Pain assessment: An alternative measure

A 21-numbered circle visual analog scale (VAS) may be a desirable alternative to the traditional 10-cm horizontal line for pain and patient global estimate on a Multidimensional Health Assessment Questionnaire (MDHAQ). The results are similar, and less than half the time is required for scoring.

Pincus and colleagues conducted a study of patients with any diagnosis at 3 rheumatology clinical care institutions. Each patient completed the MDHAQ with VAS for pain and global estimate at each visit. VAS formats other than a traditional (unnumbered) 10-cm horizontal line based on 21 circles at 0.5-cm intervals were analyzed.

The median time to score MDHAQ with a 10-cm line VAS was 15.6 seconds, compared with 7.4 seconds for the 21-numbered circle VAS. Labeling of intermittent numerical rating values or different intermittent symbols from circles, designed to facilitate scoring, was affected by clustering.

The authors noted that the 21-circle format presents at least 3 advantages: (1) an assessor can score the VAS without a ruler, saving time; (2) the need to reproduce an exact 10-cm line is eliminated, avoiding the problem of distortion; and (3) patients appear to have a better understanding of how to respond to the 21 circles.