Ren Xinhua S, Kazis Lewis E, Lee Austin, Rogers William H
Center for Health Quality, Outcomes, and Economic Research (CHQOER), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA 01730, USA.
J Ambul Care Manage. 2005 Apr-Jun;28(2):157-66. doi: 10.1097/00004479-200504000-00006.
Using longitudinal data from the Veterans Health Study (VHS), we extended our earlier published cross-sectional analysis in comparing the generic SF-36 physical functioning (PF) and role limitations (role-physical [RP]) scales with the disease-specific PF and RP scales using disease attributions. The present study included 569 patients with chronic lung disease (CLD) and 352 patients with chronic low back pain (LBP) who received Veterans Affairs (VA) ambulatory care between June 1993 and March 1996. Consistent with our earlier study, we found that changes in the generic PF and RP scales had higher correlations with the other generic SF-36 scales than those in the disease-specific PF and RP scales over 12 months. On the other hand, disease-specific measures of PF and RP had larger R and t statistic values in discriminating the impacts of symptom-based illness severity as well as clinical services on physical and role functioning. These results suggest that the generic and disease-specific measures of PF and RP behave distinctly different from each other over time. The generic measures of PF and RP tend to assess a broad array of health-related quality of life, whereas disease-specific attributions of PF and RP scales tend to evaluate disease progression and clinical management associated with specific disease conditions. Disease-specific attribution is an important alternative to the development of new disease-specific instruments for assessing illness severity and the impact of clinical services.
利用退伍军人健康研究（VHS）的纵向数据，我们扩展了之前发表的横断面分析，通过疾病归因，将通用的SF - 36身体功能（PF）和角色限制（角色 - 身体[RP]）量表与特定疾病的PF和RP量表进行比较。本研究纳入了1993年6月至1996年3月期间接受退伍军人事务部（VA）门诊治疗的569例慢性肺病（CLD）患者和352例慢性下腰痛（LBP）患者。与我们之前的研究一致，我们发现，在12个月的时间里，通用PF和RP量表的变化与其他通用SF - 36量表的相关性高于特定疾病的PF和RP量表。另一方面，PF和RP的特定疾病测量在区分基于症状的疾病严重程度以及临床服务对身体和角色功能的影响方面，具有更大的R值和t统计量值。这些结果表明，PF和RP的通用测量和特定疾病测量随时间的表现明显不同。PF和RP的通用测量倾向于评估广泛的与健康相关的生活质量，而PF和RP量表的特定疾病归因倾向于评估与特定疾病状况相关的疾病进展和临床管理。特定疾病归因是开发用于评估疾病严重程度和临床服务影响的新的特定疾病工具的重要替代方法。
