Lin Kiat Yap Philip, Yen Ni Goh Jenny, Henderson Linda Mary, Min Han Pei, Shin Ong Kui, Si Ling Kwek Serene, Yi Hui Ong Elizabeth, Pui Kwan Loh Donus
Department of Geriatric Medicine, Alexandra Hospital, Singapore.
Int Psychogeriatr. 2008 Jun;20(3):482-93. doi: 10.1017/S1041610207006096. Epub 2007 Sep 17.
This study examines the psychometric properties and clinical experience in using the Mandarin translation of the Quality of Life-Alzheimer's Disease (QoL-AD) instrument in Chinese patients with dementia in Singapore.
A Mandarin version of QoL-AD was established following standard guidelines for transcultural adaptation of QoL measures. The instrument was administered to 70 patient-carer dyads; patients with severe dementia (MMSE < 10) were excluded. Reliability by internal consistency and test-retest, and construct validity by correlating the known domains of QoL-AD with validity measures for the respective domains, was performed. Guidelines for Rating Awareness Deficits (GRAD) measured patients' insight into their deficits.
Three patients were not able to complete the QoL-AD. Internal consistency (Cronbach's alpha) was high for both patient (0.9) and carer (0.8) QoL-AD ratings, as was test-retest reliability, intraclass correlation coefficient (ICC) 0.7 and 0.8 respectively. Correlation of QoL-AD with domain measures was moderate for carer ratings (0.21 < r < 0.51) and poor for patient (-0.17 < r < 0.13). Patient self-rated QoL correlated poorly with, and was significantly higher than, carer-rated QoL. Correlation between patient and carer QoL-AD was stronger in patients with better insight (GRAD 3-4).
The results suggest that while the Mandarin version of QoL-AD can be used reliably in our population, patients' self perceived QoL can be different from carer ratings and from objective QoL measures. The disparity can be attributed to patients' poor insight, denial, fear of "losing face," normalization and accommodation of standards with aging. The patients' lack of education and seclusion from Western cultural exposure are also contributory.
本研究探讨在新加坡华裔痴呆患者中使用生活质量-阿尔茨海默病（QoL-AD）量表中文译本的心理测量特性及临床应用经验。
按照生活质量测量跨文化调适的标准指南，建立QoL-AD的中文版。该量表应用于70对患者-照料者；排除重度痴呆（简易精神状态检查表<10）患者。通过内部一致性和重测法评估信度，通过将QoL-AD的已知领域与各领域的效度指标进行相关分析评估结构效度。采用缺陷认知评定指南（GRAD）评估患者对自身缺陷的认知。
3例患者无法完成QoL-AD量表。患者（0.9）和照料者（0.8）QoL-AD评分的内部一致性（克朗巴哈系数）均较高，重测信度也较高，组内相关系数（ICC）分别为0.7和0.8。照料者评分中，QoL-AD与各领域测量指标的相关性中等（0.21<r<0.51），患者评分相关性较差（-0.17<r<0.13）。患者自评生活质量与照料者评分相关性较差，且显著高于照料者评分。在认知较好（GRAD 3-4）的患者中，患者与照料者QoL-AD评分的相关性更强。
结果表明，虽然QoL-AD中文版在我们的研究人群中可可靠使用，但患者自我感知的生活质量可能与照料者评分及客观生活质量测量指标不同。这种差异可归因于患者认知差、否认、怕“丢脸”、随着年龄增长标准的正常化和适应。患者缺乏教育以及与西方文化接触较少也有一定作用。
