Cella David, Hahn Elizabeth A, Dineen Kelly
Evanston Northwestern Healthcare and Northwestern University, Evanston, Illinois 60201, USA.
Qual Life Res. 2002 May;11(3):207-21. doi: 10.1023/a:1015276414526.
There has been increased recent attention to the clinical meaningfulness of group change scores on health-related quality of life (HRQL) questionnaires. It has been assumed that improvements and declines of comparable magnitude have the same meaning or value.
We assessed 308 cancer patients with the Functional Assessment of Cancer Therapy (FACT) and a Global Rating of Change. Patients were classified into five levels of change in HRQL and its dimensions based upon their responses to retrospective ratings of change after 2 months: sizably worse, minimally worse, no change, minimally better, and sizably better. Raw score and standardized score changes on the FACT-G subscales and total score were then compared across different categories of patient-rated change.
The relationship between actual FACT change scores and retrospective ratings of change was modest but usually statistically significant (r: 0.07 to 0.35). Change scores associated with each retrospective rating category were evaluated to determine estimates of meaningful difference. Patients who reported global worsening of HRQL dimensions had considerably larger change scores than those reporting comparable global improvements. Although related to a ceiling effect, this remained true even after removing cases that began near the ceiling of the questionnaire.
Relatively small gains in HRQL have significant value. Comparable declines may be less meaningful, perhaps due to patients' tendency to minimize personal negative evaluations about one's condition. This has important implications for the interpretation of the meaningfulness of change scores in HRQL questionnaires. Factors such as adaptation to disease, response shift, dispositional optimism and the need for signs of clinical improvement may be contributing to the results and should be investigated in future studies.
近期，人们越来越关注健康相关生活质量（HRQL）问卷中群体变化分数的临床意义。人们认为，同等程度的改善和下降具有相同的意义或价值。
我们使用癌症治疗功能评估（FACT）和总体变化评分对308名癌症患者进行了评估。根据患者对2个月后变化的回顾性评分，将其分为HRQL及其维度变化的五个水平：明显变差、略有变差、无变化、略有改善和明显改善。然后比较了FACT-G子量表和总分的原始分数和标准化分数变化在不同患者自评变化类别中的情况。
FACT实际变化分数与变化回顾性评分之间的关系适中，但通常具有统计学意义（r：0.07至0.35）。对与每个回顾性评分类别相关的变化分数进行评估，以确定有意义差异的估计值。报告HRQL维度总体恶化的患者的变化分数明显高于报告同等总体改善的患者。尽管这与天花板效应有关，但即使去除问卷上限附近开始的病例后，情况仍然如此。
HRQL相对较小的改善具有重要价值。同等程度的下降可能意义较小，这可能是由于患者倾向于尽量减少对自身状况的负面个人评价。这对解释HRQL问卷中变化分数的意义具有重要影响。适应疾病、反应转移、性格乐观以及对临床改善迹象的需求等因素可能导致了这些结果，未来的研究应对此进行调查。
