Lara-Muñoz Carmen, De Leon Sergio Ponce, Feinstein Alvan R, Puente Alicia, Wells Carolyn K
Servicios Clínicos, Instituto Nacional de Psiquiatría Ramón de la Fuente, Mexico City, Mexico.
Arch Med Res. 2004 Jan-Feb;35(1):43-8. doi: 10.1016/j.arcmed.2003.07.007.
An interest in measuring subjective phenomena such as pain, nausea, anxiety, etc. has led clinicians to develop three types of ratings: the visual analog scale (VAS); the verbal rating scale (VRS), and the numeric rating score (NRS). These ratings are regarded as global scales because they lack criteria to demarcate diverse dimensions or categories that comprise each scale. The purpose of this study was to evaluate validity and consistency of usage for these scales. Criterion for validity consisted of an experimentally controlled intensity for auditory stimuli.
We conducted a prospective, experimentally controlled, clinimetric study at the Audiology Department at the Hospital of Puebla Autonomous University (in Puebla State, Mexico). Participants included 25 medical students, two psychology students, and three practicing physicians. Interventions consisted of pure 1,000 Hz tones in five different intensities applied for 3 sec with a 1-min interval between stimuli at three sessions for each observer. Main outcome measure was validity and consistency of usage for VAS, VRS, and NRS scales.
Correlation coefficients between scale results and standard stimuli were 0.818 for VAS, 0.735 for NRS, and 0.796 for VRS. Mean weighted kappa indices for intraobserver agreement were 0.70, 0.59, and 0.65, respectively, for scales with five categories each. Mean weighted kappa indices for inter-observer variability were 0.61, 0.48, and 0.54 for VAS, NRS, and VRS again with five categories each.
The three instruments appeared reasonably accurate, with VAS having highest scores. VRS appeared sufficiently consistent to be regarded as providing reliable scientific information.
临床医生因对测量疼痛、恶心、焦虑等主观现象感兴趣，从而开发了三种评分方式：视觉模拟量表（VAS）、语言评定量表（VRS）和数字评定量表（NRS）。这些量表被视为整体量表，因为它们缺乏划分构成每个量表的不同维度或类别的标准。本研究的目的是评估这些量表使用的有效性和一致性。有效性标准包括听觉刺激的实验控制强度。
我们在普埃布拉自治大学医院（位于墨西哥普埃布拉州）的听力学部进行了一项前瞻性、实验控制的临床测量研究。参与者包括25名医科学生、2名心理学学生和3名执业医师。干预措施包括以五种不同强度施加纯1000赫兹音调，持续3秒，每次刺激间隔1分钟，每位观察者进行三个疗程。主要观察指标是VAS、VRS和NRS量表使用的有效性和一致性。
量表结果与标准刺激之间的相关系数，VAS为0.818，NRS为0.735，VRS为0.796。对于每个有五个类别的量表，观察者内一致性的平均加权kappa指数分别为0.70、0.59和0.65。观察者间变异性的平均加权kappa指数，VAS、NRS和VRS再次分别为0.61、0.48和0.54，每个也有五个类别。
这三种工具看起来相当准确，VAS得分最高。VRS看起来一致性足够高，可被视为能提供可靠的科学信息。
