VAS and NRS, Same or Different? Are Visual ... - Hindawi

In summary, based on results of our study, VAS evaluates the pain not only in aspects of its intensity but also in its character and its affective perception by ... PainResearchandManagement+JournalMenuPDFJournaloverviewForauthorsForreviewersForeditorsTableofContentsSpecialIssuesSubmitPainResearchandManagement/2022/ArticleArticleSectionsOnthispageAbstractIntroductionMethodsResultsDiscussionDataAvailabilityConflictsofInterestReferencesCopyrightRelatedarticlesResearchArticle|OpenAccessVolume2022|ArticleID5337483|https://doi.org/10.1155/2022/5337483JoannaBielewicz,BeataDaniluk,PiotrKamieniak,"VASandNRS,SameorDifferent?AreVisualAnalogScaleValuesandNumericalRatingScaleEquallyViableToolsforAssessingPatientsafterMicrodiscectomy?",PainResearchandManagement,vol.2022,ArticleID5337483,6pages,2022.https://doi.org/10.1155/2022/5337483ShowcitationVASandNRS,SameorDifferent?AreVisualAnalogScaleValuesandNumericalRatingScaleEquallyViableToolsforAssessingPatientsafterMicrodiscectomy?JoannaBielewicz,1BeataDaniluk,2andPiotrKamieniak31DepartmentofNeurology,MedicalUniversityofLublin,Lublin,Poland2InstituteofPsychology,MarieCurie-SkłodowskaUniversityinLublin,Lublin,Poland3DepartmentofNeurosurgery,MedicalUniversityofLublin,Lublin,PolandShowmoreAcademicEditor:RedhaTaiarReceived07Jul2021Accepted16Mar2022Published29Mar2022Objectives.Tocomparetheviabilityofthenumericalratingscale(NRS)andthevisualanaloguescale(VAS)asapainassessmenttoolsamongalargecohortofpatientswhounderwentmicrodiscectomy.SummaryofBackgroundData.Thepainintensity(PI)reductionisaparameterofsurgicaltreatmentefficacy.ThetwomostcommonlyusedscalesofPIareNRSandVAS.Manystudieshaveshownstrongsimilaritiesbetweenthosetwoscales,butthedirectinterchangeisdifficult.Methods.Patients,whounderwentmicrodiscectomy,wereprospectivelyenrolledintothestudyandassessedusingVASandNRSfortheback(NRS-B)andtheleg(NRS-L),ShortFormofMcGillPainQuestionnaire(SF-MPQ)includedPainRatingIndex(PRI)andOswestryDisabilityIndex(ODI)1daybeforeand1monthand3monthsaftertheprocedure.Results.131patientswereincludedinthestudy.NRS-L,NRS-B,VAS,andODIweresignificantlylower()1monthaftermicrodiscectomy.NRS-LandNRS-BratingsremainedatasimilarlevelwhileVASandODIdecreasedafter3months.TherateofdeclineofPImeasuredbyNRS-Lcorrelatedstatisticallysignificant(rs = 0.366;)withODI1monthaftersurgery.Beforesurgery,themostsignificantcorrelationwasfoundbetweenODIandNRS-L(rs = 0.494;),thelowestwithNRS-B(rs = 0.319;).3monthsaftersurgery,therewashighercorrelationsbetweenODIandVAS(rs = 0.634)thanNRS-L(rs = 0.265).PRIcorrelatedsignificantly()andmorestrongerwithVASthanwithNRS-LandNRS-Bineverypointsofassessment.Conclusion.TheresultsshowedthatPImeasurementsbyNRS-L/NRS-BandVASmutuallycorrelateandimpairfunctionalityevaluatedbyODI(convergentvalidity)butindifferentmodes(differentialvalidity).NRSandVASarenotparallelscalesandassessdifferentaspectsofpain.ThemeasurementofNRS-L1monthaftermicrodiscectomyseemstogivequickinsightintotheeffectivenessoftheprocedure.1.IntroductionReliableassessmentofdiscectomyresultsinpatientswithlowbackpain(LBP)andlumbarradicularpain(LRP)stillremainsachallenge.Anevaluativeendpointofsuchtreatmentisnotdefined.TheevaluationofLBP/LRPtreatmenteffectsisstilldifficultduetoinsufficientoutcomeparametersused[1].Inmanystudies,thereductionofpainintensity(PI)isstillconsideredaparameterofsurgicaltreatmentefficacy[2].Nowadays,theassessmentofpainreliesonsubjectiveevaluation,duetolackofobjectivebiochemicalmarkers.OneappliesdifferentscaleswhichmainlyevaluatePI.Twosuchscalesnumericalratingscale(NRS)andvisualanaloguescale(VAS)havebeenusedsince1950[3].NRSis11-points(NRS-11)or101-points(NRS-101)scalewhichcountsthepainandiswildlyusedinclinicalsettingsbecauseitiseasytoadministerandscore[4].ConductingofVAS,thepatientisaskedforvisualizationofhispainasapointon10 cmlinepresentedonpaper.AlthoughmanystudieshaveshownahighcorrelationsbetweenVASandNRS[5],NRSshowsgreatercomplianceandeaseofusecomparedtoVAS[4].ThepopularityofbothscalessometimescausesVAStobemistakenasNRSandviceversa.Thatconfusioninterfereswithobjectiveevaluationandcomparingtheresultsofresearchstudies.Functionaldisabilityisanothervaluetoconsiderevaluatingendpointsurgeryoutcome.TheOswestryDisabilityIndex(ODI)derivedfromtheself-reportedOswestryLowBackPainQuestionnairewasusedtoquantifydisabilityforLBPandisconsideredasa“functionalscale.”Thepatientisaskedtoassesshowthelegandbackpainaffectsnine,dailyactivities.ItisimportanttorememberthatthefirstquestionconcernsmeasuringPIbythenecessityofpainkillersusage.ThisvalidatedquestionnairewasfirstpublishedbyFairbanketal.inPhysiotherapyin1980[6].ThecurrentversionwaspublishedintheSpineintheyear2000[7],anditisnowregisteredwiththeInternationalConsortiumforHealthOutcomesMeasurementasastandardoutcomemeasure[8].Currently,ODIisusedasafunctionalindicatoroftheeffectivenessofsurgicalproceduresfortreatingdifferentvertebralcolumnandspinedisorders[9].ODIalsoassessestheusefulnessofanaesthetictechniquesappliedduringsurgery[10],anditisavaluabletoolforappraisingillnessperceptionsinagroupofpatientsaffectedbychroniclowbackpain[11].AnODIscore≤22scorecouldbeusedasacriterionoftreatmentsuccessofpatientswithalumbarspinedisorders[12].TheaimofthisstudywastoassessandcompareNRSandVASinthegroupofpatientswhounderwentdiscectomyasatreatmentofpharmacologicallyrefractoryLRP/LBP.TheircorrelationswithODIandalsowithShortFormofMcGillPainQuestionnaire(SF-MPQ)andBeckDepressionInventory(BDI)candefinetheirproperties.Theresultsofourstudycanbehelpfulindeterminingthemostaccurateandusefultoolstomonitorandevaluatetreatmentseffectsinthisgroupofpatients.2.PatientsandMethods2.1.Patients131(63femaleand68male)patientswithLBPand/orLRPadmittedtotheDepartmentofNeurosurgeryoftheMedicalUniversityofLublinwereprospectivelyenrolledintothestudy.Theywerequalifiedtomicrodiscectomy.Allpatientsreceivedwrittenandverbalinformationregardingstudyproceduresaswellassignaninformedconsent.Inaccordancewithbindinglegislationinthisfield,theEthicsCommitteeoftheMedicalUniversityofLublininPolandapprovedtheprotocolaswellasthedetailsoftheinformedconsent.Thepatientsmeanagerangedfrom18to76(M = 38.95,SD = 11.23).80(61.1%)hadajobrequiringhardphysicalactivity.Durationofpainwasbetween1and144months(M = 13.49,SD = 21.01)beforesurgicaltreatment.2.2.NeurosurgicalProcedureTheinclusioncriteriaformicrodiscectomywereasfollows:(1)theageofpatientsbetween18and80years,(2)thediagnosisofclinicallysymptomaticdischerniation(DH),(3)theconfirmationofclinicaldiagnosisbymagneticresonanceimaging(MRI),and(4)persistentpainandlackofconservativetreatmenteffects.Theexclusioncriteriawereasfollows:(1)previouscorticosteroidtherapyduringthreemonthsprecedingsurgery,(2)previousspinesurgeryorspinalstenosis,and(3)coexistenceofothermedicalconditionssuchasrheumatoiddiseases,diabetes,cancer,psychiatricdisorders,recentsurgeryforreasonotherthanDH,pregnancy,andalcoholordrugabuse.AllpatientswereoperatedonbythesamesurgeonwhousedthestandardmicrodiscectomymethodonasingleDHlevel.Theprocedurewascarriedoutundergeneralanaesthesia.2.3.ClinicalAssessmentAllpatientswereassessedaccordingtoNRSintheback(NRS-B)andtheleg(NRS-L)aswellasVAS,SF-MPQ,ODI,andBDI,separately.Thesubjectswereevaluatedadaybeforeoperationandsubsequentlyoneandthreemonthsfollowingtheprocedurebythesameinvestigator.NRS:thepatientisaskedtoindicatethevalueofhispainonthescale.A11-pointscalewasused,with“0”representing“nopain”and“10”representingthe“mostseverepainimaginable”atthetimeofassessment.VAS:itisassessedona100 mmhorizontalline.Thepatientisinformedthattheleftendofthescalerepresents“nopain”andthattherightendrepresentsthe“mostseverepainimaginable.”ThepatientistheninstructedtomarkPIcurrentlybeingexperiencedontheline.ODI:thepatientisaskedtoassesshowhislegandbackpainaffectsnineactivities:personalcare,lifting,walking,sitting,standing,sleeping,employment/homemaking,traveling,andsociallife.TheanswerforthefirstquestionvaluesPIaccordingtothenecessityofpainkillerintake.Eachanswerisscoredfrom0to5.Basedonthetotalscore,whichrangesfrom0to50,itispossibletoevaluatedisabilityforLBPasminimal,moderate,severe,cripplingbackpain,ordisabilitywhichmakesthepatientbed-bound.SF-MPQ:itconsistsofthePainRatingIndex(PRI),PresentPainIntensity(PPI),andVAS.ForPRI,thepatientisaskedtodescribethesensoryandaffectivequalitiesofhisexperience.Descriptorsareratedonanintensityscaleas0 = none,1 = mild,2 = moderate,or3 = severe.PRIisthesumoftheintensityvaluesofdescriptorswhichcharacterizepain.PPIisasixstepsscaleratingPI,from0(“nopain”)to5(“excruciatingpain”).BDI(BeckDepressionInventory):thepatientisaskedtoanswer21questionsregardinghismood.Everyanswerisratedfrom0to4.Thepresenceandintensityofdepressivedisturbancesareevaluatedagainsttotalscore.2.4.StatisticalAnalysisStatisticalanalysiswasperformedwiththeuseoftheIBMSPSSStatistics(StatisticalPackageforSocialSciences)softwareforWindows(Version25.0,PredictiveSolutionsSp.zoo.,Poland).Themeanandstandarddeviationvaluesfordescriptiveanalysiswereprovided.Beforecomparativeanalyzeswerecarriedout,alldatasetshadbeentestedfornormaldistributionbyKolmogorov–Smirnovtest.StatisticaldifferencesbetweennondependentgroupswerecalculatedusingthenonparametricMann–WhitneyUtest.Fridman’sranktestandWilcoxonsigned-ranktestwereusedtocomparethedependentgroups.SignificancevalueshavebeenadjustedbyBonferronicorrectionformultipletests.Kendall’sWcoefficientwasusedtoestimatetheeffectsize.ThecorrelationcoefficientofSpearman’srhowasemployedtoassesstheassociationsbetweenvariables.Thelevelofsignificancewasα = 0.05.3.ResultsNRS-L,NRS-B,VAS,ODI,PRI,andPPIscores1monthand3monthsaftermicrodiscectomy:NRS-L,NRS-B,VAS,ODI,PRI,andPPIscoreswereallsignificantlylower()1monthafterdiscectomy.NRS-L,NRS-B,andPPIscoresremainedstablewhileODI(),VAS(),andPRI()scoresdecreased3monthsaftersurgery.However,themostsignificantdecreaseinPIwasrecordedinNRS-L(W = 0.78)(Table1). Before(a)1monthafter(b)3monthsafter(c)χ2(value)EffectsizeKendall’sWPaircomparisonsNRS-B3.54(3.01)1.17(1.97)0.75(1.51)100.47(<0.001)0.38a-b(<0.001)a-c(<0.001)b-c(>0.05)NRS-L5.40(2.68)0.85(1.65)0.45(1.22)203.22()0.78a-b(<0.001)a-c(<0.001)b-c(>0.05)PRI16.6(10.29)7.10(7.92)6.08(8.06)137.63()0.52a-b(<0.001)a-c(<0.001)b-c(0.016)PPI2.47(1.03)1.21(0.93)1.07(0.99)123.64()0.47a-b(<0.001)a-c(<0.001)b-c(>0.05)VAS58.50(24.13)22.25(22.50)16.77(21.24)159.34()0.61a-b(<0.001)a-c(<0.001)b-c(0.018)ODI22.56(8.79)14.98(9.62)10.90(8.77)114.88(<0.001)0.44a-b(<0.001)a-c(<0.001)b-c(<0.001)Table1 NRS-L,NRS-B,VAS,ODI,PRI,andPPIscores1monthbeforeand1and3monthsaftermicrodiscectomy.CorrelationsofNRS-L,NRS-B,VAS,PRI,andPPIscoreswithODIscorebeforesurgery:significantcorrelationsbetweeneveryscaleofpainassessmentresultsandODIscorewereobserved.ThehighestcorrelationwithODIscorewasobservedwithPPI(rs = 0.527)andNRS-L(rs = 0.494),thelowestwithNRS-B(rs = 0.319)results.IncreasedPIcorrelateswithagreaterdegreeofdisability.CorrelationsofNRS-L,NRS-B,VAS,PRI,andPPIscoreswithODIscore1and3monthsaftersurgery:1and3monthsaftersurgerysignificantcorrelationswerestillobservedbetweeneveryscaleofpainassessmentresultswithODIscore.Inthefirstmonthofassessment,highercorrelationsbetweenPRI(rs = 0.599),PPI(rs = 0.584),andVAS(rs = 0.560)scoresandtheweakerbetweenNRS-B(rs = 0.361)andespeciallyNRS-L(rs = 0.354)withODIscorewereobserved.3monthsaftersurgery,thestrengthofcorrelationsbetweenODIwithPRI(rs = 0.722),PPI(rs = 0.742),VAS(rs = 0.634),andNRS-B(rs = 0.418)scoresincreasedbutwithNRS-L(rs = 0.265)scoredecreased(Table2). NRS-BNRS-LPRIPPIVASBeforeODI0.3190.4940.3600.5270.449<0.001<.001>