Comparative responsiveness of four visual analogue scales in microdiscectomy for lumbar disc herniation

  • Karthik VishwanathanEmail author
  • Ian Braithwaite



There is a paucity of studies reporting responsiveness of visual analogue scale (VAS) measures in patients treated by discectomy for symptomatic lumbar disc herniation. The aim of this study was to evaluate the responsiveness of different types of VAS.


VAS score was measured separately for constant leg pain (VAS-LP-constant), severe episode of leg pain (VAS-LP-severe), constant backache (VAS-BP-constant) and severe episode of backache (VAS-BP-severe) in a cohort of patients undergoing discectomy surgery for sciatica. VAS was evaluated preoperatively and postoperatively at final follow-up. Responsiveness was determined using standardised response mean (SRM), effect size (ES) and the area under the curve (AUC) analysis using receiver operating characteristic curves. For AUC analysis, the success of discectomy from the patient’s perspective was chosen as the external anchor.


Ninety-eight patients were included in this prospective study. Outcome was assessed at a mean follow-up of 12 weeks postoperatively. The SRM of VAS-LP-severe, VAS-LP-constant, VAS-BP-severe and VAS-BP-constant was 2.16, 2.16, 0.87 and 0.53, respectively. The ES of VAS-LP-severe, VAS-LP-constant, VAS-BP-severe and VAS-BP-constant was 3.53, 2.70, 0.89 and 0.53, respectively. The AUC of VAS-LP-severe, VAS-LP-constant, VAS-BP-severe and VAS-BP-constant was 0.88, 0.75, 0.74 and 0.59, respectively.


We recommend the use of VAS-LP-Severe as the most responsive VAS measure when evaluating the results of discectomy surgery for sciatica.


Responsiveness Lumbar disc herniation Discectomy Visual analogue scale (VAS) 


Author contributions

All authors were involved in conception and design and collected and assembled the data. Ian Braithwaite was involved in provision of patients. Ian Braithwaite provided administrative support. All authors analysed and interpreted the data. Karthik Vishwanathan was involved in manuscript drafting. Ian Braithwaite contributed to critical revision of the manuscript and supervision.

Compliance with ethical standards

Conflict of interest

Dr. Karthik Vishwanathan and Mr. Ian Braithwaite declare that they have no conflict of interest pertaining to the present manuscript.


  1. 1.
    Testa MA, Simonson DC (1996) Assessment of quality-of-life outcomes. N Engl J Med 334:835–840CrossRefGoogle Scholar
  2. 2.
    Terwee CB, Bot SD, de Boer MR, van der Windt DA, Knol DL, Dekker J, Bouter LM, de Vet HC (2007) Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol 60:34–42CrossRefGoogle Scholar
  3. 3.
    Irrgang JJ, Lubowitz JH (2008) Measuring arthroscopic outcome. Arthroscopy 24:718–722CrossRefGoogle Scholar
  4. 4.
    Norman GR, Stratford P, Regehr G (1997) Methodological problems in the retrospective computation of responsiveness to change: the lesson of Cronbach. J Clin Epidemiol 50:869–879CrossRefGoogle Scholar
  5. 5.
    Stucki G, Liang MH, Fossel AH, Katz JN (1995) Relative responsiveness of condition-specific and generic health status measures in degenerative lumbar spinal stenosis. J Clin Epidemiol 48:1369–1378CrossRefGoogle Scholar
  6. 6.
    Price DD, McGrath PA, Rafii A, Buckingham B (1983) The validation of visual analogue scales as ratio scale measures for chronic and experimental pain. Pain 17:45–56CrossRefGoogle Scholar
  7. 7.
    Revill SI, Robinson JO, Rosen M, Hogg MI (1976) The reliability of a linear analogue for evaluating pain. Anaesthesia 31:1191–1198CrossRefGoogle Scholar
  8. 8.
    Sriwatanakul K, Kelvie W, Lasagna L, Calimlim JF, Weis OF, Mehta G (1983) Studies with different types of visual analog scales for measurement of pain. Clin Pharmacol Ther 34:234–239CrossRefGoogle Scholar
  9. 9.
    Bolton JE, Wilkinson RC (1998) Responsiveness of pain scales: a comparison of three pain intensity measures in chiropractic patients. J Manip Physiol Ther 21:1–7Google Scholar
  10. 10.
    Van der Leeden M, Steultjens MP, Terwee CB, Rosenbaum D, Turner D, Woodburn J, Dekker J (2008) A systematic review of instruments measuring foot function, foot pain, and foot-related disability in patients with rheumatoid arthritis. Arthritis Rheum 59:1257–1269CrossRefGoogle Scholar
  11. 11.
    Husted JA, Cook RJ, Farewell VT, Gladman DD (2000) Methods for assessing responsiveness: a critical review and recommendations. J Clin Epidemiol 53:459–468CrossRefGoogle Scholar
  12. 12.
    Blanchard C, Feeny D, Mahon JL, Bourne R, Rorabeck C, Stitt L, Webster-Bogaert S (2003) Is the Health Utilities Index responsive in total hip arthroplasty patients? J Clin Epidemiol 56:1046–1054CrossRefGoogle Scholar
  13. 13.
    Schouffoer AA, van der Giesen FJ, Beaart-van de Voorde LJ, Wolterbeek R, Huizinga TW, Vliet Vlieland TP (2016) Validity and responsiveness of the Michigan Hand Questionnaire in patients with systemic sclerosis. Rheumatology (Oxford) 55:1386–1393CrossRefGoogle Scholar
  14. 14.
    Naal FD, Impellizzeri FM, Rippstein PF (2010) Which are the most frequently used outcome instruments in studies on total ankle arthroplasty. Clin Orthop Relat Res 468:815–826CrossRefGoogle Scholar
  15. 15.
    Bessette L, Sangha O, Kuntz KM, Keller RB, Lew RA, Fossel AH, Katz JN (1998) Comparative responsiveness of generic versus disease-specific and weighted versus unweighted health status measures in carpal tunnel syndrome. Med Care 36:491–502CrossRefGoogle Scholar
  16. 16.
    Turner JA, Fulton-Kehoe D, Franklin G, Wickizer TM, Wu R (2003) Comparison of the Roland–Morris Disability Questionnaire and generic health status measures: a population-based study of workers’ compensation back injury claimants. Spine (Phila Pa 1976) 28:1061–1067Google Scholar
  17. 17.
    Parker SL, Adogwa O, Paul AR, Anderson WN, Aaronson O, Cheng JS, McGirt MJ (2011) Utility of minimum clinically important difference in assessing pain, disability and health state after transforaminal lumbar interbody fusion for degenerative lumbar spondylolisthesis. J Neurosurg Spine 14:598–604CrossRefGoogle Scholar
  18. 18.
    Parker SL, Adogwa O, Mendenhall SK, Shau DN, Anderson WN, Cheng JS, Devin CJ, McGirt MJ (2012) Determination of minimum clinically important difference (MCID) in pain, disability, and quality of life after revision fusion for symptomatic pseudoarthrosis. Spine J 12:1122–1128CrossRefGoogle Scholar
  19. 19.
    Parker SL, Mendenhall SK, Shau D, Adogwa O, Cheng JS, Anderson WN, Devin CJ, McGirt MJ (2012) Determination of minimum clinically important difference in pain, disability, and quality of life after extension of fusion for adjacent-segment disease. J Neurosurg Spine 16:61–67CrossRefGoogle Scholar
  20. 20.
    Parker SL, Mendenhall SK, Shau DN, Adogwa O, Anderson WN, Devin CJ, McGirt MJ (2012) Minimum clinically important difference in pain, disability, and quality of life after neural decompression and fusion for same level recurrent lumbar stenosis: understanding clinical versus statistical significance. J Neurosurg Spine 16:471–478CrossRefGoogle Scholar
  21. 21.
    Mannion AF, Junge A, Grob D, Dvorak J, Fairbank JC (2006) Development of a German version of the Oswestry Disability Index. Part 2: sensitivity to change after spinal surgery. Eur Spine J 15:66–73CrossRefGoogle Scholar
  22. 22.
    Hartz A, Marsh JL (2003) Methodologic issues in observational studies. Clin Orthop Relat Res 413:33–42CrossRefGoogle Scholar
  23. 23.
    Kooistra B, Dijkman B, Einhorn TA, Bhandari M (2009) How to design a good case series. J Bone Joint Surg Am 91(Suppl 3):21–26CrossRefGoogle Scholar
  24. 24.
    Terwee CB, Mokkink LB, Knol DL, Ostelo RW, Bouter LM, de Vet HC (2012) Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Qual Life Res 21:651–657CrossRefGoogle Scholar
  25. 25.
    Chaichana KL, Mukherjee D, Adogwa O, Cheng JS, McGirt MJ (2011) Correlation of preoperative depression and somatic perception scales with postoperative disability and quality of life after lumbar discectomy. J Neurosurg Spine 14:261–267CrossRefGoogle Scholar
  26. 26.
    Lebow R, Parker SL, Adogwa O, Reig A, Cheng J, Bydon A, McGirt MJ (2012) Microdiscectomy improves pain-associated depression, somatic anxiety, and mental well-being in patients with herniated lumbar disc. Neurosurgery 70:306–311CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopaedics, Charutar Arogya MandalShri Krishna Hospital and Pramukhswami Medical CollegeGokalnagar, KaramsadIndia
  2. 2.Nuffield hospitalChesterUK

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