Ettema T P, Hensen E, De Lange J, Dröes R M, Mellenbergh G J, Ribbe M W
Department of Psychiatry, Institute for Extramural Medicine, VU Medical Center Amsterdam, The Netherlands.
Aging Ment Health. 2007 Nov;11(6):734-42. doi: 10.1080/13607860701366236.
This study investigates whether a modified version of the COOP/WONCA charts is suitable to assess quality of life (QOL) in persons with dementia in nursing homes. A group of 112 institutionalized persons with moderate to severe dementia were approached for an interview. Twenty-two were observed not to be communicative, leaving 90. Sixty-seven persons were able to answer four out of six questions adequately (interviewable). Inter-observer reliability (n=38) was excellent (weighted kappa 0.90 to 0.97). Test-retest reliability (n=34; one week interval) ranged from poor for Daily and Social Activities and for the QOL charts, to moderate for Feelings and Pain, and satisfactory for Physical Functioning (weighted kappa 0.23 to 0.67). Interviewability was associated with severity of the dementia and communication ability. Support for convergent validity was found in medium-sized Spearman correlations between the COOP/WONCA charts and related variables. Support for discriminant validity was found in the absence of association between the Ccharts and non-related variables. The modified COOP/WONCA charts can be used to assess QOL in 60% of people with dementia in nursing homes but further modification is needed. Severe cognitive impairment and communication disabilities proved limiting factors for the use of the instrument. Although the illustrations on the charts appeared not to be helpful, the written response options in addition to verbal presentation proved useful during the administration of the charts.
本研究调查了COOP/WONCA图表的修改版是否适用于评估养老院中痴呆症患者的生活质量（QOL）。我们对112名中度至重度痴呆的机构化患者进行了访谈。发现22人无法交流，剩余90人。67人能够充分回答六个问题中的四个（可访谈）。观察者间信度（n = 38）极佳（加权kappa系数为0.90至0.97）。重测信度（n = 34；间隔一周）范围从每日和社交活动以及生活质量图表的较差，到情感和疼痛方面的中等，以及身体功能方面的令人满意（加权kappa系数为0.23至0.67）。可访谈性与痴呆严重程度和沟通能力相关。在COOP/WONCA图表与相关变量之间的中等大小Spearman相关性中发现了对收敛效度的支持。在图表与非相关变量之间不存在关联中发现了对区分效度的支持。修改后的COOP/WONCA图表可用于评估60%的养老院痴呆症患者的生活质量，但需要进一步修改。严重的认知障碍和沟通障碍被证明是使用该工具的限制因素。尽管图表上的插图似乎没有帮助，但在图表管理过程中，除了口头表述外，书面回答选项被证明是有用的。
