Cramer J, Rosenheck R, Xu W, Henderson W, Thomas J, Charney D
NorthEast Program Evaluation Center, VA Connecticut Healthcare System, West Haven 06516-2770, USA.
Schizophr Bull. 2001;27(2):227-34. doi: 10.1093/oxfordjournals.schbul.a006869.
Instrument-based scores are often used as outcome measures. However, little is known about what changes in scores mean in terms of a clinical assessment of improvement or deterioration. The purpose of this report was to determine how much change in standard instrument scores represents a clinically detectable improvement or deterioration. The Veterans Affairs (VA) Cooperative Study of Clozapine in Refractory Schizophrenia evaluated 423 patients on clozapine or haloperidol. Symptoms and quality of life scales were completed at baseline; 6 weeks; and 3, 6, and 12 months. Among patients judged as "improved" by clinicians, the average percentage changes were a 21 percent decrease in Positive and Negative Syndrome Scale (PANSS) scores and a 26 percent increase in Quality of Life Scale (QLS) scores across all followup periods. The change in mean seven-point item scores were -0.46 (PANSS) and 0.23 (QLS). A major gain in clinically assessed improvement to "much better" was associated with a 45 percent decline in PANSS scores and 50 percent increase in QLS scores (change in mean seven-point item scores -0.88 and 0.92, respectively). Thus, modest changes in psychometric scales assessing symptoms and quality of life reflect clinically detectable improvement.
基于工具的评分通常用作结果指标。然而，对于评分变化在改善或恶化的临床评估方面意味着什么，人们知之甚少。本报告的目的是确定标准工具评分的多大变化代表临床上可检测到的改善或恶化。退伍军人事务部（VA）对难治性精神分裂症患者使用氯氮平的合作研究评估了423例接受氯氮平或氟哌啶醇治疗的患者。在基线、6周以及3、6和12个月时完成症状和生活质量量表评估。在被临床医生判定为“改善”的患者中，在所有随访期间，阳性和阴性症状量表（PANSS）评分平均下降21%，生活质量量表（QLS）评分平均增加26%。七点项目平均评分的变化分别为-0.46（PANSS）和0.23（QLS）。临床评估改善至“好多了”的显著提升与PANSS评分下降45%和QLS评分增加50%相关（七点项目平均评分变化分别为-0.88和0.92）。因此，评估症状和生活质量的心理测量量表的适度变化反映了临床上可检测到的改善。
