开发和验证一种新的工具，用于评估术后患者使用患者自控镇痛模式的易用性。

Development and validation of a new instrument to evaluate the ease of use of patient-controlled analgesic modalities for postoperative patients.

机构信息

Center for Health Outcomes Research, United BioSource Corporation, 7101 Wisconsin Avenue, Bethesda, MD 20814, USA.

出版信息

J Med Econ. 2010 Mar;13(1):42-54. doi: 10.3111/13696990903484637.

DOI:10.3111/13696990903484637

PMID:20001659

Abstract

OBJECTIVE

To describe the development and psychometric evaluation of a questionnaire assessing the ease of use that patients associate with patient-controlled analgesia (PCA) modalities.

METHODS

Qualitative interviews were conducted with patients who had experience with intravenous (IV) PCA for postoperative pain management to generate items relevant to the ease of using PCA modalities. The content validity of the resulting questionnaire was examined through follow-up patient interviews, and an expert panel reviewed the questionnaire. Cognitive debriefing interviews were conducted with patients to determine the clarity and content of the instructions, items, and response scales, and the ease of completing the instrument. Psychometric evaluation was performed with patients who had undergone surgery and received IV PCA for postoperative pain management. Item and scale quality and the internal consistency reliability of the questionnaire were assessed. Construct validity was evaluated by examining the relationship between subscales of the questionnaire with patient-reported outcome measures. Known-groups validity was determined by assessing the instrument's ability to differentiate between patients with versus without an IV PCA problem. A potential limitation of this study was the exclusive sampling of patients who had experience with IV PCA.

RESULTS

The Patient Ease-of-Care (EOC) Questionnaire included 23 items in the following subscales: Confidence with Device, Comfort with Device, Movement, Dosing Confidence, Pain Control, Knowledge/Understanding, and Satisfaction. Coefficient alpha reliability estimates were ≥ 0.66 for Overall EOC (includes all subscales except Satisfaction) and all EOC subscales. Construct validity was supported by the moderate relationship between the Pain Control subscale and measures of pain severity and pain interference; additional evidence of construct validity was provided by correlations of the Confidence with Device subscale, the Satisfaction subscale, and Overall EOC with measures of pain severity, pain interference, and satisfaction. Significant mean score differences were reported between participants with and without IV PCA problems for Overall EOC and for the Comfort with Device, Confidence with Device, Movement, Pain Control, and Satisfaction subscales indicating known-groups validity.

CONCLUSIONS

Results provide evidence for the reliability and validity of the Patient EOC Questionnaire as a measure of the ease of use that patients associate with PCA systems and may be useful for evaluating emerging PCA modalities.

摘要

目的

描述一种评估患者对患者自控镇痛（PCA）模式易用性感知的问卷的开发和心理测量学评估。

方法

对有静脉（IV）PCA 用于术后疼痛管理经验的患者进行定性访谈，以生成与 PCA 模式易用性相关的项目。通过后续患者访谈和专家小组审查来检查得出的问卷的内容效度。对患者进行认知剖析访谈，以确定说明、项目和反应量表的清晰度和内容，以及完成仪器的难易程度。对接受过手术并接受 IV PCA 用于术后疼痛管理的患者进行心理测量学评估。评估问卷的项目和量表质量以及内部一致性信度。通过检查问卷子量表与患者报告的结果测量之间的关系来评估结构有效性。通过评估仪器区分有无 IV PCA 问题的患者的能力来确定已知组有效性。本研究的一个潜在局限性是仅对有 IV PCA 经验的患者进行抽样。

结果

患者护理舒适度（EOC）问卷包括以下子量表的 23 个项目：对设备的信心、对设备的舒适度、运动、剂量信心、疼痛控制、知识/理解和满意度。总体 EOC（包括除满意度以外的所有子量表）和所有 EOC 子量表的总体可靠性估计值均≥0.66。结构有效性得到了疼痛控制子量表与疼痛严重程度和疼痛干扰测量之间中度关系的支持；对设备的信心子量表、满意度子量表和总体 EOC 与疼痛严重程度、疼痛干扰和满意度测量之间的相关性提供了结构有效性的额外证据。在总体 EOC 以及舒适度、对设备的信心、运动、疼痛控制和满意度子量表方面，报告了有和没有 IV PCA 问题的参与者之间存在显著的平均得分差异，表明具有已知组有效性。