Pickard A Simon, Johnson Jeffrey A, Feeny David H, Shuaib Ashfaq, Carriere K C, Nasser Abdul M
College of Pharmacy, University of Illinois at Chicago, 60612, USA.
Stroke. 2004 Feb;35(2):607-12. doi: 10.1161/01.STR.0000110984.91157.BD. Epub 2004 Jan 15.
Proxy informants can provide information on patients who are limited in ability to self-assess health-related quality of life (HRQL) after stroke. One alternative is to exclude assessments of such patients and attenuate generalizability. The purpose of this study was to examine patient-proxy agreement on the domains and summary scores of the EQ-5D and Health Utilities Index Mark 3 (HUI3) after stroke.
An observational longitudinal cohort of 124 patients hospitalized after ischemic stroke and their family caregivers completed the HRQL measures at baseline and were followed up for 6 months. Patient and proxy agreement was assessed by use of weighted kappa or the intraclass correlation coefficient (ICC).
At baseline, the more observable domains of HRQL demonstrated greater agreement than the more subjective components. Cross-sectional point estimates of agreement were generally acceptable (ICC >0.70) for the EQ-5D Index and HUI3 summary scores when assessed >or=1 month after baseline. Agreement between change scores was generally poor to fair (ICC <0.60), but systematic bias was not observed for the indirect preference-based summary scores between baseline and 6 months.
Results suggest that proxy assessments obtained 6 months after stroke are more reliable than those obtained within 2 to 3 weeks after stroke. Although proxy-assessed change scores for indirect preference-based summary scores of the EQ-5D and HUI3 provided suboptimal agreement with patient assessment, limited systematic bias may support their consideration as alternatives to missing data or statistical imputation. Further research into the validity and reliability of proxy assessments is suggested.
代理 informant 可以提供有关中风后自我评估健康相关生活质量（HRQL）能力受限患者的信息。一种选择是排除对此类患者的评估并削弱普遍性。本研究的目的是检查中风后患者与代理在 EQ-5D 和健康效用指数 Mark 3（HUI3）的领域及汇总得分上的一致性。
对 124 例缺血性中风后住院患者及其家庭照顾者组成的观察性纵向队列在基线时完成 HRQL 测量，并随访 6 个月。通过加权 kappa 或组内相关系数（ICC）评估患者与代理的一致性。
在基线时，HRQL 中更具可观察性的领域比更主观的成分表现出更高的一致性。当在基线后≥1 个月进行评估时，EQ-5D 指数和 HUI3 汇总得分的横断面一致性点估计总体上是可接受的（ICC>0.70）。变化得分之间的一致性总体上较差至中等（ICC<0.60），但在基线和 6 个月之间基于间接偏好的汇总得分未观察到系统偏差。
结果表明，中风后 6 个月获得的代理评估比中风后 2 至 3 周内获得的评估更可靠。尽管 EQ-5D 和 HUI3 基于间接偏好的汇总得分的代理评估变化得分与患者评估的一致性欠佳，但有限的系统偏差可能支持将其视为缺失数据或统计插补的替代方法。建议对代理评估的有效性和可靠性进行进一步研究。
