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Validity and utility of the 11-point NRS is sufficient and it is responsive to changes in individuals [ 20- 22].
Although this cross-sectional approach of looking at severity levels was efficient and in line with cost constraints, future research can use this instrument to determine if it is responsive to changes in mental health status over time.
Moreover, there is evidence of previous use in PAH clinical trials [ 14, 15, 28, 29], and that it is responsive to changes following treatment in PAH [ 15, 29- 31].
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It is responsive to change and is internally consistent [ 38].
It is responsive to change before and after stigma intervention.
It is responsive to change [ 7] and highly acceptable in both clinical and non-clinical settings [ 4, 6, 8].
It is responsive to change against self-reported change in health status [ 2], physician global assessment [ 2, 11, 12], BILAG [ 2], LFA defined flare [ 2], SLEDAI [ 11, 12] and SELENA Flare Index [ 11, 12].
It is therefore a common endpoint used in clinical trials, because it is responsive to change in physical/functional outcomes, sometimes more than a total (overall) multidimensional aggregated score, which includes social and emotional well-being.
It is responsive to change over 12 weeks [ 35] and has high internal consistency (Cronbach's alpha =.95) and high reproducibility over a 7-day interval (ICC =.86) [ 30].
This instrument consists of positive, neutral and negative colors and its validation in normal adults and those with anxiety or depression showed that it is responsive to change and reproducible.
In addition to its availability in Arabic, it is a valuable tool that is responsive to changes in patient clinical status over time when used for treatment maintenance and adjustment [ 6, 8, 12- 14].
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