Krause James S, Reed Karla S, McArdle John J
College of Health Professions, Medical University of South Carolina, 77 President St, Suite 117, PO Box 250700, Charleston, SC 29425, USA.
J Spinal Cord Med. 2010;33(1):22-32. doi: 10.1080/10790268.2010.11689671.
To develop and validate a latent model of health outcomes among persons with spinal cord injury.
Survey data were collected at a large specialty hospital in the southeastern USA from 1,388 adult participants with traumatic spinal cord injury of at least 1 year's duration. Multiple indicators of health outcomes were used, including general health ratings, days adversely affected by poor health and poor mental health, treatments and hospitalizations, depressive symptoms, symptoms of illness or infection (eg, sweats, chills, fever), and multiple individual conditions (eg, pressure ulcers, subsequent injuries, fractures, contractures).
We performed exploratory factor analysis on half of the sample and confirmatory factor analysis on the other. A 6-factor solution was the best overall solution, because there was an excellent fit with the exploratory factor analysis (root mean square error of approximation = 0.042) and acceptable fit with the confirmatory factor analysis (root mean square error of approximation = 0.065). Four of the factors were types of secondary conditions, including symptoms of illness or infection, orthopedic conditions, pressure ulcers, and subsequent injuries. The 2 remaining factors reflected global health and treatment. Gender, race-ethnicity, age, injury severity, and years of education were all significantly related to at least 1 factor dimension, indicating variations in health outcomes related to these characteristics.
Identification of the 6 factors represents an improvement over the utilization of multiple individual indicators, because composite scores generated from multiple individual indicators provide more informative and stable outcome scores than utilization of single indicators.
建立并验证脊髓损伤患者健康结局的潜在模型。
在美国东南部一家大型专科医院收集了1388名创伤性脊髓损伤至少1年的成年参与者的调查数据。使用了多种健康结局指标，包括总体健康评分、健康状况不佳和心理健康状况不佳对天数的不利影响、治疗和住院情况、抑郁症状、疾病或感染症状（如出汗、寒战、发热）以及多种个体状况（如压疮、后续损伤、骨折、挛缩）。
我们对一半样本进行了探索性因子分析，对另一半进行了验证性因子分析。六因子解决方案是总体上最佳的解决方案，因为它与探索性因子分析拟合良好（近似均方根误差 = 0.042），与验证性因子分析拟合可接受（近似均方根误差 = 0.065）。其中四个因子是继发性状况的类型，包括疾病或感染症状、骨科状况、压疮和后续损伤。其余两个因子反映了整体健康和治疗情况。性别、种族、年龄、损伤严重程度和受教育年限均与至少一个因子维度显著相关，表明与这些特征相关的健康结局存在差异。
识别这六个因子比使用多个个体指标有所改进，因为从多个个体指标生成的综合评分比使用单个指标提供了更丰富、更稳定的结局评分。
