Comparison of three rating scales for measuring subjective phenomena in clinical research. I. Use of experimentally controlled auditory stimuli

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: The three instruments appeared reasonably accurate, with VAS having highest scores. VRS appeared sufficiently consistent to be regarded as providing reliable scientific information.     

3种不同直径穿刺针甲状腺活检时患者疼痛程度调查

目的探讨不同直径的穿刺针进行甲状腺穿刺活检时患者疼痛程度之间有无差别。方法对2010年10月～2013年3月在成都军区总医院内分泌科进行甲状腺穿刺活检的136例甲状腺结节患者，使用3种不同直径的穿刺活检针进行甲状腺穿刺，采用主诉疼痛分级法（VRT）和数字疼痛分级法（NRS）两种痛觉分级方法让患者对术中和术后当日的疼痛感觉进行评估。采用Z检验的等级相关分析和线性趋势检验，分析受试者疼痛程度与穿刺针型号之间的关系。结果VRT评估3种直径活检针穿刺疼痛程度0—1级，3组患者之间疼痛程度没有差别，不同性别之间也没有差异。NRS评估3种直径活检针穿刺疼痛程度0～3级，3组之间疼痛程度没有差别，疼痛程度与活检针直径没有关系。结论使用不同直径的活检针进行甲状腺穿刺，患者的疼痛程度之间没有差异，应根据患者结节的性质选择适宜的穿刺针。     

视觉模拟测量和利克特测量用于评价中风痉挛性瘫痪患者报告结局的比较

目的 比较“视觉模拟测量”和“利克特测量”对中风痉挛性瘫痪患者报告结局的评价,选择相对适合的测量尺度.方法 横断面现场调查的方式,利用先前研制的“基于中风痉挛性瘫痪患者报告结局评价量表”中的19个问题,104例患者分别使用“连续型”和“离散型”视觉模拟测量进行回答,另有110例患者使用5级“典型的”和5级“形式的”利克特测量进行回答.信度分析采用克拉巴赫α系数,相关分析采用Spearman相关系数法,结构效度采用因子分析.结果 除心理领域外,症状和社会领域得分,以及量表总分方面,“连续型”和“离散型”视觉模拟测量量表的克朗巴赫系数均高于5级“典型的”和5级“形式的”利克特测量.“视觉模拟测量”比“利克特测量”在量表的内部一致性信度方面更占优势.每个条目与其所属领域得分间相关系数绝大多数在0.4以上,使用“视觉模拟测量”可以获得更高的相关性.“视觉模拟测量”在量表的探索性因子分析,形成了3个因子,其结果与量表预想的症状、心理、社会三个领域大体一致;“利克特测量”在量表结构效度方面,结果并不理想.结论 测量精度越高,性能评价越好.如果患者不需要他人辅助完成量表,优先选择“视觉模拟测量”.     

皮下神经干扰治疗带状疱疹后遗神经痛的疗效观察

目的比较皮下神经干扰治疗带状疱疹后遗神经痛的临床效果。方法选择经确诊为带状疱疹后遗神经痛的患者60例,随机分为3组,每组20例。A组为皮下神经干扰组,B组为局部神经阻滞组,C组为药物治疗组。通过定期随访,观察并记录患者治疗前（T。）、治疗后当日（T1）、治疗后3d（T2）、7d（T3）,14d（T4）、1个月（T5）各时间点的口述疼痛评分（VAs）、数字疼痛评分（NRS）、睡眠质量评分（QS）及疼痛发生频率（F）,以综合评估患者治疗效果。结果在不同时间点,A组与B组VRS、NRS评分比较差异无统计学意义（P〉O．05）,在T。时间点,A组QS评分明显高于B组,F值明显低于B组,差异有统计学意义（P〈O．05）;在T1、T2时间点,A组VRS、NRS评分及F值明显低于C组,QS评分明显高于C组,差异有统计学意义（P〈O．05）;在T3、T4时间点,A组VRS、NRS评分明显高于C组,差异有统计学意义（P〈0．05）;在T4时间点,A组QS评分明显低于C组,F值明显高于C组,差异有统计学意义（P〈0．05）。结论皮下神经干扰法能有效治疗带状疱疹后遗神经痛,有操作简单,并发症少的优点。     

Fatigue severity of patients with idiopathic chronic fatigue compared to healthy subjects

OBJECTIVE:To analyze the fatigue severity of patients with idiopathic chronic fatigue(ICF) and to compare the severity of this group with that of healthy subjects.METHODS:one hundred and nine ICF patients and 98 healthy subjects were enrolled in this study.Fatigue severity was measured using the Korean-translated Chalder fatigue severity questionnaire.All subjects scored each item on a 10-point scale as a self-rating numeric scale(NRS),and additionally rated their feeling of general fatigue by visual analogue scale(VAS).RESULTS:The total NRS scores of patients with ICF was 53 ± 15 compared with 25 ± 14 of healthy subjects(2.4 folds for physical symptoms vs.1.7 folds for mental symptoms respectively).The VAS scores of patients with ICF were 2.7 times as high as those of healthy subjects.CONCLUSION:This report is the first to compare the severity of fatigue between ICF patients and healthy subjects.This study contains reference data applicable for the management of this disorder in field of complementary and alternative medicine.     

基于COSMIN指南对癌症患者支持性照护需求量表的系统评价

背景国内外用于评估癌症患者支持性照护需求的量表较多，但有关此类量表质量的标准化评价研究及不同量表间的横向比较研究较为缺乏，也少有研究者对此类量表的测量特性进行系统的整合与评价。目的评价中文版癌症患者支持性照护需求量表的测量学性能及研究的方法学质量。方法2021年4月检索中国知网、万方数据知识服务平台、维普中文科技期刊全文数据库、中国生物医学文献数据库、PubMed、EmBase、Web of Science、CINAHL Complete数据库，获取有关中文版癌症患者支持性照护需求量表测量学性能评价的研究，检索时限均为建库至2021年3月30日。由两位研究者独立筛选文献、提取资料后，采用健康测量工具遴选标准（COSMIN）系统综述指南，在对量表的测量特性及研究的方法学质量进行评价的基础上，综合评定中文版癌症患者支持性照护需求评估量表各测量特性的证据等级，并形成对于量表的最终推荐意见。采用描述分析法对评价结果进行汇总、分析。结果共纳入15项研究，涉及8个中文版癌症患者支持性照护需求评估量表〔癌症患者支持性照护需求简明问卷中文版（SCNS-SF34）、中文版支持性照护需求筛查工具（SCNS-ST9-C）、癌症患者综合需求评估量表（CNAT）、癌症需求简明问卷（CNQ-SF）、中文版癌症患者未满足需求量表（CaSUN-C）、癌症患者未满足需求简明量表（SF-SUNS）、晚期癌症患者需求评估问卷（ACNQ-41）、晚期癌症患者需求评估表简表（ACNQ-29）〕。就量表的测量特性质量而言，除ACNQ-29的内容效度为"未提及"外，其余7个量表的内容效度均为"不确定"；除CaSUN-C、SF-SUNS的结构效度为"充分"外，其余6个量表的结构效度均为"不确定"；SCNS-SF34、CNQ-SF、CaSUN-C、SF-SUNS的内部一致性为"充分"，ACNQ-41的内部一致性为"不充分"，其余3个量表的内部一致性为"不确定"；CNAT、CNQ-SF、ACNQ-29的假设检验为"未提及"，CaSUN-C、SF-SUNS、ACNQ-41的假设检验为"不确定"，SCNS-SF34、SCNS-ST9-C的假设检验为"充分"；除ACNQ-41的稳定性为"不充分"，SCNS-ST9-C、ACNQ-29的稳定性为"未提及"外，其余5个量表的稳定性均为"充分"；仅SCNS-SF34的跨文化效度为"充分"，其余7个量表的跨文化效度均为"未提及"。8个量表的推荐等级均为B级。结论SCNS-SF34的测量特性得到了最为全面的评价，其具有较好的信效度，且临床应用可行性高，可暂时被推荐使用，但上述结论仍有待更多高质量证据加以支撑。     

New approaches to measuring nausea

Valid measures of nausea are needed to evaluate the various treatments used to counter the nausea produced by chemotherapy. The overall nausea intensity (ONI) produced by 17 chemotherapy drugs was estimated by 17 physicians and 8 nurses, and 25 patients undergoing chemotherapy described the subjective qualities and ONI of their nausea on a modified form of the McGill Pain Questionnaire. The scores for the affective and miscellaneous categories of words in the questionnaire were found to correlate significantly with the physicians' and nurses' ONI estimates. The results formed the basis for the Nausea Questionnaire, which provided three indices of nausea: a nausea rating index (NRI), ONI and intensity of nausea according to a visual analogue scale (VAS). All three indices correlated significantly with the physicians' and nurses' ONI estimates and were significantly intercorrelated. All three also provided significant differences when the scores of patients who had received cisplatin or 5-fluorouracil were compared. The results indicate that the Nausea Questionnaire provides three valid indices of the subjective experience of nausea.     

儿童受虐量表的编制及信度和效度分析

目的 编制一套符合我国文化背景的儿童受虐量表.由儿童自评,对其受虐的程度作出定量评估,为研究儿童受虐提供一个可操作的量化工具.方法 通过文献分析和修订既往量表中的相关条目,建立条目库.经相关专家评定,筛选出效价高的条目.在湘潭市某中学初中一、二年级学生及湘潭市某职业技术学院一年级新生中施测,有效问卷871份.通过儿童受虐量表、父母养育方式评价量表等进行横断面调查.结果 通过项目分析、探索性因素分析及验证性因素分析最终形成由35条目构成儿童受虐量表.该量表由躯体虐待、言语虐待、性虐待3个分量表组成.儿童受虐量表总的Cronbach's α系数为0.87,重测相关系数0.88.各分量表躯体虐待分量表Croubach's Alpha系数为0.73～0.86,重测相关系数0.81～0.88之间.躯体受虐分量表、言语虐待分量表、性虐待分量表各条目在各层面的各条目的 负荷为0.33～0.74.验证性因素分析结果显示:卡方值与自由度的比值为3.81,拟合优度指数为0.91,TuckerLewis指数为0.89,近似误差均方根为0.04.该量表能有效地证明儿童受虐的程度与父母养育方式及儿童个性等存在明显的相关性.结论 儿童受虐量表条目区分度符合测量学要求,具有较为理想的信度、效度.     

综合医院门诊病人满意度量表研制初探

目的 编制一份综合医院门诊病人满意度量表,用于医院门诊医疗质鼍的评价.方法 以杭州市级4所综合医院内外科门诊病人为调查对象,应用统计学和心理学方法评价量表的信度和效度.结果 量表的条目应答率为98.82%,有效率为96.8%,量表的内部一致性系数为0.76-0.87,量表的构成与管理实际相吻合,因素内相关性强于因素间相关性,支持内容效度;经因子分析,因子负荷和结构与量表结构吻合,支持结构效度.结论 本量表各信效度指标均达到了心理测量学的要求,可以用于门诊病人满意度的评价,为评价医院医疗质量提供依据.     

Correlation and consistency of pain severity ratings by teens using different pain scales

100 teens ranked pain experienced for their most recent "shot"on three different scales: casual 0-10 scale (mean 3.3), faces scale (mean 2.8), and 10 cm visual analog scale (mean 2.4). All pain scores showed wide variation (poor validity). Pain severity values were not equivalent across the different pain scales with the casual 10 scale most likely to overestimate pain values.     

Is a line the same as a box? Speech assessment by VAS is not superior to Likert scales in laryngeal cancer patients.

BACKGROUND: The primary purpose was to assess if VAS or Likert was relatively more suitable when assessing self-ratings of voice and speech in patients treated for laryngeal cancer. An additional purpose was to investigate whether the scales differed in measuring change after treatment. MATERIAL/METHODS: Using both VAS and Likert, 71 patients answered three questions at baseline and 12 months after treatment began. For test-retest analyses, additional data were used from 21 subjects. Non-parametric statistical methods suitable for comparing scales with different numbers of response alternatives were applied. RESULTS: Test-retest reliability was strongest for the Likert scale. From baseline to follow-up, both scales detected significant improvements. However, for some Likert scores the associated VAS values varied across a wide range, and this was true for assessments at baseline, at follow-up, and for score changes. At baseline the inter-scale concordance showed a greater number of disordered pairs than at follow-up and on both occasions the older group produced a greater number of disordered pairs. CONCLUSIONS: No support for the superiority of VAS over Likert was found. However, VAS may produce instability in response patterns. When using self-ratings of voice and speech to identify a need of further rehabilitation, Likert scales seem better suited.     

Using dementia rating scales in the diagnosis of Alzheimer''s disease

Objective: To study the significance of dementia rating scales in the diagnosis of Alzheimer' s disease (AD).Methods: Probable AD patients(118 cases) diagnosed according to NINCDS-ADRDA criteria and the normal controls(100 cases) were examined with a battery of neuropsychological tests and the dementia severity of AD patients was determined with clinical dementia rating(CDR). Changed neuropsychological characteristics of different AD dementia severities were analyzed. The discriminant analysis and ROC curve analysis were performed to analyze the specificity, the sensitivity, and the general accuracy of various dementia rating scales in the diagnosis of AD, and the area under the ROC curve. Results: The total cognition function in mild (CDR = 1), moderate(CDR = 2) and severe stages(CDR=3) of AD had an obvious trend of continuous decline, with the MMSE values 17.44 ± 2.64, 13.90 ± 4.32, and5.50± 3.90 respectively. The trend of decline of the verbal fluency function in AD was same as that of total cognition function. The visuospatial function was reduced in early stage of AD (CDR = 1 ) and completely lost in moderate and severe AD. Delay memory function began to show decline in the early stage of AD, and the decline turned apparent in moderate and severe AD. Immediate memory function showed unchanged in early stage of AD, while showed decline in moderate AD, and the decline became very quick in severe AD. The impairment of daily living ability and social activity function developed with the severity degree of AD. But the decline of social activity function was very quick in moderate stage of AD. In general, the leading scale to diagnose AD was FOM, followed by RVR, POD, MMSE, BD,ADL and DS. When MMSE was combined with one or more of FOM, RVR, BD, DS, the general accuracy in distinguishing AD from the normal controls was improved. Conclusion: Neuropsychological test is useful in the diagnosis of AD, especially in the early stage. The validity is improved when dementia rating scales are combined correctly.     

直升机飞行员工作绩效评定量表的构建

目的:初步构建直升机飞行员工作绩效评定量表.方法:采用定性与定量相结合的方法,根据对15名飞行专家,12名行政及政工干部的开放式问卷调查及访谈结果,编制含有28个条目的问卷初稿;随后对197名直升机飞行员进行调查,得到有效问卷176份;根据分析结果和简约原则对条目进行筛选并对量表进行信度和效度检验.结果:直升机飞行员绩效主要包括3个因子:"飞行质量"、"工作能力"、"工作态度".量表整体及各个分量表的内部一致性系数均大于0.72,并具有良好的区分效度、内容效度和结构效度.结论:本量表全面具体的反映了直升机飞行员的工作绩效,信度和效度符合心理测量学的要求,具有一定的实用价值.     

周期序贯针灸疗法对原发性痛经患者疼痛症状及情绪影响的疗效观察

[目的]观察周期序贯针灸疗法对原发性痛经(primary dysmenorrhea,PD)患者疼痛症状及焦虑情绪的影响.[方法]选择2017年1月至2018年6月丹阳市人民医院针灸科门诊就诊的PD患者90例,随机分为药物组、常规针刺组和序贯针灸组,每组各30例.药物组予布洛芬缓释胶囊口服,常规针刺组采用常规针灸方案,序...     

椎体后凸成形术治疗骨质疏松性椎体压缩性骨折

目的探讨经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的疗效。方法对11例患者在C形臂透视下行椎体后凸成形术,对术前术后的疼痛数字评分法（NRS）、椎体高度的恢复情况进行统计学分析。结果本组手术均成功,所有患者疼痛明显缓解,NRS术前5-8分降为术后48 h 0-1分,术后3个月0-1分,NRS评分与病椎前缘高度术前术后差异统计学意义有（P〈0.05）。结论经皮椎体后凸成形术可迅速缓解患者疼痛,是一种安全有效的方法。     

氯胺酮联合吗啡、可乐定用于晚期癌痛患者硬膜外自控镇痛

目的:探讨吗啡+氯胺酮+可乐定对晚期癌痛的自控镇痛效果。方法:60例三阶梯疗法欠佳的晚期癌症疼痛病人随机均分4组,分别配制吗啡、吗啡+氯胺酮、吗啡+可乐定、吗啡+氯胺酮+可乐定镇痛液进行硬膜外自控镇痛(PCEA),记录第1、3、6、10、15、17、20 d的视觉模拟评分(VAS),测量血压、脉搏、氧饱和度,并用汉密顿抑郁量表(HAMD)进行治疗前后的抑郁情绪评估,记录恶心、呕吐、尿潴留、皮肤瘙痒、呼吸抑制等并发症。结果:吗啡+氯胺酮+可乐定组VAS评分和HAMD评分均较其他3组低、不良反应次数最少。结论:吗啡+氯胺酮+可乐定用于晚期癌症镇痛效果好,副作用少,安全性高。     

Development of Improved Version of Quality of Life Assessment Instrument for Lung Cancer Patients Based on Traditional Chinese Medicine (QLASTCM-Lu)

Objective: To develop an improved version of the Quality-of-Life Assessment instrument for Lung Cancer Patients Based on Traditional Chinese Medicine (QLASTCM-Lu) and to evaluate its psychometric property. Methods: The structured group method and the theory in developing rating scale were employed to revise the preliminary scale. The psychometric property (reliability, validity, and responsiveness) of the established QLASTCM-Lu (modified) were evaluated by quality of life data measured in 100 lung cancer patients. Statistical analyses were made accordingly by way of correlation analysis, factor analysis and paired t-test. Results: The internal consistency reliability of the overall scale and all domains was from 0.80 to 0.94. Correlation and factor analyses demonstrated that the scale was good in construct validity. The criterion validity was formed with European Organization for Research and Treatment of Cancer-Quality of Life Questionnaire Lung Cancer (EORTC QLQ-LC43) as the criterion. Statistically significant changes were found apart from such domain as "mental condition" and "social function", with the standardized response means being close to those of QLQ-LC43. Conclusion: QLASTCM-Lu (modified) could be used to measure the quality of life of lung cancer patients with good reliability, validity and a certain degree of responsiveness.     

肌肉内效贴治疗急性颈椎关节周围炎的临床疗效

目的 探讨肌肉内效贴对急性颈椎关节周围炎疼痛的治疗效果.方法 将门诊收治的56例急性颈椎关节周围炎患者随机分为肌肉内效贴 (kinesio taping, KT) 治疗组 (n=28) 和常规康复治疗对照组 (n=28) .于治疗后3 d后和6 d分别应用视觉模拟评分 (visual analogue scale, VAS) 、总体症状改变等级评分 (global rating of change scales, GRCS) 评价治疗效果.2组间VAS评分比较采用t检验.GRCS评分改变用Wilcoxon秩和检验.2组分别采用的治疗方法效果比较采用卡方检验.结果 KT治疗组在治疗后3 d和6 d, VAS评分分别为 (3.81±1.56) 分和 (0.85±0.79) 分, 与对照组相比差异有统计学意义 (P<0.05) .GRCS评分在治疗3 d后, 治疗组有63.85%的患者评分在3分以上;而在治疗6 d后, 有96.5%的患者评分超过3分, 其中有67.85%的患者评分超过5分, 与对照组相比差异有统计学意义 (P<0.05) .结论 肌肉内效贴对急性颈椎关节周围炎能显著缓解急性颈椎关节周围炎的疼痛症状, 值得临床推广.     

聚醚砜过滤针头缓解异丙酚注射痛的临床观察

目的：观察聚醚砜一次性无菌过滤针头（英国whatman公司）对异丙酚注射痛的缓解作用。方法：对300例日间手术患者随机分为3组：过滤组（n=100）经聚醚砜过滤针头注射异丙酚1mg／kg；利多卡因组（n=100）经22G套管针注射利多卡因异丙酚复合液（5mg／ml）1mg／kg，复合过滤组（n=100）经聚醚砜过滤针头注射利多卡因异丙酚复合液。观察并记录疼痛程度（VRS）及刺激性不良反应，计算疼痛发生率。结果：复合组注射痛的发生率和疼痛强度显著低于过滤组及利多卡因组（P〈0．05），结论：聚醚砜一次性过滤针头可缓解异丙酚注射痛，结合利多卡因可显著缓解异丙酚注射痛发生。     

丙泊酚注射痛预测人工流产术后镇痛的可行性

目的探讨依据丙泊酚注射痛选择人工流产术后镇痛方法的可行性。方法拟行人工流产术者1500例,随机分为3组,Ⅰ组为对照组;Ⅱ组静脉注射布托啡诺;Ⅲ组静脉注射布托啡诺并下腹部行物理治疗。每组根据疼痛语言等级评定量表（VRS）分为3亚组：VRS=0为a亚组;VRS=1为b亚组;VRS≥2为c亚组。诱导时当丙泊酚给药量达总量1／4时暂停给药,进行VRS评分,之后静脉注射剩余量丙泊酚完成麻醉诱导。术后30min时采用VAS评分。记录VRS、VAS、术前及术后的MAP、HR。结果术后疼痛发生率Ⅱ、Ⅲ组低于Ⅰ组（P〈0．05）,Ⅰa与Ⅱa、Ⅲa组比较差异无统计学意义（P〉0．05）,Ⅱb组低于Ⅰb组（P〈0．05）,Ⅱb与Ⅲb组比较无统计学差异（P〉0．05）,Ⅱc组低于Ⅱc组（P〈0．05）。结论丙泊酚注射人工流产术时无注射痛者无需给予术后镇痛,轻微注射痛者仅给予布托啡诺镇痛就足够,中、重度注射痛者给予布托啡诺和下腹部物理治疗联合镇痛效果更优。