Skip to main content Accessibility help

Clinical applications of visual analogue scales: a critical review

  • Heather M. McCormack (a1), David J. de L. Horne (a1) and Simon Sheather (a1)

Visual Analogue Scales (VAS) provide a simple technique for measuring subjective experience. They have been established as valid and reliable in a range of clinical and research applications, although there is also evidence of increased error and decreased sensitivity when used some subject groups. Decisions concerned with the choice of scoring interval, experimental design, and statistical analysis for VAS have in some instances been based on convention, assumption and convenience, highlighting the need for more comprehensive assessment of individual scales if this versatile and sensitive measurement technique is to be used to full advantage.

Corresponding author
1 Address for correspondence: Dr Heather M. McCormack, Department of Psychiatry, Royal Melbourne Hospital, University of Melbourne, Parkville, Victoria, Australia, 3052.
Hide All
Ahles, T. A., Ruckdeschel, J. C. & Blanchard, E. B. (1984). Cancerrelated pain. II, Assessment with visual analogue scales. Journal of Psychosomatic Research 28, 121124.
Aitken, R. C. B. (1969). A growing edge of measurement of feelings. Proceedings of the Royal Society of Medicine 62, 989996.
Aitken, R. C. B. & Zealley, A. K. (1970). Measurement of moods. British Journal of Hospital Medicine iv, 215225.
Areskog, B., Uddenberg, N. & Kjessler, B. (1984). Postnatal emotional balance in women with and without antenatal fear of childbirth. Journal of Psychosomatic Research 28, 213220.
Beaumont, G., Rooney, J. F. F., Murphy, J. E. & Donald, J. F. (1970). The use of patients self rating scales in assessment of anxiolytic drugs.7th CINP Meeting Prague,Czechoslovakia. (Quoted in Malpas et al. (1974).).
Beck, A. T., Ward, C.Mendelson, M., Mock, J. & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry 4, 561571.
Beck, A. T., Schuyler, D. & Herman, I. (1974). Development of suicidal intent scales. In The Prediction of Suicide (ed. Beck, A. T., Resnick, H. L. P. and Lettieri, D. J.), Charles Press: Bowie.
Bond, A. & Lader, M. (1974). The use of analogue scales in rating subjective feelings. British Journal of Medical Psychology 47, 211217.
Carlsson, A. M. (1983). Assessment of chronic pain. I. Aspects of the reliability and validity of the visual analogue scale. Pain 16, 87101.
Carroll, B. J., Feinberg, M., Smouse, P. E., Rawson, S. G. & Greden, J. F. (1981). The Carroll rating scale for depression. I. Development, reliability, and validation. British Journal of Psychiatry 138, 194200.
Chapman, C. R. (1976). Measurement of pain: problems and issues. In Advances in Pain Research and Therapy, vol. 1 (ed. Bonica, J. J. and Albe-Fessard, D. G.), pp. 345354:. Raven Press: New York.
Clyde, D. J. (1950). Construction and validation of an emotional association test. Unpublished Ph.D. thesis, Pennsylvania State College, Philadelphia. (Quoted in Folstein and Luria (1973).)
Coates, A., Dillenbeck, C. F., McNeil, D. R., Kate, S. B., Sims, K., Fox, R. M., Woods, R. L., Milton, G. W., Solomon, J. & Tattersal, H. N. (1983). On the receiving end. II. Linear analogue selfassessment (LASA) in evaluation of aspects of the quality of life of cancer patients receiving therapy. European Journal of Cancer and Clinical Oncology 19, 16331637.
Davies, B., Burrows, G. & Poynton, C. (1974). A comparative study of four depression rating scales. Australian and New Zealand Journal of Psychiatry 9, 2124.
Derogatis, L. R. (1977). SCL-90-R Manual. Johns Hopkins School of Medicine: Baltimore.
Feinberg, M., Carroll, B. J., Smouse, P. E. & Rawson, S. G. (1981). The Carroll rating scale for depression. III. Comparison with other rating instruments. British Journal of Psychiatry 138, 205209.
Folstein, M. F. & Luria, R. (1973). Reliability, validity, and clinical application of the visual analogue mood sale. Psychological Medicine 3, 479486.
Folstein, M. F., Maiberger, R. & McHugh, P. R. (1977). Mood disorder as a specific complication of stroke. Journal of Neurology, Neurosurgery, and Psychiatry 40, 10181020.
Folstein, M. F., DePaulo, J. R. & Trepp, K. (1982). Unusual mood stability in patients taking lithium. British Journal of Psychiatry 140, 188191.
Freyd, M. (1923). The graphic rating scale. Journal of Educational Psychology 14, 83102.
Gaston-Johansson, F. (1984). Pain assessment: differences in quality and intensity of the words pain, ache and hurt. Pain 20, 6976.
Goldney, R. D. (1979). Assessment of suicidal intent by a visual analogue scale. Australian and New Zealand Journal of Psychiatry 13, 153155.
Hackett, T. P. & Cassem, N. H. (1974). Development of a quantitative rating scale to assess denial. Journal of Psychosomatic Research 18, 93100.
Hamilton, M. (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 5662.
Handley, S. L., Dunn, T. L., Waldron, G. & Baker, J. M. (1980). Tryptophan, cortisol and puerperal mood. British Journal of Psychiatry 136, 498508.
Hardy, J. D., Wolff, H. G. & Goodell, H. (1952). Pain Sensations and Reactions. Williams & Watkins: Baltimore.
Hayes, M. H. & Patterson, D. G. (1921). Experimental development of the graphic rating method. Psychological Bulletin 18, 9899.
Henderson, A. S., Byrne, D. G. & Duncan-Jones, P. (1981). Neurosis and the Social Environment. Academic Press: Sydney.
Herbert, M., Johns, W. & Dore, C. (1976). Factor analysis of analogue scales measuring subjective feelings before and after sleep. British Journal of Medical Psychology 49, 373379.
Hettmansperger, T. P. (1984). Statistical Inference Based on Ranks. Wiley: New York.
Hornblow, A. R. & Kidson, M. A. (1976). The visual analogue scale for anxiety: A validation study. Australian and New Zealand Journal of Psychiatry 10, 339341.
Huskisson, E. C. (1974). Measurement of pain. The Lancet (ii), 11271129.
Joyce, C. R. B., Zutshi, D. W., Hrubes, V. & Mason, R. M. (1975). Comparison of fixed interval and visual analogue scales for rating chronic pain. European Journal of Clinical Pharmacology 8, 415420.
Kremer, E., Atkinson, J. H. & Ignelzi, R. J. (1981). Measurement of pain: patient preference does not confound pain measurement. Pain 10, 241248.
Little, J. C. & McPhail, N. I. (1973). Measures of depressive mood at monthly intervals. British Journal of Psychiatry 122, 447452.
Lundberg, P. (1980). Assessment of drugs' side effects. Visual analogue scale versus check-list format. Perceptual and Motor Skills 50, 10671073.
Luria, R. E. (1975). The validity and reliability of the visual analogue mood scale. Journal of Psychiatric Research 12, 5157.
Malpas, A., Legg, N. J. & Scott, D. F. (1974). Effects of Hypnotics on anxious patients. British Journal of Psychiatry 124, 482484.
Melzack, R. (1975). The McGill Pain Questionnaire: major properties and scoring methods. Pain 1, 277299.
Morrison, D. P. (1983). The Crichton Visual Analogue Scale for the assessment of behaviour in the elderly. Acta Psychiatrica Scandinavica 68, 408413.
Norris, H. (1971). The action of sedatives on brain stem oculomotor systems in man. Neuropharmacology 10, 181191.
Ohnhaus, E. E. & Alder, R. (1975). Methodological problems in the measurement of pain: A comparison between the verbal rating scale and the visual analogue scale. Pain 1, 379384.
Priestman, T. J. & Baum, M. (1976). Evaluation of quality of life in patients receiving treatment for advanced breast cancer. Lancet i, 899901.
Priestman, T. J., Baum, M., Jones, V. & Forbes, J. (1977). Comparative trial for endocrine versus cytotoxic treatment in advanced breast cancer. British Medical Journal 1, 12481250.
Price, D. D., McGrath, P. A., Rafil, A. & Buckingham, B. (1983). The validation of visual analogue scale measures for chronic and experimental pain. Pain 17, 4556.
Rampling, D. J. & Williams, R. A. (1977). Evaluation of group processes using visual analogue scales. Australian and New Zealand Journal of Psychiatry 11, 189191.
Reading, A. (1980). A comparison of pain rating scales. Journal of Psychosomatic Research 24, 119124.
Revill, S. I., Robinson, J. O., Rosen, M. & Hogg, M. I. J. (1976). The reliability of a linear analogue for evaluating pain. Anaesthesia 31, 11911198.
Robinson, R. A. (1961). Some problems of clinical trials in elderly people. Gerontologia Clinica 3, 247257.
Robinson, R. G., McHugh, P. R. & Folstein, M. F. (1975). Measurement of appetite disturbances in psychiatric disorders. Journal of Psychiatric Research 12, 5968.
Scott, J. & Huskisson, E. C. (1976). Graphic representation of pain. Pain 2, 175184.
Silverstone, J. T. & Stunkard, A. J. (1968). The anorectic effect of dexamphetamine sulphate. British Journal of Pharmacological Chemotherapy 33, 513522.
Slavney, P. R., Breitner, J. C. S. & Rabins, P. (1977). Variability of mood and hysterical traits in normal women. Journal of Psychiatric Research 13, 155160.
Snedecor, G. W. & Cochran, W. G. (1967). Statistical Methods, (sixth edn). Ames: Iowa.
Spielberger, C. D., Gorsuch, R. L. & Lushene, R. E. (1970). Manual for the State-Trait Anxiety Inventory. Consulting Psychologists: Palo Alto, California.
Spring, B., Maller, O., Wurtman, J., Digman, L. & Cozolino, L. (1983). Effects of protein and carbohydrate meals on mood and performance: Interactions with sex and age. Journal of Psychiatric Research 17, 155167.
Taylor, J. A. (1953). A personality scale of manifest anxiety. Journal of Abnormal and Social Psychology 48, 285290.
Woodforde, J. M. & Merskey, H. (1972). Some relationships between subjective measures of pain. Journal of Psychosomatic Research 16, 173178.
Zealley, A. K. & Aitken, R. C. B. (1969). Measurement of mood. Proceedings of the Royal Society of Medicine 62, 993996.
Zung, W. W. K. (1965). A self rating depression scale. Archives of General Psychiatry 12, 6370.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed