Thakar Sumit, Christopher Solomon, Rajshekhar Vedantam
Department of Neurological Sciences, Christian Medical College, Vellore, India.
J Neurosurg Spine. 2009 Oct;11(4):402-12. doi: 10.3171/2009.4.SPINE08749.
In this study, the authors assessed the construct validity and the reliability of the World Health Organization Quality of Life-Bref (WHOQOL-Bref) questionnaire in patients with cervical spondylotic myelopathy (CSM) and compared the performance of the WHOQOL-Bref and the 36-Item Short Form Health Survey (SF-36) in assessing quality of life (QOL) in patients with CSM.
In this prospective study, 70 patients with CSM were assessed preoperatively and again 1 year after central corpectomy using the Nurick scale, the SF-36, and the WHOQOL-Bref. Construct validity and reliability of the WHOQOL-Bref, its responsiveness compared with that of the SF-36, and the correlations between the 2 scales were studied.
The WHOQOL-Bref was found to be valid (p < 0.001, Cuzick test for trend between the physical domain of the WHOQOL-Bref and Nurick grade) and reliable (Cronbach alpha > 0.7). It had smaller floor and ceiling effects (ranges 1.4-7.1% and 0-7.1%, respectively) than the SF-36 (ranges 2.9-71.4% and 0-14.1%, respectively). There was significant postoperative improvement in patient scores on all the SF-36 scales (p < 0.001) and the physical, psychological, and environment domains of the WHOQOL-Bref (p < 0.001). The SF-36 scales were more responsive to change (relative efficiency range 0.24-1) than the WHOQOL-Bref domains (relative efficiency range 0.002-0.73). Among scales measuring similar concepts, only the physical functioning and bodily pain scales of the SF-36 had a moderate correlation (r = 0.57 and 0.53, respectively; p < 0.001) with the physical domain of WHOQOL-Bref. Many of the scales of these 2 QOL instruments unexpectedly had a fair correlation with one another (r range = 0.2-0.4).
The WHOQOL-Bref, like the SF-36, is valid and reliable in assessing outcome in patients with CSM. It measures impairment in CSM in a more uniform manner than the SF-36, but its domains are less responsive to postoperative changes. Because the WHOQOL-Bref measures different constructs and has additive value, it should be used along with the SF-36 for QOL assessment in patients with CSM.
在本研究中，作者评估了世界卫生组织生活质量简表（WHOQOL-Bref）问卷在脊髓型颈椎病（CSM）患者中的结构效度和信度，并比较了WHOQOL-Bref与36项简明健康调查量表（SF-36）在评估CSM患者生活质量（QOL）方面的表现。
在这项前瞻性研究中，70例CSM患者在术前以及椎体次全切除术后1年接受了Nurick量表、SF-36和WHOQOL-Bref评估。研究了WHOQOL-Bref的结构效度和信度、与SF-36相比的反应度以及两个量表之间的相关性。
发现WHOQOL-Bref有效（p < 0.001，WHOQOL-Bref身体领域与Nurick分级之间的Cuzick趋势检验）且可靠（Cronbach α>0.7）。与SF-36相比，它的地板效应和天花板效应更小（范围分别为1.4-7.1%和0-7.1%）（SF-36的范围分别为2.9-71.4%和0-14.1%）。所有SF-36量表以及WHOQOL-Bref的身体、心理和环境领域患者得分术后均有显著改善（p < 0.001）。SF-36量表对变化的反应性比WHOQOL-Bref领域更高（相对效率范围为0.24-1）（WHOQOL-Bref领域相对效率范围为0.002-0.73）。在测量相似概念的量表中，只有SF-36的身体功能和身体疼痛量表与WHOQOL-Bref的身体领域有中度相关性（分别为r = 0.57和0.53；p < 0.001）。这两种QOL工具的许多量表意外地彼此有中等程度的相关性（r范围=0.2-0.4）。
与SF-36一样，WHOQOL-Bref在评估CSM患者的结局方面是有效且可靠的。它比SF-36以更统一的方式测量CSM中的损伤，但其领域对术后变化的反应性较低。由于WHOQOL-Bref测量不同的结构且具有附加价值，因此在评估CSM患者的QOL时应与SF-36一起使用。
