General Surgery Department, The Ayr Hospital, Ayr, UK.
Patient. 2011;4(2):73-87. doi: 10.2165/11584660-000000000-00000.
The worldwide prevalence of obesity has been steadily rising, reaching alarming levels. Obesity, particularly morbid obesity, carries significant health risks to the lives of affected patients, including physical, psychological, and social co-morbidities. Bariatric surgery provides the only effective and sustainable approach to treat morbid obesity and reverse its adverse effects. The reduction in well-being due to poor health in obesity may have adverse effects on health-related quality of life (HR-QOL). There are numerous studies reporting HR-QOL in bariatric patients; however, there is a paucity of studies examining the psychometric properties of the HR-QOL instruments used. The main aim of this review is to identify the instruments used in assessing HR-QOL in bariatric patients and evaluate their content validity. We believe that this is the first systematic review of its kind to look in depth at various generic- and obesity-specific HR-QOL instruments that were used in bariatric surgery, and to analyze their content validity. A systematic and structured search of Ovid databases (1980-2009) was conducted using terms synonymous with bariatric surgery, combined with terms synonymous with HR-QOL instruments. A total of 112 relevant studies were identified, detailing the use of eight generic, nine obesity-specific, and numerous other condition-specific instruments. A conceptual framework comprising 20 domains pertinent to bariatric surgery and morbid obesity was proposed, against which the identified generic- and obesity-specific instruments were assessed. The results of this assessment showed that neither the generic nor the specific instruments were adequate instruments in terms of content validity. Given the lack of adequate HR-QOL instruments in the rapidly developing field of bariatric surgery, we suggest building a new bariatric-specific instrument informed by the proposed framework, which will then enable clinicians to assess the full impact of morbid obesity and bariatric surgery on HR-QOL.
全球肥胖患病率持续上升，已达到令人担忧的水平。肥胖症，尤其是病态肥胖症，会给患者的生命带来重大的健康风险，包括身体、心理和社会合并症。减重手术是治疗病态肥胖症和逆转其不良影响的唯一有效且可持续的方法。肥胖导致的健康状况不佳可能会对健康相关生活质量（HR-QOL）产生不利影响。有许多研究报告了减重患者的 HR-QOL，但对用于评估 HR-QOL 的工具的心理测量学特性进行研究的却很少。本综述的主要目的是确定用于评估减重患者 HR-QOL 的工具，并评估其内容效度。我们相信，这是首次对用于减重手术的各种通用和肥胖症特异性 HR-QOL 工具进行深入系统评估，并对其内容效度进行分析。使用同义词搜索 Ovid 数据库（1980-2009 年），同义词包括减重手术和 HR-QOL 工具。共确定了 112 项相关研究，详细介绍了 8 种通用工具、9 种肥胖症特异性工具和许多其他特定疾病的工具的使用情况。提出了一个包含 20 个与减重手术和病态肥胖症相关的领域的概念框架，并用该框架评估了确定的通用和肥胖症特异性工具。评估结果表明，通用工具和肥胖症特异性工具在内容效度方面都不充分。鉴于减重手术这一快速发展领域缺乏充分的 HR-QOL 工具，我们建议根据提出的框架构建一个新的减重特异性工具，这将使临床医生能够评估病态肥胖症和减重手术对 HR-QOL 的全面影响。
