Comparison of Visual Analog Pain Score Reported to Physician vs Nurse in Nonoperatively Treated Foot and Ankle Patients

Martin, Kevin D.; McBride, Trevor; Wake, Jeffrey; Buren, J Preston Van; Dewar, Cuyler

doi:10.1177/1071100718788507

Cited by 10 publications

(18 citation statements)

References 14 publications

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“…Only 53% of patients reported higher pain scores to the physician as opposed to 81% in the first study. The average difference in reported VAS scores was 1 point [7].…”

Section: Discussionmentioning

confidence: 99%

“…There is additional concern with relying solely on these subjective measurements for pain as patient care is often directed from these self-reported scores. Previous research has demonstrated that patients report different pain scores to the nursing staff and physician during the same clinic visit [7-8]. It is currently unknown if patients report a consistent pain score to different members of the medical team in the postoperative setting.…”

Section: Introductionmentioning

confidence: 99%

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A Prospective, Blinded Study Comparing In-hospital Postoperative Pain Scores Reported by Patients to Nurses Versus Physicians

Foster¹,

Shi²,

Lesser³

et al. 2019

Cureus

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Introduction: Referred to as the “fifth vital sign”, pain is unique in that it cannot be obtained accurately by objective measurements. Instead, providers rely on patient-reported scales, such as the numerical rating scale (NRS), to determine a patient’s pain level. Research has shown that patients report different pain scores to nurses and physicians in the clinic setting. It is unknown if this also occurs in the acute postoperative period. We hypothesized that patients report similar pain scores to the nursing staff and physician postoperatively. The primary aim of this study was to examine the degree of agreement between these patient-reported pain scores.Methods: A prospective study was conducted on 90 postoperative patients. During rounds, the surgeon collected a patient-reported pain score using the 11-point verbal NRS. Following rounds, the nursing staff obtained a pain score using the same scale. The patient was blinded to the study.Results: The median score reported to both the surgeon and nurses was 3 (range: 0-10), with a median difference of 0 (range: -2.5 to 7). Fifty-four percent of patients reported the same score to both the surgeon and the nurse and 88% of patients reported scores within a 1-point difference. This corresponded to an interclass correlation coefficient of 0.90, indicating very good agreement. The degree of agreement in pain scores reported to surgeons and nurses was consistent according to sex and age.Conclusion: The results of the study demonstrate a high degree of agreement between the pain scores reported by the patients to both the nursing staff and the surgeon postoperatively, with 88% of the scores at most being 1-point different.

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“…Only 53% of patients reported higher pain scores to the physician as opposed to 81% in the first study. The average difference in reported VAS scores was 1 point [7].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Prospective, Blinded Study Comparing In-hospital Postoperative Pain Scores Reported by Patients to Nurses Versus Physicians

Foster¹,

Shi²,

Lesser³

et al. 2019

Cureus

View full text Add to dashboard Cite

show abstract

“…Our 2 previous studies concluded that patients who went on to have surgery and those who did not, both reported increased pain scores to the surgeon when compared to the nursing staff. 13,14 Therefore, we hypothesized that there would be clinically significant differences in postoperative patients' pain scores when reporting to a treating surgeon vs a nurse.…”

Section: Introductionmentioning

confidence: 99%

Visual Analog Pain Scores Reported to a Nurse and a Physician in a Postoperative Setting

McBride

Wilke

Chisholm

et al. 2020

Foot & Ankle Orthopaedics

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Background: The purpose of this study was to compare postoperative foot and ankle patient-reported visual analog pain scores (VAS) to nursing staff and the treating surgeon during a single encounter. Prior literature established preoperative patients reported higher pain scores to a surgeon as compared to nursing staff. We hypothesized that there will be no differences in postoperative patients’ pain scores when reporting to nursing staff vs a surgeon. Methods: This study was a retrospective cohort of 201 consecutive postoperative foot and ankle patients with 3 follow-up encounters treated by a single surgeon. The patients were asked to rate their pain intensity using the VAS with 0 “no pain” and 10 “worst pain” at 2, 6, and 12 weeks postoperatively by a nurse and surgeon. Results: At all time intervals, the mean pain score was significantly higher when reported to the surgeon, although these were not clinically relevant. The mean scores at 2 weeks were 2.8 reported to the surgeon and 2.5 reported to the nurse ( P < .001). The mean scores at 6 weeks were 2.0 reported to the surgeon and 1.8 reported to the nurse ( P = .002). The mean scores at 12 weeks were 2.3 reported to the surgeon and 2.0 reported to the nurse ( P = .005). Conclusion: This study found that postoperative foot and ankle patients did not overemphasize their VAS pain scores to the physician vs nursing staff. These findings contrast with our 2 previous studies that found preoperative and nonoperative patients reported clinically significant higher scores to the surgeon. Level of Evidence: Level III, comparative study.

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“…8 However, recently the validity of the scale as an effective outpatient PROM for foot and ankle surgeons has been questioned. 9,10 Martin et al 9 found that significantly higher VAS scores were reported 81% of the time to a physician compared to a nurse (6.2 vs 3.3), by new patient referrals with operative foot and ankle pathology during the same initial encounter. A follow-up study 10 by the same authors compared the VAS reported by new referrals with nonoperative foot and ankle pathology and found similar results, with higher scores reported to the physician in 53% of the encounters (4.2 vs 3.2).…”

Section: Introductionmentioning

confidence: 99%

“…9,10 Martin et al 9 found that significantly higher VAS scores were reported 81% of the time to a physician compared to a nurse (6.2 vs 3.3), by new patient referrals with operative foot and ankle pathology during the same initial encounter. A follow-up study 10 by the same authors compared the VAS reported by new referrals with nonoperative foot and ankle pathology and found similar results, with higher scores reported to the physician in 53% of the encounters (4.2 vs 3.2). Although the authors speculated that an overemphasis of pain by patients seeking surgery, and/or an innate disposition of patients to magnify their pain to justify the appointment/time spent may explain the disparate scores, the exact reasons remain unclear.…”

Section: Introductionmentioning

confidence: 99%

The Visual Analogue Scale for Pain: A Comparison of Scores Reported to Residents Versus an Attending Foot and Ankle Surgeon

Rushing

Spinner

Hardigan

2019

Foot & Ankle Specialist

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Background. Recent studies have raised concerns regarding the usefulness of the visual analogue scale (VAS) as an effective outpatient patient-reported outcome measure (PROM), with disparate scores reported during the same encounter to a nurse versus physician. The purpose of present study was to assess the VAS reported by new patient referrals to 2 different physicians of varying training levels (resident, attending), during the same initial outpatient encounter. Methods. One hundred and one patients treated by a single foot and ankle surgeon were included in the retrospective cohort. Each patient was asked to rate their pain intensity by a resident, and then by the attending surgeon using a standard horizontal VAS 0 to 10, from “no pain” to the “worst pain.” Differences in reported scores were analyzed. Results. Overall, the mean VAS reported to the residents (4.97 ± 2.75) and the attending surgeon (5.02 ± 2.71) were not significantly different ( P = .61). On the 11-point scale, the mean difference accounted for only 0.05 points. Conclusion. Taken into consideration with previous studies, the data suggest collection personnel may influence the reported VAS, possibly owing to patients’ preferences and perception of their care. Although the exact reasons remain unclear, our findings lend credence to the previous concerns expressed regarding the subjective nature of the VAS. Levels of Evidence: Level III: Comparative study

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Comparison of Visual Analog Pain Score Reported to Physician vs Nurse in Nonoperatively Treated Foot and Ankle Patients

Abstract: Level III, comparative study.

Cited by 10 publications

References 14 publications

A Prospective, Blinded Study Comparing In-hospital Postoperative Pain Scores Reported by Patients to Nurses Versus Physicians

A Prospective, Blinded Study Comparing In-hospital Postoperative Pain Scores Reported by Patients to Nurses Versus Physicians

Visual Analog Pain Scores Reported to a Nurse and a Physician in a Postoperative Setting

The Visual Analogue Scale for Pain: A Comparison of Scores Reported to Residents Versus an Attending Foot and Ankle Surgeon

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