VU Research Portal Measurement Properties of Visual Analogue Scale, Numeric Rating Scale, and Pain Severity Subscale of the Brief Pain Inventory in Patients With Low Back Pain Chiarotto, Alessandro; Maxwell, Lara J.; Ostelo, Raymond W.; Boers, Maarten; Tugwell, Peter; Terwee, Caroline B. published in Journal of Pain 2019 DOI (link to publisher) 10.1016/j.jpain.2018.07.009 document version Publisher's PDF, also known as Version of record document license Article 25fa Dutch Copyright Act Link to publication in VU Research Portal citation for published version (APA) Chiarotto, A., Maxwell, L. J., Ostelo, R. W., Boers, M., Tugwell, P., & Terwee, C. B. (2019). Measurement Properties of Visual Analogue Scale, Numeric Rating Scale, and Pain Severity Subscale of the Brief Pain Inventory in Patients With Low Back Pain: A Systematic Review. 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Sep. 2021 The Journal of Pain, Vol 20, No 3 (March), 2019: pp 245−263 Available online at www.jpain.org and www.sciencedirect.com Critical Review Measurement Properties of Visual Analogue Scale, Numeric Rating Scale, and Pain Severity Subscale of the Brief Pain Inventory in Patients With Low Back Pain: A Systematic Review AlessandroD1XX Chiarotto,*D2XX,y LaraD3XX J. Maxwell,D4XzXRaymondD5XX W. Ostelo,*D6XX,y MaartenD7XX Boers,*D8XX,x PeterD9XX Tugwell,D10XzX,{ and CarolineD1XX B. Terwee*D12XX *Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, Netherlands. yDepartment of Health Sciences, Amsterdam Movement Sciences Research Institute, Vrije Universiteit, Amsterdam, Netherlands zCentre for Practice-Changing Research, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada. xAmsterdam Rheumatology and Immunology Center, VU University Medical Center, Amsterdam, Netherlands. {Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada. Abstract: The Visual Analogue Scale (VAS), Numeric Rating Scale (NRS), and Pain Severity sub- scale of the Brief Pain Inventory (BPI-PS) are the most frequently used instruments to measure pain intensity in low back pain. However, their measurement properties in this population have not been reviewed systematically. The goal of this study was to provide such systematic evi- dence synthesis. Six electronic sources (MEDLINE, EMBASE, CINAHL, PsycINFO, SportDiscus, Goo- gle Scholar) were searched (July 2017). Studies assessing any measurement property in patients with nonspecific low back pain were included. Two reviewers independently screened articles and assessed risk of bias using the COSMIN checklist. For each measurement property, evidence quality was rated as high, moderate, low, or very low (GRADE approach) and results were classi- fied as sufficient, insufficient, or inconsistent. Ten studies assessed the VAS, 13 the NRS, 4 the BPI-PS. The 3 instruments displayed low or very low quality evidence for content validity. High- quality evidence was only available for NRS insufficient measurement error. Moderate evidence was available for NRS inconsistent responsiveness, BPI-PS sufficient structural validity and inter- nal consistency, and BPI-PS inconsistent construct validity. All VAS measurement properties were underpinned by no, low, or very low quality evidence; likewise, the other measurement proper- ties of NRS and BPI-PS. Perspectives: Despite their broad use, there is no evidence clearly suggesting that one among VAS, NRS, and BPI-PS has superior measurement properties in low back pain. Future adequate quality head-to-head comparisons are needed and priority should be given to assessing content validity, test-retest reliability, measurement error, and responsiveness. © 2018 by the American Pain Society Key words: Low back pain, pain intensity, visual analogue scale, numeric rating scale, Brief Pain Inventory. Supported by the Task Force for Research of the Spine Society of Europe Address reprint requests to Alessandro Chiarotto, Department of Epide- (EUROSPINE) [grant number: EUROSPINE TFR 5-2015]. These funding miology and Biostatistics, Amsterdam Public Health research institute, bodies did not have any role in in designing the study, in collecting, ana- Amsterdam Movement Sciences research institute, VU University Medi- lyzing and interpreting the data, in writing this manuscript, and in cal Center, de Boelelaan 1089a, Medical Faculty F-vleugel, 1081HV, deciding to submit it for publication. Amsterdam, the Netherlands. E-mail: [email protected] The authors have no conflicts of interest to declare. 1526-5900/$36.00 Supplementary data accompanying this article are available online at © 2018 by the American Pain Society www.jpain.org and www.sciencedirect.com. https://doi.org/10.1016/j.jpain.2018.07.009 245 246 The Journal of Pain Measurement Properties of the VAS, NRS, and BPI-PS in LBP ow back pain (LBP) is the most disabling health Delphi study to reach consensus on which core out- condition worldwide.33 Measuring the impact of come measurement instrument(s) to endorse for pain LLBP on patients’ lives is fundamental to monitor- intensity in LBP clinical trials.8 For this reason, in con- ing clinical management and to study the (cost) effec- trast with previous reviews that had a more generic tiveness of treatments.4 Patients with LBP have focus on various pain conditions,6,42,47,52,86,94,108 this indicated that the most important domains to be mea- review focused solely on studies in patients with LBP, sured are physical functional activities, pain reduction, following the approach adopted in Cochrane reviews quality of life, enjoyment of life, emotional well-being, of randomized clinical trials on the effectiveness of and fatigue.9,43,103 A core outcome set initiative (involv- interventions in patients with LBP.32 ing patients) aimed at standardizing measurement for LBP identified 4 core outcome domains for clinical trials: physical functioning, pain intensity, health-related qual- Methods 9 ity of life, and number of deaths. Among these This systematic review was conducted according to domains, pain intensity is the most frequently assessed COSMIN guidance84 and reported according to the 31 in LBP clinical trials. PRISMA statement.71 Its protocol was registered in Pain intensity, defined as “how much a patient the international prospective register of systematic hurts, reflecting the overall magnitude of the pain reviews (http://www.crd.york.ac.uk/PROSPERO/), regis- 102 experience,” is the pain domain that ranked the tration number: CRD42015020006. highest among various pain domains (eg, pain qual- ity, temporal aspects of pain, pain behavior, and pain Measurement Instruments interference) in consensus exercises to establish core The VAS is a self-reported scale consisting of a hori- outcome domains for LBP9 and other pain condi- zontal or vertical line, usually 10 cm long (100 mm) tions.53,77 The visual analogue scale (VAS) is the anchored at the extremes by 2 verbal descriptors refer- patient-reported outcome measure (PROM) most fre- ring to the pain status.45 An introductory question (with quently used to measure pain intensity in LBP trials, or without a time recall period) asks the patient to tick followed by the numeric rating scale (NRS) and the the line on the point that best refers to his or her pain. Pain Severity subscale of the Brief Pain Inventory The introductory question, the recall period, and the (BPI-PS).7,31 Recent consensus-based studies have content of the external verbal descriptors vary in the shown that researchers and clinicians prefer the NRS literature.39 over other instruments to measure pain intensity in The NRS is a numbered version of the VAS in which LBP.13,17,22,24 However, this choice has not been the patient can select one number that best describes explicitly based on its measurement properties and the pain.23 Like in the VAS, the NRS introductory ques- feasibility.5,85 tion, time recall period and verbal descriptors can vary; The NRS, VAS, and BPI-PS are highly feasible for the most frequently used version is the 11-point (0-10) clinical research and practice, providing very little NRS.39 burden to professionals and patients.39 Various The BPI-PS consists of four 11-point NRSs, two of reviews have attempted to synthesize their measure- which asking the patient to rate the pain at its worst ment properties in samples of patients with and least in the last 24 hours, and the other two asking pain.6,42,47,52,86,94,108 All these reviews focused on about pain on the average and right now.15 For each chronic pain broadly and two of them solely focused NRS, the verbal descriptors are no pain and