Developmental differences in children's use of rating scales.

OBJECTIVE: To examine the effect of child age and number of response choices on children's tendency to respond at the extremes of Likert-type scales rating emotional states. METHODS: Sixty children (5-6 years, 7-9 years, 10-12 years) were randomly assigned to use either three or five response choices in providing ratings in three different task conditions. Tasks were designed to have correct choices at the midpoints of the rating scales. Children also completed a self-report feelings questionnaire. RESULTS: Results showed that younger children responded in an extreme manner when rating emotion-based, but not physical, tasks. Children's extreme scores did not vary as a function of number of response choices used. More extreme scores on the three tasks were related to more extreme scores on the feelings questionnaire. CONCLUSIONS: These results indicate that young children may respond in an extreme manner when rating emotional states. Researchers and clinicians should take this into account when interpreting children's self-reporting ratings.     

Measurement of dyspnea: word labeled visual analog scale vs. verbal ordinal scale

We previously used a verbal ordinal rating scale to measure dyspnea. That scale was easy for subjects to use and the words provided consistency in ratings. We have recently developed a word labeled visual analog scale (LVAS) with labels placed by the subjects, retaining the advantages of a verbal scale while offering a continuous scale that generates parametric data. In a retrospective meta-analysis of data from 43 subjects, individuals differed little in their placement of words on the 100 mm LVAS (mean+/-S.D. for slight=20+/-2.5 mm, moderate=50+/-5 mm and severe=80+/-6 mm) and ratings were distributed uniformly along the scale. A significant stimulus-response correlation was obtained for both the LVAS (r(2)=0.98) and for the verbal ordinal scale (Spearman r=0.94). The resolution of the two scales differed only slightly. With meaningful verbal anchors, well-defined end-points, and clear instructions about the specific sensation to be rated, both scales provide valid measures of dyspnea.     

Oxygen uptake kinetics during severe exercise: a comparison between young and older men

This study examined the relationship between the slow component of oxygen uptake (VO2) kinetics and muscle electromyography (EMG) during severe exercise in nine young (21.7+/-0.9 yr) and nine older (71.6+/-0.8 yr) men. Oxygen uptake (VO2) and surface EMG activity of the left vastus lateralis muscle were measured during a 7-min square-wave bout of severe exercise on a cycle ergometer. The absolute amplitude of the VO2 slow component was greater and occurred approximately 60 s earlier in the young compared to older subjects. However, the rate of increase in the slow component, expressed as a percentage of the total VO2 response per unit time, was not different between young and older subjects (young: 4.8+/-0.5%.min(-1); older: 4.9+/-0.6%.min(-1)). The mean power frequency (MPF) of the EMG increased significantly during the slow component phase of exercise by 6.4+/-1.0% in the young and by 5.4+/-0.7% in the older group and this rise was not significantly different between the two groups. These results indicate that normal ageing may not alter the VO2 slow component (measured as the rate of increase in VO2) and that this finding may be related to similar muscle fibre recruitment patterns in the two groups during severe-intensity exercise.     

A standard procedure enhances the correlation between subjective and objective measures of sleepiness

OBJECTIVE: The goal of this study was to assess whether instituting a standard procedure to minimize transient activation prior to the subjective rating of sleepiness can improve the predictive value of the rating process. METHODS: Thirty young adults, aged 19 to 26 years, participated in the study. Subsequent to sleeping at home with bedtime restricted to 5 hours, they came to the sleep laboratory. They were instructed to rate their level of sleepiness on the Stanford Sleepiness Scale (SSS) and visual analog scales (VAS). A "calm-down" procedure, sitting quietly with eyes closed for 1 minute, was instituted prior to sleepiness ratings for half of the subjects (experimental group) but not for the other half of the subjects (control group). A nap trial with polysomnographic recording was then conducted, followed by a vigilance test. RESULTS: For the experimental group, VAS results of "sleepiness" and "alertness" both correlated significantly with sleep-onset latency during the nap (SOL: r = -.62 and .64, respectively, P values < .05) and with reaction time (RT) on the vigilance test (r = .56 and -.54, P values < .05). The SSS ratings showed significant correlation with nap SOL (r = -.58, P < .05) but not with RT on the vigilance test (r = .19, p = .52). For the control group, none of the subjective ratings showed significant correlation with objective measures. The differences between the resultant correlations for the 2 groups were statistically significant for 2 sets of correlations: the correlation between VAS of "alertness" and nap SOL and the correlation between VAS of "sleepiness" and RT on the vigilance test. CONCLUSION: The results indicate that the subjective ratings of the sleepiness state for individuals with mild sleep restriction more faithfully reflect a physiologic tendency to fall asleep as well as cognitive attentiveness when the ratings are conducted subsequent to sitting still with eyes closed for a sufficient time to minimize transient activation.     

Cortical evoked potentials and clinical rating scales as measures of depressive illness

Relationships between clinical ratings and cortical evoked potentials were examined before and during antidepressant drug treatment in 32 patients with major depressive disorder (DSM-III). Clinical rating scales included Hamilton Rating Scale for Depression, Beck Depression Inventory, Present State Examination (PSE) and Newcastle Scale. Evoked potentials included contingent negative variation (CNV), post-imperative negative variation (PINV) and auditory evoked potential (AEP) There were close correlations between all rating scales, and factor analysis produced only one component, suggesting that the common variance between them related to severity of depression. CNV magnitude before treatment correlated negatively with severity of depression regardless of diagnostic category. Depressed patients had a prominent PINV which persisted during antidepressant treatment. The amplitude of late components (N1P2) of the AEP was reduced strikingly in patients with a history of suicide attempts.     

Age-related changes of exercise-induced plasma catecholamines and neuropeptide Y responses in normal human subjects.

Age-related plasma noradrenaline and neuropeptide Y were evaluated in seven young (mean +/- SD, 28 +/- 3 years) and seven elderly (64 +/- 8 years) normal subjects during rest and different work loads on a cycle ergometer. In the supine and the sitting position plasma noradrenaline and neuropeptide Y were almost identical in the two groups. Plasma neuropeptide Y did not increase during exercise at 100 W for 15 min. At this load plasma noradrenaline levels were higher in the older subjects (mean +/- SEM, 0.97 +/- 0.12 vs. 0.60 +/- 0.09 ng ml-1). There was a significant correlation between plasma noradrenaline and the relative work load at 100 W (r = 0.794, P = 0.0007). At 75% of maximal work load plasma noradrenaline and neuropeptide Y were higher in the young group (1.84 +/- 0.16 vs. 1.26 +/- 0.13 ng ml-1 (noradrenaline) and 38 +/- 4 vs. 22 +/- 5 pmol l-1 (neuropeptide Y)). In the elderly group plasma neuropeptide Y did not increase during exercise and showed a tendency to fall below basal level 5 min post-exercise. It is concluded, that plasma noradrenaline does not increase more in older subjects during exercise when correcting for the generally lower physical fitness in this group compared to younger subjects, and that plasma neuropeptide Y does not increase during exercise in older subjects, suggesting an age-reduced capacity in this system.     

Evaluation of the Numeric Rating Scale for perception of effort during isometric elbow flexion exercise

The aim of the study was to examine the reliability and validity of the numerical rating scale (0-10 NRS) for rating perception of effort during isometric elbow flexion in healthy people. 33 individuals (32 ± 8 years) participated in the study. Three re-test measurements within one session and three weekly sessions were undertaken to determine the reliability of the scale. The sensitivity of the scale following 10 min isometric fatiguing exercise of the elbow flexors as well as the correlation of the effort with the electromyographic (EMG) activity of the flexor muscles were tested. Perception of effort was tested during isometric elbow flexion at 10, 30, 50, 70, 90, and 100% MVC. The 0-10 NRS demonstrated an excellent test–retest reliability [intra class correlation (ICC) = 0.99 between measurements taken within a session and 0.96 between 3 consecutive weekly sessions]. Exploratory curve fitting for the relationship between effort ratings and voluntary force, and underlying EMG showed that both are best described by power functions (y = ax ^b ). There were also strong correlations (range 0.89–0.95) between effort ratings and EMG recordings of all flexor muscles supporting the concurrent criterion validity of the measure. The 0-10 NRS was sensitive enough to detect changes in the perceived effort following fatigue and significantly increased at the level of voluntary contraction used in its assessment (p < 0.001). These findings suggest the 0-10 NRS is a valid and reliable scale for rating perception of effort in healthy individuals. Future research should seek to establish the validity of the 0-10 NRS in clinical settings.     

Vestibulo-ocular reflex to transient surge translation: complex geometric response ablated by normal aging

The linear vestibulo-ocular reflex (LVOR) to surge (fore-aft) translation has complex kinematics varying with target eccentricity and distance. To determine normal responses and aging changes, 9 younger [age, 28 +/- 2 (SE) yr] and 11 older subjects (age, 69 +/- 2 yr) underwent 0.5 g whole body surge transients while wearing binocular scleral search coils. Linear chair position and head acceleration were measured with a potentiometer and accelerometer. Subjects viewed centered and 10 degrees horizontally and vertically eccentric targets 50, 25, or 15 cm distant before unpredictable onset of randomly directed surge in darkness (LVOR) and light (V-LVOR). Response directions were kinematically appropriate to eccentricity in all subjects, but there were significantly more measurable LVOR and V-LVOR responses (63-79%) in younger than older subjects (38-44%, P < 0.01). Minimal LVOR latency averaged 48 +/- 4 ms for younger and significantly longer at 70 +/- 6 ms for older subjects. In the interval 200-300 ms after surge onset, horizontal LVOR gain (relative to ideal velocity) of younger subjects averaged over all target distances was 0.55 +/- 0.04 and was significantly reduced in older subjects to 0.33 +/- 0.04. Horizontal V-LVOR gain was 0.58 +/- 0.04 in younger and significantly lower at 0.35 +/- 0.06 in older subjects. Vertical gains did not differ significantly between groups. Target visibility had no effect in either group during the initial 200 ms. The LVOR and V-LVOR were augmented by saccades in younger more than older subjects. Aging thus decreases LVOR velocity gain, response rate, and saccade augmentation, but prolongs latency.     

Active forearm blood flow adjustments to handgrip exercise in young and older healthy men.

1. Our purpose was to test the hypothesis that ageing impairs the active muscle hyperaemia consequent to dynamic exercise in humans. 2. Eleven young (19-29 years) and eleven older (60-74 years) healthy, non-obese men with similar chronic physical activity levels and forearm size performed two protocols of dynamic handgrip exercise: (a) brief (1 min), incremental loads to exhaustion, and (b) sustained (8 min), submaximal loads. Active forearm blood flow (FBF) was measured at rest and during a brief period of relaxation at the end of each minute of exercise. Arterial blood pressure was recorded to calculate active forearm vascular conductance (FVC). Sustained forearm ischaemia plus handgrip was used to elicit a peak forearm vasodilatatory response. 3. There were no differences in pre-exercise levels of any variable between the young and older men. During exercise, ratings of perceived effort, the peak workload attained, and the ability to sustain submaximal workloads were all similar for the two groups. 4. During brief exercise, both submaximal and peak levels of FBF were similar in the two groups; however, the peak increases in FVC were greater in the older men. During sustained exercise, FBF and FVC were not different in the two groups at the lowest loads, but the increases became relatively greater in the older men with increasing workloads. 5. Peak levels of FBF and FVC in response to the peak vasodilatatory stimulus were similar in the young and older men. 6. These findings fail to support the postulate that ageing results in impaired active muscle hyperaemia and vasodilatation during small-muscle dynamic exercise.(ABSTRACT TRUNCATED AT 250 WORDS)     

Comparing visual-analog and numeric scales for assessing menstrual pain

Measurements from visual-analog (VAS) and numeric scales were used to assess menstrual pain in a prevalence study of 1,387 women in Madrid, Spain. The data obtained from these 2 scales were compared to determine if significant differences existed between the 2 rating methods. Findings indicated that both scales are useful for assessing menstrual pain. A high degree of correlation was found between the 2 scales; larger rating differences were seen in only a small percentage of the sample. The numeric scale is easier and more convenient to use than the VAS and is recommended in epidemiologic and prevalence studies such as this one.     

Lack of interchangeability between visual analogue and verbal rating pain scales: a cross sectional description of pain etiology groups

Background:  

Rating scales like the visual analogue scale, VAS, and the verbal rating scale, VRS, are often used for pain assessments both in clinical work and in research, despite the lack of a gold standard. Interchangeability of recorded pain intensity captured in the two scales has been discussed earlier, but not in conjunction with taking the influence of pain etiology into consideration.     

Blood flow to exercising limbs varies with age, gender, and training status.

Understanding the effects of physiological aging on blood flow to active skeletal muscle and its regulation during exercise has important functional, hemodynamic, and metabolic implications for our rapidly expanding elderly population. During peak exercise involving a large muscle mass, blood flow to the legs is lower in healthy older compared to younger persons; this results from central (reduced cardiac output) and peripheral (reduced leg vascular conductance) limitations. There is considerable variability in the literature concerning age-related changes in leg blood flow during submaximal exercise, with reports of similar or reduced leg blood flow and vascular conductance in older vs. younger subjects depending on the exercise intensity and the gender and training status of the subjects. However, all the studies involving non-endurance-trained subjects are consistent in that older subjects achieve the requisite leg blood flow at higher arterial perfusion pressures than young subjects, suggesting altered local vasoregulatory mechanisms with aging. Although the nature of these age-related alterations is poorly understood, we have preliminary evidence for augmented sympathetic vasoconstrictor responsiveness in the legs of older men during exercise, and blunted leg vasodilator responsiveness in older women. Systematic research will be needed in order to define the central and local mechanisms underlying these age- and gender-specific differences in muscle vascular responsiveness. Such information will be important for designing future interventions aimed at improving muscle blood supply and functional capacity in older persons.     

New physiological insights into exercise-induced diaphragmatic fatigue

Data on the dynamic process and time-point of manifestation of exercise-induced diaphragmatic fatigue (DF) are lacking. Therefore, this study was aimed assessing dynamic changes of diaphragmatic strength during exercise and determining the time-point of DF manifestation. Fourteen trained subjects (maximal oxygen uptake (VO2(max)) 59.3+/-5.5 ml/min/kg) performed standardized exercise protocols (maximal workload: 85% VO2(max)) followed by recovery (6 min). Ergospirometric data and twitch transdiaphragmatic pressure (TwPdi) were consecutively assessed. DF was induced (TwPdi-rest: 2.34+/-0.26 versus TwPdi-end-recovery 2.01+/-0.21 kPa, p<0.01). TwPdi progressively increased during exercise (TwPdi-rest: 2.34+/-0.26 versus TwPdi-maximal-workload: 3.28+/-0.38 kPa, p<0.001). DF was detectable immediately after exercise-termination (TwPdi-maximal-workload: 3.28+/-0.38 versus TwPdi-early-recovery 2.55+/-0.34 kPa, p<0.001). TwPdi during exercise was highly correlated to workload, VO2(max) and dyspnea (r=0.96/r=0.92/r=0.97; all p<0.0001). In conclusion, diaphragmatic strength progressively increases with increasing workload, and DF manifests after - rather than during - exercise. In addition, TwPdi is highly correlated to key-measures of ergospirometry, approving the physiological thesis that muscle strength is progressively enhanced and escapes fatiguing failure during high-intensity exercise performance.     

Heterogeneous vascular responses to hypoxic forearm exercise in young and older adults

We aimed to assess age-related differences in compensatory hypoxic vasodilation during moderate-to-high dynamic exercise at absolute workloads. We hypothesized healthy older adults (n = 12, 61 ± 1 years) would exhibit impaired hypoxic vasodilation at a moderate absolute workload, and this effect would be exaggerated at a higher workload when compared to young adults (n = 17, 27 ± 2 years). Forearm blood flow (FBF) was measured with Doppler ultrasound. Dynamic forearm exercise (20 contractions/min) was completed at two absolute workloads (8 and 12 kg) under normoxic (0.21 FiO2, ~98% SpO2) and isocapnic hypoxic (~0.10 FiO2, 80% SpO2) conditions performed in random order. FBF was normalized as forearm vascular conductance (FBF / mean arterial blood pressure = FVC) to control for differences in blood pressure and to assess vasodilation. FVC increased with exercise and hypoxia (main effects, p < 0.05); vascular responses were not different between young and older adults (interaction effect exercise × group p = 0.37 and hypoxia × group p = 0.96). Results were confirmed when analyzed as either an absolute or relative change in FVC (ΔFVC and %ΔFVC, respectively). Although group responses to hypoxia were not different, individual results were highly variable (i.e., some adults constricted and others dilated to hypoxia). These data suggest (1) compensatory hypoxic vasodilation in older adults is not impaired during forearm exercise at both moderate and higher absolute exercise intensities, and (2) vascular responses to hypoxia are heterogeneous in both young and older adults. Results suggest unique individual differences exist in factors regulating vascular responses to hypoxia.     

Correlations of visual analog scales with Edinburgh Postnatal Depression Scale

BACKGROUND: The purpose of this study was to search for correlations of scores on the visual analog scales (VAS) taken during the third week postpartum with scores on the Edinburgh Postnatal Depression Scale (EPDS) taken on approximately day 28 postpartum. METHODS: Thirty-four women filled out six visual analog scales on postpartum days 15-21 and took the EPDS at their 4-week postpartum visit to the clinic. Results were analyzed by simple linear regression and multiple backward stepwise regression. RESULTS: Responses to all six statements of the VAS correlated significantly with 4-week EPDS scores. Approximately 54% of the variability of 4-week EPDS scores can be predicted by the variability in VAS question 6. LIMITATIONS: Relatively small sample size is a moderately limiting factor of this study. CONCLUSION: Mood in the third week postpartum was predictive of EPDS score on postpartum day 28. Mood lability during the third week postpartum was a better predictor of EPDS score on day 28 than the other five measures, including feelings of sadness or anxiety. The EPDS may have potential use with an acceptable degree of accuracy earlier than the standard 4 weeks postpartum.     

Age-related changes of exercise-induced plasma catecholamines and neuropeptide Y responses in normal human subjects

Age-related plasma noradrenaline and neuropeptide Y were evaluated in seven young (mean ± SD, 28 ± 3 years) and seven elderly (64 ± 8 years) normal subjects during rest and different work loads on a cycle ergometer. In the supine and the sitting position plasma noradrenaline and neuropeptide Y were almost identical in the two groups. Plasma neuropeptide Y did not increase during exercise at 100 W for 15 min. At this load plasma noradrenaline levels were higher in the older subjects (mean ± SEM, 0.97 ± 0.12 vs. 0.60 ± 0.09 ng ml^-l). There was a significant correlation between plasma noradrenaline and the relative work load at 100 W (r = 0. 794 , P = 0.0007). At 75% of maximal work load plasma noradrenaline and neuropeptide Y were higher in the young group (1.84 ± 0.16 vs. 1.26 ± 0.13 ng ml^-l (noradrenaline) and 38 ± 4 vs. 22 ± 5 pmol 1^-1 (neuropeptide Y)). In the elderly group plasma neuropeptide Y did not increase during exercise and showed a tendency to fall below basal level 5 min post-exercise. It is concluded, that plasma noradrenaline does not increase more in older subjects during exercise when correcting for the generally lower physical fitness in this group compared to younger subjects, and that plasma neuropeptide Y does not increase during exercise in older subjects, suggesting an age-reduced capacity in this system.     

Anaerobic Power of the Arms and Legs of Young and Older Men

The purpose of this study was to examine differences in the anaerobic exercise performance of young and older men. Eight healthy, active older (68.5 +/- 2.4 years old, mean S.D.) and eight healthy, active young (30.6 +/- 4.5 years old) subjects were assessed for peak and mean power output (PP and MP, respectively) of the legs and arms, during 30 s Wingate tests. PP during leg exercise was significantly (P < 0.05) higher in the young (14.6 +/- 1.6 W kg-1) compared with the older (10.7 +/- 1.0 W kg-1) group. MP of the legs was also greater in the young subjects (10.7 +/- 0.7 vs. 7.4 +/- 0.9 W kg-1). These differences in PP and MP remained significant when expressed relative to lean leg volume. PP during arm cranking was significantly greater in the young subjects (8.9 +/- 0.7 vs. 7.5 +/- 0.6 W kg-1) as was MP (6.4 +/- 0.7 vs. 5.0 +/- 0.7 W kg-1). Post-exercise blood lactate concentration in the older group (7.0 +/- 1.6 mmol l-1) was less (P < 0.05) than in the young group (10.6 +/- 2.0 mmol l-1), for leg work only. The significant loss of anaerobic power in the older group could not be explained by a difference in muscle mass. Power output was also lower in the arms, but to a lesser extent. The results of this study suggest that a reduction in the ability to perform high intensity exercise may be an inevitable consequence of ageing. The extent, however, of this decline varies with different muscle groups.     

The effects of eccentric exercise on motor performance in young and older women

Summary The purpose of the present study was to determine if old individuals show a greater exercise-induced decrement in motor performance and slower recovery compared to young individuals. Ten college-age women (23.6 years) and ten older women (67.4 years) performed an exercise consisting of 24 eccentric actions of the forearm flexors. In young subjects, eccentric exercise is known to produce repairable muscle damage. Before the exercise and for 5 days after, isometric strength, soreness, reaction time, and movement time were measured. For both groups, strength was reduced and soreness developed in the days following the exercise, generally indicating that muscle damage had occurred. The older subjects showed a slower strength recovery such that by 5 days after exercise they had not returned to their initial level of strength. There was no significant difference in soreness development between groups. Reaction time and movement time were not adversely affected by the exercise. Thus, the older subjects demonstrated a slower strength recovery after damage-inducing exercise, and, with regard to response speed, the older subjects could compensate for the impaired muscle function as well as the younger subjects.     

Age-related stimulatory and inhibitory effects of suckling regulate lactation in rabbits

Milk production and the duration of lactation were compared between control rabbits nursing their own pups and those whose litters were replaced by younger, i.e., 4-6 days old, or older pups (20-23 days old) starting at pp days 4, 10 or 15. In rabbits whose pups were exchanged on pp day 4 by older pups, an early decline of milk secretion was induced and similar yields to those of late-lactating controls were produced during mid lactation. Conversely, yields similar to those of mid-lactating controls were produced in late-lactating mothers nursing young pups continuously since pp day 10 and high yields were maintained in these animals until pp day 45. When litter exchanges, by either older or younger pups, were delayed until pp day 15, yields were not significantly different from controls. These results indicate that qualitative changes in suckling stimulation develop as the litter grows older, i.e., young pups stimulate milk secretion, whereas old pups inhibit it. Thus, suckling itself may determine the overall pattern of milk secretion in these species.     

Sensory evaluations of fat-sucrose and fat-salt mixtures: relationship to age and weight status

Young (mean age 22.4 years) and elderly (mean age 82.3 years) subjects tasted and rated a range of liquids containing between 0.5% and 36% dairy fat by weight. The liquids also contained either sucrose (0-20%) or NaCl (0-0.584%). Within each age group both normal weight and overweight subjects participated. The fat content in the mixtures was unrelated to pleasantness ratings for elderly subjects. The concentrations of both fat and sucrose in the mixtures determined the hedonic responses of young normal weight subjects. Overweight young subjects' hedonic responses were predominantly influenced by sucrose concentration. Fat content in dairy-salt mixtures was significantly related to pleasantness ratings by young subjects, but did not influence ratings by elderly subjects. These findings suggest that the elderly can significantly reduce dietary fat intake without sacrificing perceived pleasantness.