Visual analogue scale

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The visual analogue scale (VAS) is a psychometric response scale that can be used in questionnaires. It is a measurement instrument for subjective characteristics or attitudes that cannot be directly measured. When responding to a VAS item, respondents specify their level of agreement to a statement by indicating a position along a continuous line between two end points.

Comparison to other scales[edit]

This continuous (or "analogue") aspect of the scale differentiates it from discrete scales such as the Likert scale. There is evidence showing that visual analogue scales have superior metrical characteristics than discrete scales, thus a wider range of statistical methods can be applied to the measurements.[1]

The VAS can be compared to other linear scales such as the Likert scale or Borg scale. The sensitivity and reproducibility of the results are broadly very similar, although the VAS may outperform the other scales in some cases.[1][2] These advantages extend to measurement instruments made up from combinations of visual analogue scales, such as semantic differentials.[3]


Recent advances in methodologies for Internet-based research[4] include the development and evaluation of visual analogue scales for use in Internet-based questionnaires.[1] One electronic version of the VAS that employs a 10 cm scale and various customizations is available on the Apple Store for use in research and workplace settings.

VAS is the most common pain scale for quantification of endometriosis-related pain and skin graft donor site-related pain.[5] A review came to the conclusion that VAS and numerical rating scale (NRS) were the best adapted pain scales for pain measurement in endometriosis. For research purposes, and for more detailed pain measurement in clinical practice, the review suggested use of VAS or NRS for each type of typical pain related to endometriosis (dysmenorrhea, deep dyspareunia and non-menstrual chronic pelvic pain), combined with the clinical global impression (CGI) and a quality of life scale.[6] VAS is being increasingly used for the assessment of loudness and annoyance of acute and chronic tinnitus.[7]

The usage of a visual analogue scale (VAS) measuring fear of birth (FOB) was first initiated by Rouhe et al.[8] FOBS is used to identify pregnant women with a fear of birth (FOB). It is a visual analogue scale (like VAS) that cover two constructs: worry and fear. The pregnant women are asked to rate their feelings about the approaching birth by responding to the question “How do you feel right now about the approaching birth?” on a paper with two 100 mm VAS-scale printed on it. They indicate their feeling and respond by placing a mark on the lines with the anchor words “calm/worried” and “no fear/strong fear”. The two values on the VAS-scales are added up to give a total score ranging from 0 to 100.[8] Higher scores indicate higher levels of fear, and the cut-off point for fear of birth is 60.[9] Later on, FOBS, was then developed and tested based on Rouhe’s research in pregnant women in both Sweden and Australia.[10][11] There have also been studies on pregnant women's thoughts when assessing fear of birth on the Fear of Birth Scale.[12]


  1. ^ a b c Reips, U.-D.; Funke, F (2008). "Interval level measurement with visual analogue scales in Internet-based research: VAS Generator" (PDF). Behavior Research Methods. 40 (3): 699–704. doi:10.3758/BRM.40.3.699. PMID 18697664.
  2. ^ Grant, S.; Aitchison, T.; Henderson, E.; Christie, J.; Zare, S.; McMurray, J.; Dargie, H. (1999). "A comparison of the reproducibility and the sensitivity to change of visual analogue scales, Borg scales, and Likert scales in normal subjects during submaximal exercise". Chest. 116 (5): 1208–17. doi:10.1378/chest.116.5.1208. PMID 10559077.
  3. ^ Funke, F; Reips, U.-D. (2012). "Why semantic differentials in Web-based research should be made from visual analogue scales and not from 5-point scales" (PDF). Field Methods. 24 (3): 310–327. doi:10.1177/1525822X12444061. S2CID 30305248.
  4. ^ U.-D. Reips (2006) Web-based methods. In M. Eid & E. Diener (Eds.), Handbook of multimethod measurement in psychology (pp. 73-85). Washington, DC: American Psychological Association. doi:10.1037/11383-006
  5. ^ Sinha S, Schreiner AJ, Biernaskie J, Nickerson D, Gabriel VA (June 2017). "Treating pain on skin graft donor sites: review and clinical recommendations". J Trauma Acute Care Surg. 83 (5): 954–964. doi:10.1097/TA.0000000000001615. PMID 28598907. S2CID 44520644.
  6. ^ Bourdel, N.; Alves, J.; Pickering, G.; Ramilo, I.; Roman, H.; Canis, M. (2014). "Systematic review of endometriosis pain assessment: how to choose a scale?". Human Reproduction Update. 21 (1): 136–152. doi:10.1093/humupd/dmu046. ISSN 1355-4786. PMID 25180023.
  7. ^ Adamchic, I; Langguth, B; Hauptmann, C; Tass, PA (2012). "Psychometric evaluation of visual analog scale for the assessment of chronic tinnitus". American Journal of Audiology. 21 (2): 215–225. doi:10.1044/1059-0889(2012/12-0010). PMID 22846637.
  8. ^ a b Rouhe, H; Salmela-Aro, K; Halmesmäki, E; Saisto, T (January 2009). "Fear of childbirth according to parity, gestational age, and obstetric history". BJOG: An International Journal of Obstetrics & Gynaecology. 116 (1): 67–73. doi:10.1111/j.1471-0528.2008.02002.x. PMID 19055652. S2CID 40951634.
  9. ^ Hildingsson, Ingegerd; Rubertsson, Christine; Karlström, Annika; Haines, Helen (October 2018). "Exploring the Fear of Birth Scale in a mixed population of women of childbearing age—A Swedish pilot study". Women and Birth. 31 (5): 407–413. doi:10.1016/j.wombi.2017.12.005. PMID 29249331. S2CID 20377885.
  10. ^ Ternström, Elin; Hildingsson, Ingegerd; Haines, Helen; Rubertsson, Christine (April 2015). "Higher prevalence of childbirth related fear in foreign born pregnant women – Findings from a community sample in Sweden". Midwifery. 31 (4): 445–450. doi:10.1016/j.midw.2014.11.011. PMID 25529841.
  11. ^ Haines, Helen; Pallant, Julie F.; Karlström, Annika; Hildingsson, Ingegerd (August 2011). "Cross-cultural comparison of levels of childbirth-related fear in an Australian and Swedish sample". Midwifery. 27 (4): 560–567. doi:10.1016/j.midw.2010.05.004. PMID 20598787.
  12. ^ Ternström, Elin; Hildingsson, Ingegerd; Haines, Helen; Rubertsson, Christine (June 2016). "Pregnant women's thoughts when assessing fear of birth on the Fear of Birth Scale". Women and Birth. 29 (3): e44–e49. doi:10.1016/j.wombi.2015.11.009. PMID 26710973.