van Koulil Saskia, Kraaimaat Floris W, van Lankveld Wim, van Riel Piet L C M, Evers Andrea W M
Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
Arthritis Rheum. 2009 Dec 15;61(12):1626-32. doi: 10.1002/art.24792.
Increasing attention is devoted to the patient's perspective in clinical research and practice. However, the relationship between the patient's view on treatment progress and standardized pre-post changes in health outcomes is not well understood. The objective of this study was to investigate whether the patient's perception of treatment gain converges with pre-post treatment effects of a multidisciplinary treatment as assessed by standardized self-report measures.
During a tailored multidisciplinary treatment for fibromyalgia, validated self-report questionnaires were assessed at baseline and posttreatment on the outcome measures of pain, functional disability, fatigue, anxiety, and negative mood. In addition, the participants were asked to fill in a questionnaire at the end of the treatment assessing the patient's perception of improvement on core outcomes, as well as satisfaction and usefulness of the treatment.
Moderate to relatively high correlations were found between the patient's perception of improvement and pre-post changes on the physical outcomes, in contrast to small or nonsignificant correlations for psychological outcomes. In addition, satisfaction and usefulness were significantly related to pre-post changes on physical outcomes, but no relationship was found with respect to psychological outcomes.
Results suggest that the patient's perception of treatment gain and pre-post changes in outcomes during treatment assess different aspects of the patient's treatment progress, particularly with regard to psychological functioning. Future research on clinical improvements should consider the patient's perception of treatment gain as an independent and clinically relevant outcome, in addition to standardized trial data of pre-post assessments of health outcomes.
在临床研究和实践中，患者视角受到越来越多的关注。然而，患者对治疗进展的看法与健康结果标准化的前后变化之间的关系尚未得到充分理解。本研究的目的是调查患者对治疗获益的认知是否与多学科治疗的治疗前后效果相一致，该效果通过标准化的自我报告测量进行评估。
在针对纤维肌痛的定制多学科治疗期间，在基线和治疗后使用经过验证的自我报告问卷对疼痛、功能残疾、疲劳、焦虑和负面情绪等结果指标进行评估。此外，参与者在治疗结束时被要求填写一份问卷，评估患者对核心结果改善的认知，以及治疗的满意度和有用性。
患者对改善的认知与身体结果的前后变化之间存在中度到相对较高的相关性，而心理结果的相关性较小或无显著相关性。此外，满意度和有用性与身体结果的前后变化显著相关，但与心理结果无关。
结果表明，患者对治疗获益的认知与治疗期间结果的前后变化评估了患者治疗进展的不同方面，特别是在心理功能方面。未来关于临床改善的研究除了健康结果前后评估的标准化试验数据外，还应将患者对治疗获益的认知视为一个独立且与临床相关的结果。
