Rockwood Todd H
Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis 55455-0392, USA.
Gastroenterology. 2004 Jan;126(1 Suppl 1):S106-13. doi: 10.1053/j.gastro.2003.10.057.
This article reviews self-reporting instruments to measure severity and quality of life in fecal incontinence. Severity instruments assess the frequency, type, and amount of stool loss and the impact of fecal incontinence on coping mechanisms and lifestyle/behavioral change. Non-weighted instruments use simple numerical totals to gauge severity; however, the use of vague quantifiers to describe severity can make the results highly subjective. In weighted surveys, every possible response (indicating the frequency of each type of incontinence) is multiplied by a weight that reflects the average severity assigned by a representative group of patients (or physicians), and the weighted responses are added to compile a total score. When variables such as coping mechanisms and lifestyle changes are included in severity questionnaires, the results tend to reflect patient functioning more than severity and should be interpreted cautiously. Quality-of-life scales assess variables that are not directly observable and are highly subjective. Quality-of-life scales are divided into 3 categories: (1) generic scales permit the measurement of gross change and compare the experience of the target population to other populations; (2) specialized scales are most useful in trying to isolate effects of specific variables, such as depression; and (3) condition-specific quality-of-life scales measure the relationship between specific medical conditions or treatments, and quality of life outcomes. Future research should focus on the need for weighting, further evaluation of the use of coping mechanisms as an indicator of severity, and how to integrate measures of urgency. In the area of quality of life, "modules" are needed that can be appended to established instruments to help assess and compare the experience of specific populations.
本文综述了用于测量大便失禁严重程度和生活质量的自我报告工具。严重程度工具评估大便失禁的频率、类型和量，以及大便失禁对应对机制和生活方式/行为改变的影响。非加权工具使用简单的数值总和来衡量严重程度；然而，使用模糊的量词来描述严重程度会使结果具有高度主观性。在加权调查中，每个可能的回答（表明每种类型失禁的频率）乘以一个权重，该权重反映了一组代表性患者（或医生）分配的平均严重程度，然后将加权后的回答相加得出总分。当应对机制和生活方式改变等变量包含在严重程度问卷中时，结果往往更多地反映患者的功能而非严重程度，应谨慎解读。生活质量量表评估的变量无法直接观察且具有高度主观性。生活质量量表分为三类：（1）通用量表允许测量总体变化，并将目标人群的经历与其他人群进行比较；（2）专门量表在试图分离特定变量（如抑郁）的影响时最有用；（3）特定疾病的生活质量量表测量特定医疗状况或治疗与生活质量结果之间的关系。未来的研究应关注加权的必要性、进一步评估将应对机制作为严重程度指标的使用情况，以及如何整合紧迫性测量。在生活质量领域，需要“模块”，可以附加到已有的工具上，以帮助评估和比较特定人群的经历。
