Poster presentation, 18th ARRC International Acupuncture Research Symposium, King’s College London, 19th March 2016
relative sensitivity of numerical rating and Likert scales in the context of teaching electroacupuncture.
© David Mayor 1 and Tony Steffert 2
1. School of Health and Social Work, University of Hertfordshire;
2. Music Computing Lab, Open University.
Background information (PDF)
The poster (PDF)
Background. Mood and its changes are important but often overlooked in acupuncture research. A number of mood questionnaires exist, all using Likert scales, such as the validated, open-access 24-item Brunel Mood Scale (BRUMS24). This comprises six subscales – five of negative valence (ANGer, CONFusion, DEPRession, FATigue, TENSion), one positive (VIGour), with a derived construct, Total Mood Disturbance (TMD).
Our own acupuncture research called for a quick and easy method of assessing mood and its changes before, during and after stimulation. Following several pilot studies, we developed a multiple numerical rating scale for mood (NRS-M) with four negative subscales (Anxious, Confused, Fatigued, Gloomy) corresponding to those in BRUMS24, and four positive subjective states (Comfortable, Lively, Relaxed and overall ‘Good mood’) that would be useful in our research, rather than focusing solely on the pathological states emphasised by BRUMS24. Using fewer words, we hoped this would be easier to understand for non-native English speakers and those with learning difficulties, as well as quicker to complete even than BRUMS24. Here we analyse its use in a teaching situation.
Main objectives. To assess validity and reliability of NRS-M and determine whether it is more sensitive to mood and its changes than BRUMS24. To conduct factor and cluster analyses for NRS-M and BRUMS24, and to investigate common response styles for both scales.
Methods. Ethics approval was obtained, and 158 respondents recruited from attendees at nine UK electroacupuncture (EA) training seminars. The two measures were administered in paper form in quick succession – once early on and once towards the end of the seminar. Non-parametric statistical methods were used.
Results. NRS-M concurrent validity with BRUMS24 was good, with better discriminant validity for NRS-M, but better internal consistency and test-retest reliability for BRUMS24 (suggesting greater sensitivity for NRS-M). Of six other methods used, four indicated that NRS-M was more sensitive to mood and its changes than BRUMS24. Significance levels for Pre-Post differences in corresponding subscales in NRS-M and BRUMS24 were very similar, but effect sizes were all small. Results of factor and cluster analysis were consistent for NRS-M, showing two main factors/clusters, one of positive valence and one negative. Most NRS-M respondents exhibited a ‘mild’ response style, RS (or non-extreme RS, NERS). Thus response style (RS) is unlikely to threaten the validity of conclusions drawn from responses to the two scales. However, ERS respondents to NRS-M are likely to emphasise positive moods and de-emphasise negative moods (p<0.001).
Conclusions. NRS-M is a reasonably robust, responsive and partially validated measure of mood to use in the context of acupuncture practice. It has advantages over longer Likert scales such as BRUMS24.
To Andrea Abele-Brehm for providing an English version of her Befindlichkeitsskale (mood scale); to Helmut Acker for information about this scale; to Matthew Hankins for making available his Excel spreadsheet for calculating deltaG from frequency tables, and for his advice on its use; to Bev Steffert for information on dyscalculia; to Charles van Wijk for clarification on ‘total mood distress’; to Steve Vodanovich for his thoughts on boredom; to Tim Watson and of course our spouses/partners, and our questionnaire respondents, without whom none of this would have been possible. It goes without saying that any errors in this report remain our own responsibility.
If you have any comments, please contact David Mayor at 01707 320782 or