Bias and Precision in Visual Analogue Scales: A Randomized Controlled Trial

• Published in: American journal of epidemiology Vol. 150; no. 10; pp. 1117 - 1127
• Main Authors: Paul-Dauphin, Agnès, Guillemin, Francis, Virion, Jean-Marc, Briançon, Serge
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 15.11.1999
• Subjects: Adult; Bias; Biological and medical sciences; Clinical Trials as Topic - standards; Cross-Sectional Studies; Epidemiology; Female; General aspects; Health Surveys; Humans; Male; measurement error; Medical sciences; Methodology; Middle Aged; Pain Measurement; Public health. Hygiene; Public health. Hygiene-occupational medicine; Reproducibility of Results; Research Design; Respiratory Tract Infections - classification; Sensitivity and Specificity; visualization; Human; Evaluation; Visualization; Methodology; Evaluation scale; Methodological bias; Measurement method; Epidemiology; Measurement error; Public health
• ISSN: 0002-9262; 1476-6256
• DOI: 10.1093/oxfordjournals.aje.a009937

Various types of visual analogue scales (VAS) are used in epidemiologic and clinical research. This paper reports on a randomized controlled trial to investigate the effects of variations in the orientation and type of scale on bias and precision in cross-sectional and longitudinal analyses. This trial was included in the pilot study of the SU.VI.MAX (supplementation by antioxidant vitamins and minerals) prevention trial in France in 1994. Six types of VAS (simple, middle-marked, graphic rating, graduated, graduated-numbered, and numerical rating) and two orientations (horzontal and vertical) were used to measure three symptoms of ear, nose, and throat infection at 2-month intervals in 870 subjects. Differences between scales were analyzed by comparing variances (Levene's test) and means (variance-covariance analysis for repeated measures). Scale characteristics were shown to influence the proportion of zero and low values (i.e., there was a floor effect), but not mean scores. The precision of measurements varied cross-sectionally according to the type of scale, but no differences were observed in the precision of measurement of change over time. In conclusion, the characteristics of VAS seem to be important in cross-sectional studies, particularly when symptoms of low or high intensity are being measured. Researchers should try to reach a consensus on what type of VAS to use if studies are to be compared. Am J Epidemiol 1999;150; 1117-27.