Smith Ellen M Lavoie, Cohen Jeffrey A, Pett Marjorie A, Beck Susan L
University of Michigan School of Nursing, Ann Arbor, MI 48109-5482, USA.
Cancer Nurs. 2010 May-Jun;33(3):173-83. doi: 10.1097/NCC.0b013e3181c989a3.
Assessment of chemotherapy-induced peripheral neuropathy signs and symptoms has been hampered because of the lack of simple, reliable, and valid measures.
The study objective was to examine the internal consistency and interrater reliability as well as the structural validity of a 5-component total neuropathy score-reduced (TNSr) variant and a chemotherapy-induced neuropathy-specific Neuropathic Pain Scale.
One hundred seventeen outpatients receiving taxanes or platinums were assessed by a consistent nurse practitioner using the 2 instruments. Ten subjects participated in interrater reliability testing.
Mean scores and SDs for individual items were low. The strength item was deleted because of low interitem correlations and a floor effect. The reflex item was deleted because of low interitem correlations and its negative influence on Cronbach alpha. Pin sensibility was deleted because of low factor loadings. The TNSr-short form and the chemotherapy-induced neuropathy-specific Neuropathic Pain Scale formed 2 distinct factors, providing evidence of structural validity. Cronbach alpha's for the 2 instruments were .80 and .96, respectively. The TNSr interrater reliability results suggested acceptable rater concordance, but minor revisions could further improve scoring precision.
Clinimetric evidence supports the use of 2 new instruments when monitoring taxane- and platinum-related neuropathy and pain. Further instrument modifications are recommended, followed by additional testing in diverse populations.
With these new instruments, nurses can more easily incorporate prospective neuropathy assessment into daily clinical practice. The outcome will be improved symptom awareness by oncology clinicians and patients, leading to fewer chemotherapy-induced peripheral neuropathy-related devastating effects on functionality and quality of life.
由于缺乏简单、可靠且有效的测量方法，化疗引起的周围神经病变体征和症状的评估受到了阻碍。
本研究的目的是检验一个由5个部分组成的简化总神经病变评分（TNSr）变体和一个化疗引起的神经病变特异性神经病理性疼痛量表的内部一致性、评分者间信度以及结构效度。
117名接受紫杉烷类或铂类药物治疗的门诊患者由一名固定的执业护士使用这两种工具进行评估。10名受试者参与了评分者间信度测试。
各个项目的平均分和标准差较低。由于项目间相关性低和地板效应，强度项目被删除。由于项目间相关性低及其对Cronbach α系数的负面影响，反射项目被删除。由于因子载荷低，针刺感觉项目被删除。TNSr简表和化疗引起的神经病变特异性神经病理性疼痛量表形成了两个不同的因子，提供了结构效度的证据。这两种工具的Cronbach α系数分别为0.80和0.96。TNSr评分者间信度结果表明评分者一致性可接受，但进行一些小的修订可进一步提高评分精度。
临床测量学证据支持在监测紫杉烷类和铂类药物相关神经病变和疼痛时使用这两种新工具。建议对工具进行进一步修改，随后在不同人群中进行额外测试。
对实践 的启示：有了这些新工具，护士可以更轻松地将前瞻性神经病变评估纳入日常临床实践。结果将提高肿瘤临床医生和患者对症状的认识，从而减少化疗引起的周围神经病变对功能和生活质量的破坏性影响。
