疼痛评分量表
藿香茶P u b l i s h e d b y M a n e y P u b l i s h i n g (c ) W . S . M a n e y & S o n L i m i t e d
INTRODUCTION
Physical therapists u tests and measures to evaluate patients on a daily basis: tests and measures are the ‘heart and soul of good clinical practice’.1As the pro-fession of physical therapy continues to evolve toward full professional autonomy, clinicians must develop an enhanced understanding of the applications and the implications of using specific clinical measures;additionally, physical therapy treatment approaches must be demonstrated to be clinically effective, as part of which obrved changes in patient status as a result of physical therapy interventions, should be demon-strably clinically meaningful and statistically signifi-cant. Physical therapists must go beyond the routine of performing specific tests or measures, but rather must understand the theoretical basis for the mea-surement; understand what the instrument is measur-ing; know how to cho the most appropriate tool;understand potential sources of error; know how to interpret the clinical information obtained; and
understand measurement issues, including concepts of validity and reliability.1,2
Pain is one of the primary reasons patients ek medical attention; therefore, patient perceived pain levels are commonly ud as an outcome measure and indicator of clinical change. Unlike measurements of physical impairments such as range of motion or strength, pain is a subjective and multidimensional phenomenon, its prentation depending upon a vari-ety of aetiologies and influencing factors.3–6The sub-jective nature of pain leads to some of the difficulty encountered in its measurement: instruments must translate subjective information into objective mea-sures.4Numerous pain measurement tools are com-monly ud by both clinicians and rearchers.4–18As a result of the subjective and multidimensional char-acteristics of pain, most clinical studies u a combi-nation of pain measures in an attempt to ensure a true reprentation of the patient’s pain experience.
The purpo of this literature review is to explore,compare, and contrast the psychometric properties of
W . S. Maney & Son Ltd 2005
DOI 10.1179/108331905X55776
VISUAL ANALOGUE SCALE, NUMERIC PAIN RATING SCALE AND THE McGILL PAIN QUESTION
NAIRE: AN OVER VIEW OF PSYCHOMETRIC PROPERTIES
CRISTIANA KAHL 1AND JOSHUA A. CLELAND 2,3
女性保险1
Division of Physical Therapy, Long Island University, Brooklyn, New York, USA 2
Physical Therapy Program, Franklin Pierce College, Concord, New Hampshire, USA 3
Rehabilitation Services of Concord Hospital, Concord, New Hampshire, USA
ABSTRACT
It is esntial for physical therapists to u outcome measures that identify and measure a change in patient status; however, pain is a multidimensional experience that is often difficult to measure. A variety of instruments have been developed in an attempt to obtain an accurate measure of patients’ perceived level of pain. Three of the most common outcome measures utilid by physical therapists include the visual analogue scale, the numeric pain rating scale and the McGill Pain Questionnaire. The purpo of this review is to describe the psychometric properties, including reliability and responsiveness, of the outcome measures.
Keywords : Outcome measures, psychometric properties, pain, V AS, NPRS, MPQ
Physical Therapy Reviews 2005; 10: 123–128
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three commonly ud pain measures in clinical prac-tice and rearch: the visual analogue scale (V AS), the numerical pain rating scale (NPRS), and the McGill Pain Questionnaire (MPQ).
PAIN RATING SCALES
Pain has been described as a ‘complex, multidimen-sional phenomenon, with diver etiologic and sus-taining factors’.3This renders the asssment and treatment of pain to also be complex and multidimen-sional. The extensive number of pain measurement tools is a clear demonstration of the complexity involved in capturing data that are truly descriptive of the pain phenomena. Variables such as intensity,duration, quality, related impairments, and resulting dysfunction are just a few of the domains addresd by the various measurement tools available to clini-cians. The NPRS (Appendix A) and the V AS (Appendix B) are commonly ud measures of per-ceived pain intensity.4,5,8,10,13,19The ea of u and short duration of their administration are common ration
ales for choosing the NPRS and the V AS.4,8,10However, it is equally important to understand that the are unidimensional measures that asss only the perceived intensity of pain.4,8,10In contrast, the MPQ (Appendix C) is a multidimensional instrument that provides information on the nsory, affective,and evaluative dimensions of the pain experi-ence.4,6,7,20Although more time consuming in its application, the multidimensionality of the MPQ pro-vides clinicians and rearchers with valuable infor-mation for asssing pain, and is often ud in conjunction with other unidimensional measures of pain intensity.4
Numerical pain rating scale
The NPRS is a lf-reported, or clinician adminis-tered, measurement tool consisting of a numerical point scale with extreme anchors of ‘no pain’ to ‘extreme pain’.4,8,10,21The scale is typically t up on a horizontal or vertical line, ranges most commonly from 0–10 or 0–100, and can be administered in writ-ten or verbal form.4,8,10,21The patient is asked to rate
his/her pain intensity and a particular time frame or descriptor is established (e.g . within the last 24 h,today, worst pain, average pain, or least pain).4,8,21The NPRS scores high on ea of administration and simplicity for
scoring.10,21Reliability is defined as the extent to which an instrument is consistent in its mea-surement, or free of
error;2,22the test–retest reliability for the NPRS has been demonstrated to be moderate
to high, varying from 0.67 to 0.96.21–23Validity is defined as the ability of a test to measure what it is intended to measure; the extent to which inferences can be made from the measurement obtained.2,22Criterion validity determines the degree to which a measurement correlates to a ‘gold standard’, or criterion test mea-sure.22Criterion validity has not been established for the NPRS as there are no ‘gold standards’ for pain mea-surement; however, when correlated with the V AS, the NPRS is determined to have 0.79 to 0.95 convergent validity .21,23The values support the u of the NPRS,as convergent validity indicates that two measures asssing the same phenomenon measure the same con-struct, and yield similar results.22 Responsiveness of a scale is defined as its ability to detect change over time.22Finch 21reports that a three-point change in the NPRS is necessary to demon-strate a true change in pain intensity, implying that there are limitations in the responsiveness of a 0–10scale. Despite the ea in administration and scoring of the NPRS, it has been established that individuals with cognitive deficits may have trouble interpreting the numbers and words on the NPRS, and may not be able to u this scale accurately.4,21
Visual analogue scale
The V AS is considered by some to be one of the best measures of pain intensity.8,13Similar to the NPRS,the V AS is a lf-reported measurement consisting of a vertical or horizontal line with extreme anchors of ‘no pain’ to ‘extreme
pain’.4,10,13,21This line reprents a continuum of pain intensity and is most often 10 cm in length.13,21The patient is asked to mark their per-ceived level of pain intensity (for a specified time frame) on the line.21The examiner scores the instru-ment by measuring the distance, in millimetres, from the ‘no pain’ anchor to the mark, which the patient identified as their level of pain.21The simplicity of its construction and u are considered the main advan-tages of the V AS.4The measurement continuum is also believed to provide greater nsitivity than a numerical scale.4,9Of great significance, at least for rearch purpos, is the fact that the V AS provides ratio data and permits the u of parametric statis-
饮料推广tics.4,8,24Disadvantages include the fact that individu-als with visual or cognitive deficits may not be able to u it accurately. A significant correlation between the number of incorrect respons to the V AS and age appears to exist;5,10in addition, measurement errors as simple as changes in the length of the line from photocopying, can occur easily.4
Test–retest reliability has been reported to be high for the V AS (ICC = 0.71–0.99);21–23,25it should be
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noted that, as a lf-reported measure, inter-rater and intrarater reliability are not applicable for the V AS.Although the lack of a ‘gold standard’ prevents the determination of criterion validity, when correlated with the NPRS and the MPQ, the V AS demonstrates convergent validity values of 0.30 to 0.95.21,23This wide range may be due to the multidimensional nature of the MPQ; nonetheless, the V AS demon-strates high correlations with the NPRS.21,23Concurrent validity has been found to be moderate for the V AS (0.71–0.78) when compared with the NPRS.25In summary, the V AS is considered a
strong,clinically uful, reliable and valid measure of pain intensity.4,8,10,13,23,25
Rates of correct respons are considered to be a problem whenever a scale is completed without supervi-sion, which can
be the ca with both the V AS and the NPRS when they are lf-reported.10The relative nsi-tivity, as determined by the number of available respons and by statistical power, is thought to vary in different conditions and has not been examined exten-sively for the NPRS.10However Jenn et al .10state that the limited number of possible respons may result in decread relative nsitivity of the NPRS when com-pared to the infinite number of respons possible in the continuum of the V AS. If considering nsitivity when defined as the measure’s ability to detect treatment effect, Jenn et al .10conclude that different scales may be more nsitive in different conditions and, therefore,one specific measure will not consistently demonstrate higher statistical power than the other.McGill Pain Questionnaire
The McGill Pain Questionnaire differs significantly from the NPRS and the V AS in that it extends beyond the measurement of pain intensity and measures pain as a multidimensional variable. The MPQ was first published by Melzack 6in 1975 and has since become one of the most widely ud measures of pain.4The original version, which takes 10–15 min to administer,is comprid of three class of word descriptors for pain (nsory, affective, and evaluative), and a numer-ical pain intensity scale.6The led to three primary measures: (i) a pain rating index (PRI) determined through the assignment of numerical values to the words in each category; (ii) the total number of wo
rds chon (NWC); and (iii) the prent pain index (PPI),which is bad on the 1–5 numerical pain intensity scale.6Studies of the original MPQ reveal that it is sufficiently nsitive and able to detect changes; it exhibits a high degree of validity and reliability, and it provides both qualitative and quantitative data that can be ud for statistical analysis.4,6,20,26,27
Melzack 6reported a correlation of 0.89 to 0.90between PRI, NWC, and PPI, indicating high internal consistency within the instrument, and a consistency of respon across three test times (test–retest reliabil-ity) of 70.3%. The findings have been supported by Reading 20and Graham and colleagues.28The primary advantages of the MPQ are its ability to measure the multidimensional aspects of pain; its ability to pro-vide quantitative and qualitative data for rearch,and its high reliability and validity.4,6,20,28On the other hand, some of the disadvantages of the MPQ include its complexity; the concentration and attention required by patients when completing the question-naire; the difficulty patients may have in understand-ing the word descriptors; and the length of time required for administration.4,6
A short-form of the MPQ (Appendix D) was pub-lished by Melzack 7in 1987 in an attempt to make the measure more attractive to tho who did not have the time to u the original version. This version takes 2–5 min to administer, contains 15 nsory and affec-tive descriptors rated on an inten
sity scale of 0–3, the prent pain index (PPI), and a V AS.7The short-form has been shown to have high correlations with the original version, with correlation coefficients varying from 0.67 to
0.90.7It has also been shown to be suffi-ciently nsitive in its ability to demonstrate change as a result of a treatment intervention.7The short-form MPQ is not intended to replace the original MPQ,but simply to provide an alternative when time is a concern.7,25
CONCLUSIONS
Pain has been defined by the International Association for the Study of Pain (IASP) as ‘an unpleasant nsory and emotional experience associ-ated with actual or potential tissue damage, or described in terms of such damage’.29The subjective and multidimensional nature of pain leads to signifi-cant challenges in its asssment and measurement;nonetheless, it remains a relevant attribute that must be measured in both the clinical and rearch arenas.This short review has described the psychometric properties of three pain measurement instruments commonly ud in the clinical and rearch ttings.The V AS and the NPRS are easy to administer and score and, as a result, are commonly ud pain mea-sures in the clinical tting.4,10,13Although also ud in the rearch tting, the measures are limited to the asssment of perceived pain intensity and do n
ot allow for extensive data analysis.10Despite its incread complexity and length, the MPQ provides a multidimensional measure of pain, allowing for the
湖南话VISUAL ANALOGUE SCALE, NUMERIC PAIN RATING SCALE AND THE McGILL PAIN QUESTIONNAIRE 125
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126KAHL AND CLELAND
CRISTIANA KAHL PT MA NCS (for correspondence)
Assistant Professor/Clinic Director, Division of Physical Therapy, Long Island University, 1 University Plaza, Brooklyn, NY 11201, USA
E-mail: ckahl@/doc/99328063f5335a8102d22027.html JOSHUA A. CLELAND DPT OCS
Assistant Professor, Physical Therapy Program, Franklin Pierce College; Physical Therapist, Rehabilitation Services of Concord Hospital,
Concord, New Hampshire; and Fellow, Manual Therapy Program, Regis University, Denver, Colorado, USA
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五香粉一般用在哪VISUAL ANALOGUE SCALE, NUMERIC PAIN RATING SCALE AND THE McGILL PAIN QUESTIONNAIRE 127
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APPENDIX C
McGill Pain Questionnaire (MPQ)
[Reprinted from The McGill Questionnaire: Major Properties and Scoring Methods , Melzak R,pp. 277–299 ? 1975 Mosby, with permission from Elvier.]
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