Hewlett S, Smith A P, Kirwan J R
University of Bristol Academic Rheumatology, Bristol Royal Infirmary, UK.
Ann Rheum Dis. 2002 Nov;61(11):986-93. doi: 10.1136/ard.61.11.986.
Measurement of disability in rheumatoid arthritis is often used to support treatment decisions and outcome assessments, but is used without reference to the impact of disability on individual patients.
To develop and validate a scale to measure individual values for functions, which is used to weight the level of an individual patient's functional loss and thus calculate the personal impact of disability.
In four linked studies, first the phraseology for values was explored to develop a stem question for the value scale couched in terms patients understand (face validity). Then short and long versions of the value scale were compared (content validity) and tests of internal consistency and short term reliability undertaken (criterion validity). Finally, the value scale was examined for long term reliability and agreement with expected variables (criterion and construct validity), after which personal impact scores were calculated and their construct validity examined.
Patients understand the concept of values, and a positively phrased stem question was developed for the value scale, for which a short version was reasonably equivalent to a long version. The value scale was reliable over one week (96% changed by <1 point) with positive interitem correlation. Reasonable six and 12 month reliability was shown (52% changed by <0.5 points), and the value scale was independent of disability and clinical, psychological, personality, and social support variables. Personal impact scores were then calculated by using the value scores to weight disability scores. Impact scores varied widely between patients of similar disability. Personal impact for disability showed convergent validity with dissatisfaction with disability, perceived increase in disability, increased disease activity, worse psychological status, low social support, and time trade off for disability. It discriminated between patients with low and high dissatisfaction with disability, life satisfaction, depression, pain, and helplessness.
This individualised personal impact scale should lend meaning to disability scores, improving the interpretation of clinical and research data.
类风湿关节炎残疾程度的测量常被用于支持治疗决策和疗效评估，但在使用时未考虑残疾对个体患者的影响。
开发并验证一种用于衡量功能个体价值的量表，该量表用于权衡个体患者功能丧失的程度，从而计算残疾对个人的影响。
在四项相关研究中，首先探索价值的措辞，以制定一个患者能够理解的价值量表的主干问题（表面效度）。然后比较价值量表的简短版和长版（内容效度），并进行内部一致性测试和短期信度测试（效标效度）。最后，检验价值量表的长期信度以及与预期变量的一致性（效标效度和结构效度），之后计算个人影响得分并检验其结构效度。
患者理解价值的概念，为价值量表制定了一个正向表述的主干问题，其简短版与长版相当。价值量表在一周内具有可靠性（96%的变化<1分），各条目间呈正相关。显示出合理的6个月和12个月信度（52%的变化<0.5分），且价值量表独立于残疾以及临床、心理、人格和社会支持变量。然后通过使用价值得分来权衡残疾得分计算个人影响得分。在残疾程度相似的患者中，影响得分差异很大。残疾的个人影响与对残疾的不满、感知到的残疾增加、疾病活动增加、心理状态较差、社会支持低以及为残疾所做的时间权衡显示出收敛效度。它能够区分对残疾不满程度低和高的患者、生活满意度、抑郁、疼痛和无助感。
这种个体化的个人影响量表应能使残疾得分具有意义，改善对临床和研究数据的解释。
