Validation of the visual analog scale in the cervical spine

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>The visual analog scale (VAS) is frequently used to measure treatment outcome in patients with cervical spine disorders. The minimum clinically important difference (MCID) is the smallest change in a score that has clinical importance to the patient. Although it has been established for other medical fields, knowledge of the VAS MCID for the cervical spine is sparse, and it has rarely been considered in relation to measurement noise. The goals in this study were as follows: 1) to validate the VAS-neck and VAS-arm instruments for the cervical spine (e.g., repeatability); 2) to investigate the possible influence of predictive factors and the Hospital Anxiety and Depression Scale (HADS) score on repeatability; and 3) to compute the MCID with 5 different methods.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A post hoc analysis of a prospective randomized controlled trial with 151 patients undergoing surgery for cervical radiculopathy due to degenerative disc disease was performed. Information on age, sex, smoking habits, exercise, employment status, HADS score, and VAS-neck and VAS-arm scores was gathered before surgery and after 1 year. The VAS was applied twice on every occasion, with 15 minutes in between. Repeatability and the association with predictors and HADS score were analyzed using the 1-sample t-test, linear regression models, and Spearman correlation. The MCID was calculated with the following methods: average change, change difference, receiver operating characteristic curve, effect size, and minimum detectable change (MDC).</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The repeatability in VAS-neck was 8.1 mm, and in VAS-arm it was 10.4 mm. Less consistent values on the VAS correlated to female sex and higher values on the HADS. For VAS-neck the MCID ranged from 4.6 to 21.4, and for VAS-arm it ranged from 1.1 to 29.1. The highest MCID came from the MDC method, which was the only method that gave values above the measurement noise in both VAS-neck and VAS-arm.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Measurement noise in VAS-neck and VAS-arm for the cervical spine was influenced by female sex and HADS score. The only method to compute MCID that consistently gave results above the measurement noise in VAS-neck and VAS-arm was the MDC.</jats:p><jats:p>Clinical trial registration no.: 44347115 (<jats:ext-link xmlns:xlink="http://www.w3.org/1999/xlink" ext-link-type="uri" xlink:href="http://www.isrctn.com">www.isrctn.com</jats:ext-link>).</jats:p></jats:sec>

Clinically significant changes in pain along the Pain Intensity Numerical Rating Scale in patients with chronic low back pain

“…The quantification of the outcome of CLBP treatment using some simple clinical scale is crucical in the clinical management [12,15]. To reveal the cutoff points and the MCID for ΔPI-NRS based on PGIC in CLBP are the most simple and acceptable for the medical staff when we quantify the treatment goal [17][18][19][20][21][22][23][24][25].…”

“…We sought to predict the MCID and cutoff value for ΔPI-NRS using the anchor-based approach by setting PGIC as the anchor [23]. Therefore, we partitioned LBP patients into two groups based on post-treatment PGIC score: Group 1: satisfied (PGIC = 1 or 2) vs. Group 2: not satisfied (PGIC = 3-7) as was done in previous studies [19,[24][25]. The utility of ΔPI-NRS in distinguishing the two groups were evaluated from satisfied (PGIC = 1 or 2) vs. not satisfied (PGIC = 3-7).…”

Artificial disc replacement versus fusion in patients with cervical degenerative disc disease and radiculopathy: a randomized controlled trial with 5-year outcomes

“…The minimum clinically important difference (MCID) is 15-17.3. 5,24,39 Secondary outcomes were the EQ-5D (range from 0 to 1, with higher scores reflecting better quality of life) 31 and visual analog scales (VASs) for neck and arm pain 18 (range 0-100 mm), with higher scores indicating more severe pain). The MCID is 21 mm for VAS-neck and 29 mm for VAS-arm.…”

“…The MCID is 21 mm for VAS-neck and 29 mm for VAS-arm. 18 We also assessed dysphagia using the Dysphagia Short Questionnaire (DSQ, 28 range 0-18, with higher values representing more severe symptoms). The Hospital Anxiety and Depression Scale (HADS 40 ) was used to assess the prevalence of anxiety (HADS-a) and depression (HADSd).…”

The Impact of Modic Changes on Preoperative Symptoms and Clinical Outcomes in Anterior Cervical Discectomy and Fusion Patients

“…Patient-reported outcomes (PROs) were collected both preoperatively and at final followup. The PROs included the following validated outcome tools: visual analogue scale (VAS)-Neck, 19 VAS-Arm, 19 Neck Disability Index (NDI), 20 Short Form 12-Item 21 and the Veterans' Rand 12-Item. 22 Postoperative surgical outcomes collected included reoperations, pseudarthrosis, and ASD at the proximal and distal levels.…”