.</p>∼<p>Post pain contains three daily measures of pain on a VAS after the completion of the trial, item threshold shave been anchored to baseline item thresholds, 15 misfitting cases have been excluded and 4 items have been deleted.</p>", "links"=>[], "tags"=>["neuroscience", "Cognitive neuroscience", "anesthesiology", "epidemiology", "health care", "physiotherapy", "neurology", "Pain management", "pain", "mathematics", "Statistics (mathematics)", "Statistical methods", "research design", "Survey research", "Survey methods", "Clinical research design", "analogue", "scores", "rasch"], "article_id"=>1056057, "categories"=>["Biological Sciences"], "users"=>["Paula Kersten", "Peter J. White", "Alan Tennant"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0099485.t002", "stats"=>{"downloads"=>1, "page_views"=>15, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Visual_analogue_scale_scores_fit_to_the_Rasch_model_/1056057", "title"=>"Visual analogue scale scores fit to the Rasch model.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-06-12 03:27:06"}

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Relative Metric

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