Clark Patricia, Lavielle Pilar, Martínez Homero
Clinical Epidemiology Unit, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Hospital General de México, OD, Mexico City, Mexico.
J Rheumatol. 2003 Jul;30(7):1584-8.
Rheumatologists often deal with patients' pain, as commonly measured by clinical scales. However, no published study in the last 25 years has explored patient preferences for the 2 most frequently used clinical scales the verbal rating scale (VRS) and the visual analog scale (VAS). We (1) evaluated patient preferences for the 10 cm horizontal VAS versus the 5 point VRS and identified associated reasons for their preferences; and (2) validated the test-retest reliability and construct validity of these scales.
Patients with painful rheumatological conditions rated the VAS and the VRS to assess pain intensity and stated which scale they preferred and why. Exploration of tender points and dolorimetry was performed in all cases.
Of 113 patients in the sample, 93% were women, 85% of whom had rheumatoid arthritis. In this sample, 52.8% preferred the VRS, 28.3% the VAS, and 18.9% expressed no preference. Patients who preferred the VRS said it was easier than the VAS to understand and rate. They also reported being more comfortable using words than numbers. Patients who preferred the VAS said that numbers classified pain better and that this allowed them to be objective and precise. Patients with 0-6 years of schooling preferred the VRS, while those with > 6 years preferred the VAS. There was a significant association between the number of tender points and pain intensity with both scales, as well as between threshold and tolerance with the VAS. High correlations were found between the VAS and the VRS (r = 0.79) and between tolerance and threshold (r = 0.96). Test-retest showed a high correlation for both scales: VAS = 0.97 and VRS = 0.89.
Both scales are valid measures of pain intensity. The choice should depend on the setting, the clinician's goal, and the patient's level of education. Patient preference is central to better physician-patient communication.
风湿病学家经常应对患者的疼痛，通常通过临床量表来衡量。然而，在过去25年中，尚无已发表的研究探讨患者对两种最常用临床量表即语言评定量表（VRS）和视觉模拟量表（VAS）的偏好。我们（1）评估了患者对10厘米水平VAS与5点VRS的偏好，并确定其偏好的相关原因；（2）验证了这些量表的重测信度和结构效度。
患有疼痛性风湿病症的患者对VAS和VRS进行评分以评估疼痛强度，并说明他们更喜欢哪种量表以及原因。所有病例均进行了压痛点检查和痛觉测量。
样本中的113名患者中，93%为女性，其中85%患有类风湿关节炎。在该样本中，52.8%的患者更喜欢VRS，28.3%更喜欢VAS，18.9%表示无偏好。更喜欢VRS的患者表示，它比VAS更容易理解和评分。他们还报告说，使用文字比数字更舒服。更喜欢VAS的患者表示，数字能更好地对疼痛进行分类，这使他们能够做到客观和精确。受教育年限为0 - 6年的患者更喜欢VRS，而受教育年限> 6年的患者更喜欢VAS。两种量表的压痛点数量与疼痛强度之间以及VAS的阈值与耐受性之间均存在显著关联。VAS与VRS之间（r = 0.79）以及耐受性与阈值之间（r = 0.96）发现高度相关。重测显示两种量表的相关性都很高：VAS = 0.97，VRS = 0.89。
两种量表都是疼痛强度的有效测量方法。选择应取决于具体情况、临床医生的目标以及患者的教育水平。患者偏好对于改善医患沟通至关重要。
