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Visual analog scales (VASs) are gaining popularity for collecting responses in computer administration of psychometric tests and surveys. The VAS format consists of a line marked at its endpoints with the minimum and maximum positions that it covers for respondents to place a mark at their selected location. Creating the line with intermediate marks along its length was discouraged, but no empirical evidence has ever been produced to show that their absence does any good. We report a study that asked respondents to place marks at pre-selected locations on a 100-unit VAS line, first when it only had numerical labels (0 and 100) at its endpoints and then when intermediate locations (from 0 to 100 in steps of 20) were also labeled. The results show that settings are more accurate and more precise when the VAS line has intermediate tick marks: The average absolute error decreased from 3.02 units without intermediate marks to 0.82 units with them. Provision of intermediate tick marks also reduced substantially inter- and intra-individual variability in accuracy and precision: The standard deviation of absolute error decreased from 0.87 units without tick marks to 0.25 units with them and the standard deviation of signed distance to target decreased from 1.16 units without tick marks to 0.24 units with them. These results prompt the recommendation that the design of VASs includes intermediate tick marks along the length of the line.

Purpose To estimate Swedish experience-based value sets for EQ-5D health states using general population health survey data. Methods Approximately 45,000 individuals valued their current health status by means of time trade off (TTO) and visual analogue scale (VAS) methods and answered the EQ-5D questionnaire, making it possible to model the association between the experience-based TTO and VAS values and the EQ-5D dimensions and severity levels. The association between TTO and VAS values and the different severity levels of respondents' answers on a self-rated health (SRH) question was assessed. Results Almost all dimensions (except usual activity) and severity levels had less impact on TTO valuations compared with the UK study based on hypothetical values. Anxiety/depression had the greatest impact on both TTO and VAS values. TTO and VAS values were consistently related to SRH. The inclusion of age, sex, education and socioeconomic group affected the main effect coefficients and the explanatory power modestly. Conclusions A value set for EQ-5D health states based on Swedish valuations has been lacking. Several authors have recently advocated the normative standpoint of using experience-based values. Guidelines of economic evaluation for reimbursement decisions in Sweden recommend the use of experience-based values for QALY calculations. Our results that anxiety/depression had the greatest impact on both TTO and VAS values underline the importance of mental health for individuals' overall HRQoL. Using population surveys is in line with recent thinking on valuing health states and could reduce some of the focusing effects potentially appearing in hypothetical valuation studies.

Objectives The study aims to increase knowledge about the performance of the EuroQol-visual analogue scales (EQ-VAS) in the UK NHS patient-reported outcome measures (PROMs) programme, which covers groin hernia, hip and knee replacement and varicose vein surgery, and make suggestions for improved collection, coding and analysis of data. Methods Four hundred scanned images of matched before-and-after EQ-VAS PROMs responses were selected at random. These were classified according to the different ways in which they were completed. Patient-level PROMs programme data linked to Hospital Episode Statistics for all patients from April 2009 to February 2011 were used to analyse the relationship between the EQ-VAS and the EQ-5D profile, index-weighted profile and condition-specific instruments. The linked PROMs and HES data comprise 331,951 anonymised patient records. Results A large majority (95 %) of EQ-VAS responses were completed in an unambiguous way, but only a minority (45 %) conformed strictly to the instructions given, posing challenges for data coding. The EQ-VAS data have a predictable and consistent relationship with the EQ-5D profile, although the correlations between the EQ-VAS and other measures of patient-reported health, both before and after surgery and in the change between them, are weak. Conclusions EQ-VAS data might be improved by providing better guidance on collection and coding. It is argued that the observed differences in results from EQ-VAS and other measures of health reflect the fact that it measures a broader underlying construct of health, arguably providing a means of summarising overall health that is closer to the patient's perspective.

Several scales are commonly used for assessing pain intensity. Among them, the numerical rating scale (NRS), visual analog scale (VAS), and verbal rating scale (VRS) are often used in clinical practice. However, no study has performed psychometric analyses of their reliability and validity in the measurement of osteoarthritic (OA) pain. Therefore, the present study examined the test-retest reliability, validity, and minimum detectable change (MDC) of the VAS, NRS, and VRS for the measurement of OA knee pain. In addition, the correlations of VAS, NRS, and VRS with demographic variables were evaluated. The study included 121 subjects (65 women, 56 men; aged 40-80 years) with OA of the knee. Test-retest reliability of the VAS, NRS, and VRS was assessed during two consecutive visits in a 24 h interval. The validity was tested using Pearson's correlation coefficients between the baseline scores of VAS, NRS, and VRS and the demographic variables (age, body mass index [BMI], sex, and OA grade). The standard error of measurement (SEM) and the MDC were calculated to assess statistically meaningful changes. The intraclass correlation coefficients of the VAS, NRS, and VRS were 0.97, 0.95, and 0.93, respectively. VAS, NRS, and VRS were significantly related to demographic variables (age, BMI, sex, and OA grade). The SEM of VAS, NRS, and VRS was 0.03, 0.48, and 0.21, respectively. The MDC of VAS, NRS, and VRS was 0.08, 1.33, and 0.58, respectively. All the three scales had excellent test-retest reliability. However, the VAS was the most reliable, with the smallest errors in the measurement of OA knee pain.

The goal of this study was to examine the efficacy and safety of the levonorgestrel intrauterine system (LNG-IUS) versus dienogest (DNG) in female subjects with symptomatic uterine adenomyosis. This study enrolled 117 women with symptomatic adenomyosis who visited our hospital from May 1, 2019, to June 30, 2022. Participants were randomized to either the LNG-IUS group (n = 48) or the DNG group (n = 79) in an as-controlled clinical trial for 36 months. Visual analog scale (VAS) scores, uterine volume, endometrial thickness, serum carcinoma antigen 125 level, estradiol, follicle-stimulating hormone, luteinizing hormone, and side effects were assessed to compare the efficacy of LNG-IUS and DNG. The VAS pain score was significantly decreased in both groups after 3 months of treatment. Three months later, patients receiving DNG reported significantly lower VAS scores compared with those treated with LNG- IUS (P < 0.05). Compared with LNG-IUS, DNG effectively controlled uterine volume growth after 12 months of treatment but neither significantly reduced uterine volume. During the treatment period, endometrial thickness in both groups was maintained at 0.4 to 0.7 cm. Both DNG and LNG-IUS significantly improved adenomyosis-associated pain after 3 months of treatment. Compared with LNG-IUS, DNG was shown to continuously relieve the symptoms of pain and effectively control the growth of uterine volume.

Objectives The visual analogue scale (VAS) has been used in the context of health and healthcare for various purposes, for example, to measure pain and to provide a single-index measure of health-related quality of life (HRQoL). This scoping review aims to describe how the VAS has been used for health state valuation in the published literature. Methods The search was carried out in Medline, Web of Science and PsycInfo. The findings of the included articles were tabulated and presented descriptively using frequencies and proportions. Results The database search yielded 4856 unique articles, out of these, 308 were included. In 83% of the articles, the main purpose for using a VAS was to value health states. The two most common perspectives when valuing health states with a VAS were hypothetical (44%) and own health (34%). Some (n = 14) articles used the VAS in the context of economic evaluations, including calculating quality-adjusted life years (QALYs). A large variation in the design of the VAS was found, including the description of the lower and upper anchors. Advantages and disadvantages with using a VAS were mentioned in 14% of the included articles. Conclusion The VAS has been a common method for valuing health states, both as a stand-alone method and in combination with other valuation methods. Despite its widespread use, the design of the VAS has been inconsistent which makes comparison of results across studies challenging. Further research on the role of using the VAS in economic evaluations is warranted.

Purpose Meta-analysis was conducted to estimate whether MiTLIF could reduce the complication rate while maintaining the similar clinical result to that of open procedures. Methods A search of the literature was conducted on pubmed or EMBASE. A database including patient clinical information was created. A systematic review of eligible studies with multivariate regression analysis was performed to quantitatively review the correlation of VAS improvement rate and the performance of MiTLIF. Results Fourteen articles with a minimum of 12-month follow-up met our inclusion criteria. The hypothesis of homogeneity could be accepted. The fixed-effects model was used to calculate the summary risk ratio (odds ratio). In the pooled analysis, the summary risk ratio (odds ratio) in patients with MiTLIF against those with open procedure for fusion rate, complication rate and revision/readmission rate was 0.99 ( p  = 0.36), 1.15 ( p  = 0.5) and 2.59 ( p  = 0.003), respectively, suggesting that MiTLIF was a risk factor for revision/readmission. Multivariate regression analysis showed that the percentage of male patients and the length of surgery exert a significant impact on VAS improvement rate. The selection of MiTLF was not significant. Conclusion Fusion rate and complication rate for both open and MiTLIF were similar. Moreover, the MiTLIF group tended to have a higher revision/readmission rate, which might be associated with the deep learning curve. Therefore, to achieve the level of surgical skill required of an MiTLIF surgeon, many years of training and experience are necessary. Otherwise, MiTLIF may yield unsatisfactory result upon patients.

Accurate quantification of pain in a clinical setting is vital. The use of an electronic pain scale enables data to be collected, analyzed, and utilized much faster compared with traditional paper-based scales. The advancement of smart technology in pediatric and adult pain evaluation may offer opportunities to introduce easy-to-use and reliable pain assessment methods within different clinical settings. If promptly introduced within different pediatric and adult pain clinic services, validated and easily accessible mobile health pain apps may lead to early pain detection, promoting improvement in patient's quality of life and leading to potentially less time off from school or work. This cross-sectional observational study aimed to investigate the interchangeability of an electronic visual analog scale (eVAS) app with a traditional paper visual analog scale (pVAS) among Australian children, adolescents, and adults for pain evaluation. Healthy participants (age range 10-75 years) were recruited from a sporting club and a secondary school in Melbourne (Australia). The data collection process involved application of pressure (8.5 kg/cm ) from a Wagner Force Dial FDK 20 to the midpoint of the thumb. The pressure was applied twice with a 5-minute interval. At each pressure application, participants were asked to randomly record their pain perception using the \"eVAS\" accessible via the \"Interactive Clinics\" app and the traditional pVAS. Statistical analysis was conducted to determine intermethod and intramethod reliabilities. Overall, 109 healthy participants were recruited. Adults (mean age 42.43 years, SD 14.50 years) had excellent reliability, with an intraclass correlation coefficient (ICC) of 0.94 (95% CI 0.91-0.96). Children and adolescents (mean age 13.91 years, SD 2.89 years) had moderate-to-good intermethod and intramethod reliabilities, with an ICC of 0.80 (95% CI 0.70-0.87) and average ICC of 0.80 (95% CI 0.69-0.87), respectively. The eVAS app appears to be interchangeable compared with the traditional pVAS among children, adolescents, and adults. This pain evaluation method may offer new opportunities to introduce user-friendly and validated pain assessment apps for patients, clinicians, and allied health professionals.

Visual analogue scales (VASs) have been shown to be valid measurement instruments and a better alternative to Likert-type scales in Internet-based research, both empirically and theoretically [1,2]. Upsides include more differentiated responses, better measurement level, and less error. Their feasibility and properties in the context of eHealth, however, have not been examined so far. The present study examined VASs in the context of a lifestyle study conducted online, measuring the impact of VASs on distributional properties and non-response. A sample of 446 participants with a mean age of 52.4 years (standard deviation (SD) = 12.1) took part in the study. The study was carried out as a randomized controlled trial, aimed at supporting participants over 8 weeks with an additional follow-up measurement. In addition to the randomized questionnaire, participants were further randomly assigned to either a Likert-type or VAS response scale version of the measures. Results showed that SDs were lower for items answered via VASs, 2P (Y ≥ 47 | n=55, P=.5) < .001. Means did not differ across versions. Participants in the VAS version showed lower dropout rates than participants in the Likert version, odds ratio = 0.75, 90% CI (0.58-0.98), P=.04. Number of missing values did not differ between questionnaire versions. The VAS is shown to be a valid instrument in the eHealth context, offering advantages over Likert-type scales. The results of the study provide further support for the use of VASs in Internet-based research, extending the scope to senior samples in the health context. Clinicaltrials.gov NCT01909349; https://clinicaltrials.gov/ct2/show/NCT01909349 (Archived by WebCite at http://www.webcitation.org/6h88sLw2Y).

Background Laparoscopy-assisted distal gastrectomy (LADG) is generally considered superior to open distal gastrectomy (ODG) with regard to postoperative quality-of-life. Differences in postoperative pain may exist due to recent pain control techniques including epidural anesthesia. There is little evidence for this difference. In this article we report the results of our randomized single-blind study in LADG versus ODG. The aim of the present study was to evaluate differences in postoperative physical activity between LADG and ODG. Methods Forty patients with early gastric cancer (stage IA and IB) were registered in this randomized study. For strict evaluation, patients were not told about the type of operation until postoperative day 7. Postoperative physical activity was evaluated objectively by Active Tracer, which records the cumulative acceleration over a 24 h period to investigate differences in postoperative recovery. Questionnaire and visual analog scale score related to postoperative pain were also investigated. Results Significant differences were observed with a more favorable outcome noted in the LADG group with respect to intraoperative blood loss ( P  < 0.001), total amount of pain rescue ( P  < 0.001), wound size ( P  < 0.001), postoperative hospital stay ( P  < 0.001), and inflammatory parameters (C-reactive protein, SaO 2 , and duration of febrile period) ( P  < 0.001). Cumulative physical recovery to 70 % of the preoperative level was significantly shorter (by 3 days, P  < 0.001) in the LADG group. Conclusions Comparison of LADG and ODG for patients with early gastric cancer showed favorable outcome and earlier recovery of physical activity in the LADG group.