Division of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China.
J Clin Rheumatol. 2011 Aug;17(5):242-8. doi: 10.1097/RHU.0b013e318228b4e2.
The objective of the study was to develop and test a survey of gout patients regarding their level of disease-related knowledge, to identify potential targets for patient education.
A 10-item questionnaire with readability at a Flesch-Kincaid grade level of 4.6 and Flesch reading ease of 83.9% was designed to address parameters considered important for patient participation in the management of gout. The questionnaire was primarily evaluated at the Veterans Affairs (VA) Medical Center in Philadelphia, but was also secondarily performed at 2 Chinese hospitals, the Sun Yat-sen Memorial Hospital of Zhong Shan University, Guangdong Province (GZ), and the Qingdao Municipal Hospital, Qingdao City, Shandong Province (QD). Demographic and questionnaire data by institution were evaluated using descriptive statistics, and significant differences were identified by χ and Fisher exact tests. Patient responses were displayed by each individual question and by the distribution of total scores. Kruskal-Wallis tests of significance were used for nonparametric or skewed data. Intraclass correlations (ICCs) were performed within the VA population to determine internal consistency of the individual questions. A high score was defined as greater than 7 (the median value). Multivariate regression models using demographic and clinical characteristics attempted to identify factors associated with correct answers to each question.
Total correct score for individual patients varied widely at each institution with a mean (SD) and median (interquartile range [IQR]) scores in all 3 hospitals of 6.15 (2.25) and 7 (5-8), respectively. The average numbers of correct responses for each institution were 4.38 (SD, 3.04) (median, 4 [IQR, 2-7]) at GZ; 7.05 (SD, 1.37) (median, 8 [IQR, 6-8]) at QD; 6.21 (SD, 1.74) (median, 7 [IQR, 6-7]) at VA; P = 0.0010. Two questions (Q4 and Q10) were identified as difficult to understand by patients and showed poor ICC (ICC = 0.0000, P > 0.5) at the VA. Questions that were more difficult to answer were (1) Q3: What inside the joint causes attacks of gout? (GZ, 28.6%; QD, 7.7%; VA, 72.4%; P = 0.000); (2) Q8: How long should patients continue with serum uric acid-lowering drugs? (GZ, 19.1%; QD, 10.3%; VA, 82.7%; P = 0.000); (3) Q6: The ideal serum uric acid to aim at during treatment? (GZ, 42.8%; QD, 89.7%; and VA, 17.2%; P = 0.000); and (4) Q5: Which drugs can lower serum uric acid? (GZ, 61.9%; QD, 89.7%; VA, 51.7%; P = 0.002).
This study describes an easy-to-read 10-item questionnaire that can identify important knowledge gaps in patients with gout. This can be the first step in designing educational interventions to improve patient understanding and improve clinical care.
本研究旨在开发并测试一份痛风患者疾病相关知识水平的调查问卷，以确定患者教育的潜在目标。
设计了一份 10 项问题的问卷，其 Flesch-Kincaid 分级阅读水平为 4.6，Flesch 阅读舒适度为 83.9%，旨在解决参与痛风管理的患者认为重要的参数。该问卷主要在费城退伍军人事务部（VA）医疗中心进行评估，但也在中山大学孙逸仙纪念医院（GZ）和青岛市立医院（QD）这两家中国医院进行了二次评估。采用描述性统计方法对各机构的人口统计学和问卷数据进行评估，并通过卡方和 Fisher 精确检验确定显著差异。通过每个问题的个体回答和总分的分布来显示患者的回答。对于非参数或偏态数据，使用 Kruskal-Wallis 检验进行显著性检验。在 VA 人群中进行组内相关系数（ICC）分析，以确定个体问题的内部一致性。高分为大于 7（中位数）。使用人口统计学和临床特征的多元回归模型，尝试确定与每个问题正确答案相关的因素。
每位患者的总分在每个机构差异很大，在所有 3 家医院的平均（标准差）和中位数（四分位距[IQR]）分别为 6.15（2.25）和 7（5-8）。每个机构的平均正确回答数分别为：GZ 为 4.38（标准差，3.04）（中位数，4 [IQR，2-7]）；QD 为 7.05（标准差，1.37）（中位数，8 [IQR，6-8]）；VA 为 6.21（标准差，1.74）（中位数，7 [IQR，6-7]）；P=0.0010。有两个问题（Q4 和 Q10）被患者认为难以理解，在 VA 中的 ICC 较差（ICC=0.0000，P>0.5）。较难回答的问题是：（1）Q3：关节内引起痛风发作的原因是什么？（GZ，28.6%；QD，7.7%；VA，72.4%；P=0.000）；（2）Q8：患者应继续使用降血尿酸药物多长时间？（GZ，19.1%；QD，10.3%；VA，82.7%；P=0.000）；（3）Q6：治疗期间理想的血清尿酸目标值是多少？（GZ，42.8%；QD，89.7%；VA，17.2%；P=0.000）；和（4）Q5：哪些药物可以降低血清尿酸？（GZ，61.9%；QD，89.7%；VA，51.7%；P=0.002）。
本研究描述了一种易于阅读的 10 项问题问卷，可识别痛风患者的重要知识空白。这可以是设计教育干预措施以提高患者理解能力和改善临床护理的第一步。
