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Evaluating Pain in Orthopedic Patients: Can the Visual Analog Scale be used as a Long-term Outcome Instrument?

Noback PC*, Cuellar DO, Lombardi JM, Swart EF and Rosenwasser MP

Study background: An analysis of the relationship between visual analog scale (VAS) pain scores and Likert pain scores over a period of up to a year in patients who sustained a distal radius fracture (DRF) in order to assess the reliability of using a VAS pain score as a long-term outcome instrument. Methods: Retrospective review was performed of prospectively collected data on all DRF's treated at our institution from 2010-2012 with consented patients. At the initial and each follow-up visit, patients indicated their level of injured extremity pain at rest by using a VAS (VAS-Rest) and when actively using the extremity (VAS-Active). At followup visits, patients completed a question asking what their perceived change in injured wrist pain was since their last orthopedic visit. This "Change in Pain" (CP) question consisted of a five-level Likert item. Patients' clinic visits were grouped into independent data sets consisting of 3 data points (VAS-Rest, VAS-Active, and CP score). Incomplete data sets were excluded. The difference in VAS pain scores between consecutive visits and the CP score were compared using Spearman's correlation coefficient and linear regression analysis. Results: A total of 74 DRF patients and 119 complete two-visit data sets were included in the study. CP scores and VAS-pain scores were collected at periods of two weeks, four weeks, six weeks, eight weeks, three months, six months, and one year post treatment. Spearman's correlation coefficients between VAS pain scores and patients' CP score were minimal (r<0.3). Linear regression analysis showed a weak relationship between VAS pain scores and CP scores. Conclusion: Although VAS pain scores play a vital role in assessing pain in the short-term setting, the VAS seems to be a poor instrument for comparing treatment outcomes of long-term orthopedic interventions. Multi-dimensional pain questionnaires may be preferable for assessing long-term orthopedic outcomes.