Comparison of Visual Analog Scale and Indiana Polyclinic Combined

Pain Scale as Pain-Assessment Tools among General Practitioners in

Indonesia

Adhitya, M. Harini

Geriatric Division, Department of Physical Medicine and Rehabilitation,

Dr. Cipto Mangunkusumo Hospital, University of Indonesia Jakarta, Indonesia

Keywords : Visual Analog Scale, Indiana Polyclinic Pain Scale

Abstract: There are numerous pain assessment tools available, with no clear superiority between them. Among

those tools are Visual Analog Scale (VAS) and Indiana Polyclinic Combined Pain Scale (IPCPS). VAS is

often used in assessing pain while IPCPS is a new tool and has more descriptive items for documenting

pain. This study is to know which pain-assessment tool is more preferred by physicians and whether there

is correlation between VAS and IPCPS. Fifty one Physical Medicine and Rehabilitation Residents in

Universitas Indonesia, were enrolled in this cross-sectional study. They were asked to fill-in the

questionnaire. Forty subjects (78,4%) preferred VAS than IPCPS to assess patient’s pain although 40

subjects stated IPCPS is more accurate in describing patient’s pain. The subjects reasoned they are more

familiarized with VAS and spend less time to complete it. On the other hand, IPCPS has more detailed

descriptions on pain and its ascociation to the patients’ activities. There is moderate correlation between

VAS and IPCPS score (r = 0,78). VAS is more preferred to assess patient’s pain as it is more familiar and

need less time to be done, but IPCPS has more items in describing pain.



1 INTRODUCTION

Pain is a common symptom which may be found in

physical medicine and rehabilitation patients. It may

manifests in several things. It may limit function,

have emotional symptoms, physical sensations, and

a change in behaviour. The evaluation of pain is

challenging and an assessment tool should be

choosed carefully by physicians. Pain scales depend

on patient’s self report, health care professional,

family member, or care giver. (Arbuck DM, 2019)

There are numerous pain assessment tools

available, with no clear superiority between them.

Among those tools are VAS and IPCPS. Visual

Analog Scale (VAS) is often used in assessing pain.

(Kunar P, 2014)

VAS is considered as a robust,

sensitive, and reproducible method in describing

pain severity. The benefits of VAS are its relative

short time to be completed and has minimal

language translation difficulties. VAS is also the

most feasible and acceptable of health state

evaluation.

(Ellison T, 2014)

However, VAS has limitation. It may conceal

variation in severe pain intensity due to ceiling

effects and may leave room for misinterpretation,

bias, and confusion due to no well defined anchors.

(Ellison T, 2014) The discrete levels of VAS limits

VAS in reporting pain (isensitive to change) because

its narrow range of scores.

It is also more difficult

to understand, especially in elderly patients.

(Elfering A, 2006)

Another tool for pain assessment is The Indiana

Polyclinic Combined Pain Scale (IPCPS). It is the

new assessment tools in assessing and documenting

pain. (Arbuck DM, 2019). VAS and IPCPS may

have some similiarity, but the physicians own

personal preferences that may influence their choice

in choosing which pain assessment tools to be used.

This study aims to to see which tool is more

preferred by the physicians and whether both tools

have correlation with each other. By knowing

physicians’ preferred tool and understanding the

Adhitya, . and Harini, M.

Comparison of Visual Analog Scale and Indiana Polyclinic Combined Pain Scale as Pain-Assessment Tools among General Practitioners in Indonesia.

DOI: 10.5220/0009064501110114

In Proceedings of the 11th National Congress and the 18th Annual Scientiﬁc Meeting of Indonesian Physical Medicine and Rehabilitation Association (KONAS XI and PIT XVIII PERDOSRI

2019), pages 111-114

ISBN: 978-989-758-409-1

111

reasoning behind it, it may show some factors which

can be considered when choosing evaluation.

2 METHOD

The design of this research is a descriptive-analytic,

cross-sectional study.

2.1 Subjects

The research population is general practitioners in

RSUPN Dr. Cipto Mangunkusumo, Jakarta. We

asked fifty-one Physical Medicine & Rehabilitation

resident as our sample. The subjects should fulfil

inclusion criterias and do not meet exclusion

criterias. The inclusion criterias are as following: (1)

physical medicine and rehabilitation resident in

RSUPN Dr. Cipto Mangunkusumo, Jakarta who has

patients with pain; (2) have internet access; and (3)

understand English. Subject who unable and does

not understand technical-instrucition of the research

could not participated in this study.

2.2 Procedure

Subjects were screened based on inclusion and

exclusion criterias. Subjects who fulfilled the

inclusion criterias then asked for their consent and

then fulfilled the online questionnaire.

The questionnaire consists of: (1) Subjects

identities; (2) Patients’ VAS score; (3) IPCPS; (4)

Their preferred tool to assess patients’ pain; and (5)

Their opinions on which tool describes patients’ pain

more accurate. The data collected was then

described and analyzed.

2.3 Statistical Methods

All data were analyzed using SPSS Statistic

Version 20 (IBM). Descriptive statistics were

generated. VAS score variable and IPCPS score

were analyzed using univariate analysis to know the

characteristics of the variables. The data was then

analyzed using bivariate analysis to know the

correlation between the variables.

3 RESULTS

From the characteristics table of the respondents in

Table 1., the respondents are more female than male

and the age is ranged variably.

Table 1: Respondent Characteristics.

n (%)

Gender 51 (100%)

Male 15 (29,4%)

Female 36 (70,6%)

median(min-max)

Age (years) 31 (26-37)

Forty subjects prefered VAS than IPCPS to

assess patient’s pain. The remaining 11 subjects

preffered IPCPS. But when they were asked about

which tool describes pain more accurate, 40 subjects

answered that IPCPS is more accurate in describing

patient’s pain than VAS.

Table 2: Gender preferences on pain assessement

tool.

VAS IPCPS

Male 13 (86,7%) 2 (13,3%)

Female 27 (75%) 9 (25%)

From 40 subjects (78,4%) who chose VAS as the

preffered tools, 13 of the subjects were male

(32,5%) and 27 of the subjects were female (67,5%).

And from 11 subjects (21,6%) who chose IPCPS as

the preffered tool, 2 of the subjects were male

(18,2%) and 9 of the remaining subjects were female

(81,8%). From 40 subjects (78,4%) who chose VAS

over IPCPS as the preferred tool, subjects were

using VAS score to 1 children (2,5%), 16 young

adults (40%), 13 older adults (32,5%), and 10

elderly (25%). And from 11 subjects who preferred

IPCPS, they used IPCS to 1(9,1%) children, 3 young

adult(27,3%), 6 older adults (54,5%) and 1 elderly

(9,1%).

From 40 subjects (78,4%) who chose IPCPS as

the tool which describes patient’s pain more

accurate, 9 of the subjects were male (22,5%) and 31

of the subjects were female (77,5%). And from 11

subjects (21,6%) who chose VAS as the tool which

describes patient’s pain more accurate, 6 of the

subjects were male (54,5%) and 5 of the remaining

subjects were female(45,5%). From 40 subjects

(78,4%) who stated IPCPS is more accurate in

describing pain, they used IPCPS to 2 children (5%),

13 young adults (32,5%), 17 older adults (42,5%),

and 8 elderly (20%). There are differences in another

11 subjects who stated that VAS is more accurate in

describing pain (21,6%). They used it to 6 young

KONAS XI and PIT XVIII PERDOSRI 2019 - The 11th National Congress and The 18th Annual Scientiﬁc Meeting of Indonesian Physical

Medicine and Rehabilitation Association

112

adults (54,5%), 2 older adults (18,2%) and 3 elderly

(27,3%).

From 40 Subjects who chose VAS score as

preferred tool to assess patient’s pain, 15 subjects

(37,5%) reasoned that they are more familiarized

with VAS than IPCPS so using VAS score to assess

pain is more convenient and easy for them. 24

subjects (60%) reasoned that VAS need less time to

complete than IPCPS and the other 1 subject (2,5%)

reasoned that VAS is more related to patient’s

responses. From 11 Subjects who chose IPCPS as

preferred tool to assess patient’s pain, 2 subjects

(18,2%) reasoned that IPCPS is more relevant and

easily applied to the patient’s disability because of

the pain. The other 9 subjects (81,8%) reasoned that

IPCPS is more descriptive than VAS to assess pain.

Table 3: Resident preferences on pain assessement

tool.

VAS IPCPS

Preparation

(Pembekalan)

9 (69,2%) 4 (30,8%)

Internship

(Magang)

20 (90,9%) 2 (9,1%)

Independent

(Mandiri)

11 (68,8%) 5 (31,3%)

There are less subjects in preparation and

independent level who chose VAS over IPCPS than

in the internship level. Most subjects who preferred

IPCPS than VAS is also from the preparation and

independent group.

From 11 subjects who stated that VAS is more

accurate to describe pain than IPCPS, 6 subjects

(54,5%) reasoned that they confirmed patients’

responses more easily than using IPCPS and it may

give more accurate value to the patient’s pain. The

other 5 subjects (45,5%) reasoned that patients was

more understand to describe their pain when using

scale in VAS score than IPCPS. But, from 40

subjects who stated IPCPS is more accurate in

describing pain, all of them reasoned that IPCPS is

stated more detailed information for the patients to

compare with their pain and what problems may be

happened with their pain quality. They also reasoned

that IPCPS is more objective and hollistic to be used

in assessing pain.

The data is not distributed normally (p<0.05), so

the Spearman test was used as a nonparametric

correlations test. The test showed that IPCPS pain

rating scale has moderate correlation with VAS

score in assessing patient’s pain (r = 0,780, p<0,05).

4 DISCUSSIONS

There was more subjects preferred using VAS score

to assess pain than IPCPS. It was because of they

were familiarized with the tool so they need less

time to complete it. A study said that social

environment and culture have influences in making

people choose something they are more familiarized

with. The more someone become familiarized with

something, it will take less time for them to do it. It

is also said that there is some tendency to continue

doing what has been done in the past. (Curtis K,

2018)

As the subjects’ patient was varied in age, there

is no statistical differences in patients age and tools

to assess their pain with (p>0.05).

The majority of the subjects stated that the

IPCPS is more accurate in describing pain than

VAS. It is more likely because the IPCPS consists

more detailed description in explaining pain and its

ascociation to functional activities than VAS. It is

said that successful explanations start with accurate

descriptions, when the questionnaire items is being a

personality markers. (Seeboth A, 2018)

The limitation of this study is we did not

consider group allocation between preparation,

internship, and independent level of the

residents. We also need study with more sample

to do realibility or validity test to IPCPS.

5 CONCLUSIONS

Based on this study, VAS is more preferred to assess

patient’s pain as it is more familiar and need less

time to be done, but IPCPS has more descriptive

items on describing pain. The usage of IPCPS may

need some education and workshop before hand so

clinicians may familiarized more and using the tool

well. Further study may be needed to test the

reliability and validty of IPCPS.

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KONAS XI and PIT XVIII PERDOSRI 2019 - The 11th National Congress and The 18th Annual Scientiﬁc Meeting of Indonesian Physical

Medicine and Rehabilitation Association

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