A novel visual facial anxiety scale for assessing preoperative anxiety

Abstract

BackgroundThere is currently no widely accepted instrument for measuring preoperative anxiety. The objective of this study was to develop a simple visual facial anxiety scale (VFAS) for assessing acute preoperative anxiety.MethodsThe initial VFAS was comprised of 11 similarly styled stick-figure reflecting different types of facial expressions (Fig 1). After obtaining IRB approval, a total of 265 participant-healthcare providers (e.g., anesthesiologists, anesthesiology residents, and perioperative nurses) were recruited to participate in this study. The participants were asked to: (1) rank the 11 faces from 0–10 (0 = no anxiety, while 10 = highest anxiety) and then to (2) match one of the 11 facial expression with a numeric verbal rating scale (NVRS) (0 = no anxiety and 10 = highest level of anxiety) and a specific categorical level of anxiety, namely no anxiety, mild, mild-moderate, moderate, moderate-high or highest anxiety. Based on these data, the Spearman correlation and frequencies of the 11 faces in relation to the 11-point numerical anxiety scale and 6 categorical anxiety levels were calculated. The highest frequency of a face assigned to a level of the numerical anxiety scale resulted in a finalized order of faces corresponding to the 11-point numeric rating scale.ResultsThe highest frequency for each of the NVRS anxiety scores were as follow: A0, A1, A2, A3, A4, A5, A7, A6, A8, A9 and A10 (Fig 2). For the six categorical anxiety levels, a total of 260 (98.1%) participants chose the face A0 as representing ‘no’ anxiety, 250 (94.3%) participants chose the face A10 as representing ‘highest’ anxiety and 147 (55.5%) participants chose the face A8 as representing ‘moderate-high’ anxiety. Spearman analysis showed a significant correlation between the faces A3 and A5 assigned to the mild-moderate anxiety category (r = 0.58), but A5 was ultimately chosen due to its higher frequency compared to the frequency of A3 (30.6% vs 24.9%)(Fig 3). Similarly, the correlation of the faces A7 and A6 was significantly correlated with moderate anxiety (r = 0.87), but A7 remained because of its higher frequency (35.9% vs 22.6%). Using frequency and Spearman correlations, the final order of the faces assigned to the categories none, mild, mild-moderate, moderate, moderate-high and highest anxiety levels was A0, A1, A5, A7, A8 and A10, respectively (Fig 4).ConclusionThe proposed VFAS was a valid tool for assessing the severity of acute [state] anxiety, and could be easy to administer in routine clinical practice.

Hypnosis and progressive muscle relaxation for anxiolysis and pain control during extraction procedure in 8–12-year-old children: a randomized control trial

“…Over-retained molars up to Grade-I mobility were included. All children who had pre-operative anxiety above mild on the proposed Visual Facial Anxiety Scale (VFAS) (Cao et al 2017 ) were considered. Children who had known allergy to local anaesthesia, or specific medical illnesses/psychological impairments and children/parents who were not willing to participate were excluded from the study.…”

“…baseline, after the intervention, after local anaesthesia and extraction (scores assigned: 0–5). The proposed VFAS by Cao et al ( 2017 ) is a simple six-point ordinal scale representing a growing level of anxiety from ‘none’ shown by neutral facial expression to ‘highest’ shown by face displaying excessive fear. The proposed VFAS is a new tool for subjective anxiety measurement, which is valid with strengthened construct validity to assess acute anxiety in busy operative settings.…”

Digital versus conventional impression method in children: Comfort, preference and time

“…Following that, in both impression‐taking methods, in the section filled by the patient, the patient was asked to report his or her feeling of general discomfort, difficulty breathing, smell/taste discomfort, heat/cold disturbance, queasiness, gag reflex, and a pain spot. Unlike in other studies, in our study, the degrees of these parameters, however, were recorded by using a 100‐mm VAS index, which was supported with facial emojis designed specifically for children, instead of the classic VAS (Figure ). Moreover, 14‐21 days after the taking of impressions in both methods, the patients were asked to respond to questions in the questionnaire prepared to learn their preferences and experiences about the impressions.…”

Investigation of analgesic dose of nalbuphine combined with remifentanil after radical gastrectomy

“…Inclusion criteria (13,14): All enrolled patients met the requirements of the American Society of Anesthesiologists (ASA) (levels I–II); all gastric cancer patients admitted were confirmed as positive by clinical diagnosis; both enrolled patients and their family members were informed and agreed before treatment. Exclusion criteria: Patients who were allergic to analgesic drugs, who had a history of drug abuse, patients undergoing chemotherapy and radiotherapy one month before operation, patients unwilling to cooperate with the treatment or with disabilities, were excluded from the study.…”