Sach Tracey H, Barton Garry R
School of Community Health Sciences, 13th Floor Tower Building, University of Nottingham, University Park, Nottingham NG7 2RD, UK.
Int J Pediatr Otorhinolaryngol. 2007 Mar;71(3):435-45. doi: 10.1016/j.ijporl.2006.11.011. Epub 2006 Dec 11.
To examine what factors are associated with EuroQol EQ-5D scores in children after unilateral cochlear implantation and to explore parental conceptualisations of health-related quality of life (HRQL) and quality of life (QoL).
Face to face interviews were conducted with the parents of 222 implanted children, in an attempt to elicit information on their child's HRQL and QoL. Post-implant, the child's HRQL was measured using the EQ-5D, completed by parental proxy. Regression analysis was undertaken in order to estimate the association between the child EQ-5D score and child characteristics, child performance, and parental characteristics, in order to assess the construct validity of the EQ-5D. HRQL was also measured using the EuroQol visual analogue scale (VAS), where the endpoints were the best and worst imaginable health state, and a VAS was also used to measure QoL (endpoints: best/worst imaginable QoL). Parents were asked to estimate scores on both these VAS measures both post-implantation and (retrospectively) pre-implantation. Throughout the HRQL and QoL elicitation process, subjects' comments, and observations were noted.
Children who had an additional disability (p<0.001), were male (p<0.05) or had a lower level of auditory perception (p<0.001) were estimated to have lower EQ-5D scores, as were children whose parents who left school before age 18 years (p<0.05). According to the EuroQol VAS the mean difference between pre- and post-implantation score was 0.14, compared to 0.35 for the QoL VAS, demonstrating that parents tended not to see HRQL and QoL as equivalent. As 67% of parents deemed there to be no difference between the pre- and post-implant EuroQol VAS scores we also infer that the majority of parents rejected the notion of deafness being a HRQL issue.
The evidence relating to the construct validity of the EQ-5D is variable-though it was able to discriminate between children with certain levels of auditory performance, it could not discriminate between children who differed in other ways. By limiting outcome from cochlear implantation to HRQL, as opposed to QoL, the benefits of cochlear implants are likely to be underestimated.
研究单侧人工耳蜗植入术后儿童的欧洲五维健康量表（EuroQol EQ-5D）得分与哪些因素相关，并探讨家长对健康相关生活质量（HRQL）和生活质量（QoL）的概念理解。
对222名接受植入手术儿童的家长进行面对面访谈，试图获取有关其孩子HRQL和QoL的信息。植入术后，通过家长代理完成欧洲五维健康量表，以此测量孩子的HRQL。进行回归分析，以估计儿童EQ-5D得分与儿童特征、儿童表现及家长特征之间的关联，从而评估欧洲五维健康量表的结构效度。还使用欧洲五维健康视觉模拟量表（VAS）测量HRQL，其端点为可想象到的最佳和最差健康状态，同时也用一个VAS测量QoL（端点：可想象到的最佳/最差QoL）。要求家长在植入术后及（回顾性地）植入术前估计这两个VAS量表的得分。在整个HRQL和QoL获取过程中，记录受试者的评论和观察结果。
患有其他残疾（p<0.001）、为男性（p<0.05）或听觉感知水平较低（p<0.001）的儿童，以及父母在18岁之前辍学的儿童（p<0.05），其EQ-5D得分预计较低。根据欧洲五维健康视觉模拟量表，植入术前和术后得分的平均差异为0.14，而生活质量视觉模拟量表的平均差异为0.35，这表明家长往往不认为HRQL和QoL是等同的。由于67%的家长认为植入术前和术后的欧洲五维健康视觉模拟量表得分没有差异，我们还推断，大多数家长拒绝将耳聋视为HRQL问题这一观点。
关于欧洲五维健康量表结构效度的证据参差不齐——尽管它能够区分具有一定听觉表现水平的儿童，但无法区分在其他方面存在差异的儿童。将人工耳蜗植入的结果局限于HRQL而非QoL，人工耳蜗植入的益处可能会被低估。
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