Van Balen Romke, Essink-Bot Marie Louise, Steyerberg Ewout, Cools Herman, Habbema Dik F
Nursing and Rehabilitation Centre Antonius Binnenweg, Nieuwe Binnenweg 33 3014 GC, Rotterdam, The Netherlands.
Disabil Rehabil. 2003 May 20;25(10):507-19. doi: 10.1080/0963828031000090443.
We compared four health status measures for the evaluation of quality of life after hip fracture.
Two hundred and eight elderly hip fracture patients were followed up to 4 months after hospital admission. We used two interviewer-administered instruments (the Rehabilitation Activities Profile (RAP) and the Barthel Index (BI)) that focus on functional status, and two self-assessment instruments (the Nottingham Health Profile (NHP) and the COOP/WONCA charts) that additionally include psychological and social health domains. The score distribution, internal consistency, construct validity, and sensitivity to change were investigated.
At 4 months only 18% of surviving patients had reached the same level of functioning as before the fracture and, compared with reference values, lower scores of health status were found in the areas of physical mobility and emotional reactions. The number of comorbidities at hospital admission was the most important prognostic factor for recovery of health status at 4 months. The RAP and the BI both performed well in the assessment of functional status in regard to score distribution, internal consistency and construct validity. In contrast to the BI, the RAP also assessed instrumental activities of daily living and perceived problems with existing disabilities. The generic health status measures produced no added value in the assessment of functional status. The NHP covered a wider range of psychological health dimensions (emotion, pain, energy, and sleep) and had better psychometric properties than COOP/WONCA. None of the four instruments performed well in assessing social functioning.
To assess health status after hip fracture, we recommend the RAP for functional status and the NHP for changes in emotion, pain, and energy. These instruments detected poor recovery in functional and emotional status at 4 months after fracture.
我们比较了四种健康状况测量方法，以评估髋部骨折后的生活质量。
对208例老年髋部骨折患者进行随访，直至入院后4个月。我们使用了两种由访员实施的工具（康复活动量表（RAP）和巴氏指数（BI）），它们侧重于功能状态，以及两种自我评估工具（诺丁汉健康量表（NHP）和COOP/WONCA图表），后者还包括心理和社会健康领域。研究了评分分布、内部一致性、结构效度和对变化的敏感性。
在4个月时，仅有18%的存活患者恢复到骨折前的功能水平，与参考值相比，在身体活动能力和情绪反应方面的健康状况得分较低。入院时的合并症数量是4个月时健康状况恢复的最重要预后因素。RAP和BI在功能状态评估方面，在评分分布、内部一致性和结构效度方面均表现良好。与BI不同，RAP还评估了日常生活中的工具性活动以及对现有残疾的感知问题。通用健康状况测量方法在功能状态评估中没有额外价值。NHP涵盖了更广泛的心理健康维度（情绪、疼痛、精力和睡眠），并且心理测量特性比COOP/WONCA更好。这四种工具在评估社会功能方面均表现不佳。
为评估髋部骨折后的健康状况，我们推荐使用RAP评估功能状态，使用NHP评估情绪、疼痛和精力方面的变化。这些工具在骨折后4个月时检测到功能和情绪状态恢复不佳。
