Mehta T, Venkata Subramaniam A, Chetter I, McCollum P
Academic Vascular Unit, Hull Royal Infirmary, Hull, UK.
Eur J Vasc Endovasc Surg. 2006 Jan;31(1):46-52. doi: 10.1016/j.ejvs.2005.08.028. Epub 2005 Oct 14.
To recommend a suitable disease-specific quality of life (QOL) instrument for use in intermittent claudication (IC) based on validity and responsiveness.
Seventy claudicants completed two generic (SF36 and EUROQOL) and three disease-specific (CLAUS, VASCUQOL and SIP(IC)) QOL instruments prior to and 6 months after treatment (angioplasty or conservative therapy). Ankle brachial pressure indices and treadmill walking distances were measured at each assessment and International Society of Cardiovascular Surgery (ISCVS) recommended outcome measures were used to stratify the results. Construct and convergent-divergent validity was assessed for the three disease-specific QOL instruments. Responsiveness was assessed using effect sizes (effect size >0.5 is clinically significant).
All clinical indicators improved significantly following treatment. All five domains of CLAUS, the VASCUQOL and SIP(IC) showed highly significant spearman correlation with intermittent claudication distance (ICD) and maximum walking distance (MWD) (0.267-0.697, p=0.01), suggesting good construct validity. There was greater correlation between like domains of CLAUS and SF36 than non-like domains suggesting good convergent-divergent validity. Pain domain of CLAUS and VASCUQOL could detect mild clinical improvement significantly (effect sizes 0.55 and 0.67). Pain and everyday life domain of CLAUS and the VASCUQOL could detect moderate clinical improvement significantly (effect sizes 0.7, 0.74 and 0.56, respectively).
The three disease-specific QOL instruments (CLAUS, VASCUQOL, SIP(IC)) showed a high degree of construct and convergent-divergent validity. Amongst the three disease-specific QOL instruments, the VASCUQOL was most responsive and we would recommend its use in clinical practice.
基于有效性和反应性，推荐一种适用于间歇性跛行（IC）的特定疾病生活质量（QOL）评估工具。
70名跛行患者在治疗（血管成形术或保守治疗）前及治疗后6个月完成了两种通用的（SF36和欧洲生活质量量表）和三种特定疾病的（CLAUS、VASCUQOL和SIP(IC)）QOL评估工具。每次评估时测量踝肱压力指数和跑步机行走距离，并使用国际心血管外科学会（ISCVS）推荐的结果指标对结果进行分层。对三种特定疾病的QOL评估工具进行结构效度和收敛-发散效度评估。使用效应量评估反应性（效应量>0.5具有临床意义）。
治疗后所有临床指标均显著改善。CLAUS、VASCUQOL和SIP(IC)的所有五个领域与间歇性跛行距离（ICD）和最大行走距离（MWD）均显示出高度显著的斯皮尔曼相关性（0.267 - 0.697，p = 0.01），表明具有良好的结构效度。CLAUS和SF36相似领域之间的相关性高于非相似领域，表明具有良好的收敛-发散效度。CLAUS和VASCUQOL的疼痛领域能够显著检测到轻度临床改善（效应量分别为0.55和0.67）。CLAUS和VASCUQOL的疼痛和日常生活领域能够显著检测到中度临床改善（效应量分别为0.7、0.74和0.56）。
三种特定疾病的QOL评估工具（CLAUS、VASCUQOL、SIP(IC)）显示出高度的结构效度和收敛-发散效度。在这三种特定疾病的QOL评估工具中，VASCUQOL反应性最强，我们建议在临床实践中使用。
