Table 2.
Summary of Key Evidence to Support Response Scale Selection for the Pediatric Population
| Reference, Evidence Typea, and Gradeb | Population | Response Option Type | Conclusions |
|---|---|---|---|
| Matza et al. 2004 [6], Direct, B | All children; referenced data supportive of children 8 years and older as well as younger children | Likert scales | Children 8 years and older have been shown to accurately use the full range of 5- and 7-point Likert scales to rate their health status, whereas children 7 and younger tend to use more extreme responses. |
| von Baeyer et al. 2006 [9], Direct, B | Children 5 years and older | Faces scales; Graphical scales; NRS; VAS; VRS | VRS may be appropriate for children 9 years and older as they require verbal fluency at a high level. NRS might be appropriate for children 8 years and older as they require numeracy and ability to think and express oneself in quantitative terms. VAS scales may be appropriate for children 6 years and older and have shown good psychometric properties. Faces scales may be appropriate for children 4 years and older as they may be simpler than equating one’s feelings to numbers of abstract verbal descriptors. Color scales allow children to select a color associated with level of pain and may be appropriate for children 4 years and older but have not been studied extensively. Pieces of hurt scales use 4 poker chips to represent amount of pain and may be appropriate for children 3 years and older. |
| Cohen et al. 2008 [10], Direct, B | Children 3 years and older | Faces scales; Graphical scales; VAS | Poker chip tool (children 3 to 4 years) VAS (children 8 years and older) Faces scales need to be considered and developed carefully given that affect portrayed (crying) might be taken literally and if the child is not crying, he/she might not select this option. |
| Tomlinson et al. 2010 [8], Direct, B | Children 5 years and older | Faces scales | For research use, the Faces scale has been recommended for children 5 years and older on the basis of utility and psychometric features. |
| D’Arcy 2011 [7], Direct, D | All children | Faces scales | The Faces scale is a reliable and valid tool that should be used in children of all ages. |
| Matza et al. 2013 [2], Direct, D | All children; referenced data supportive of children as young as 8 years old | Graphical scales; Likert scales; NRS;VAS | Studies have shown that children 8 years and older prefer Likert scale to VAS and 10-point NRS. Expert opinion believes pictorial illustrations to be helpful for children 7 years and younger but confirmatory research is needed. |
aDirect evidence: Primary research that compares different response scales within study. Indirect evidence: Review or expert opinion based on empirical evidence
bGrade Key: A) Primary research; compares different response scales within the study; B) Review or expert opinion; based on an empirical evidence base; C) Primary research; evaluates a single response scale type within the study; and D) Review or expert opinion, based on expert consensus, convention, or historical experience