Katz J N, Larson M G, Phillips C B, Fossel A H, Liang M H
Robert B. Brigham Multipurpose Arthritis Center, Brigham and Women's Hospital, Boston, MA 02115.
Med Care. 1992 Oct;30(10):917-25. doi: 10.1097/00005650-199210000-00004.
Short measures of health status are used increasingly in health services research, yet their sensitivities to clinical change have not been compared with longer, established instruments. In this study, 5 health status measures were administered preoperatively and 3 months postoperatively to 54 patients undergoing total hip arthroplasty. These instruments included the Sickness Impact Profile (SIP)--an established, long measure--and 4 short forms: the SF-36, Functional Status Questionnaire, shortened Arthritis Impact Measurement Scales, and Modified Health Assessment Questionnaire. Scores for physical, psychological, and global dimensions were constructed by aggregating subscales. Sensitivity to change, or responsiveness, was expressed with the standardized response mean (SRM), calculated as the mean change in score divided by the standard deviation of the change in score. The sampling distribution of the SRM was estimated with a jackknife procedure. Preoperative scores were moderately to highly correlated across instruments. The physical and global dimension SRMs of the brief health status measures ranged from 0.85 to 1.27 and were as large as or larger than the corresponding SIP SRMs. The SIP had the highest SRM on the psychological dimension. None of the instruments was significantly more sensitive than the others at the critical value (P = 0.005) adjusted for multiple comparisons. The brief health status measures were equally or more responsive than the SIP after total hip arthroplasty in the physical and global dimensions. Much larger samples are required to demonstrate statistically significant differences in SRMs among instruments.
健康状况的简短测量方法在卫生服务研究中的使用越来越多，但其对临床变化的敏感性尚未与更长期、已确立的工具进行比较。在本研究中，对54例行全髋关节置换术的患者在术前和术后3个月进行了5种健康状况测量。这些工具包括疾病影响量表（SIP）——一种已确立的、较长的测量方法——以及4种简短形式：SF-36、功能状态问卷、简化的关节炎影响测量量表和改良健康评估问卷。通过汇总子量表构建身体、心理和总体维度的得分。对变化的敏感性或反应性用标准化反应均值（SRM）表示，计算方法为得分的平均变化除以得分变化的标准差。SRM的抽样分布采用刀切法估计。术前得分在各工具之间呈中度至高度相关。简短健康状况测量的身体和总体维度SRM范围为0.85至1.27，与相应的SIP SRM一样大或更大。SIP在心理维度上的SRM最高。在针对多重比较进行调整的临界值（P = 0.005）时，没有一种工具比其他工具更敏感。在全髋关节置换术后的身体和总体维度上，简短健康状况测量的反应性与SIP相同或更高。需要更大的样本量才能证明各工具之间SRM存在统计学上的显著差异。
