Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
J Trauma Acute Care Surg. 2012 Apr;72(4):1102-5. doi: 10.1097/TA.0b013e3182464503.
Health-related quality of life represents a patient's experiences and expectations and should be collected from the patient. In trauma, collection of information from the patient can be challenging, particularly for subgroups where cognitive impairment is prevalent, increasing reliance on proxy reporting. This study assessed the agreement between patient and proxy reporting of health-related quality of life 12 months after injury.
The Victorian State Trauma Registry and Victorian Orthopaedic Trauma Outcomes Registry collect EQ-5D data at 12 months after injury. Cases where data were collected from the patient and proxy were extracted. Agreement between patient and proxy responses was compared using kappa (K) coefficients for the individual EQ-5D items, and Bland-Altman plots and Wilcoxon signed-rank tests for the EQ-5D summary score and visual analog scale (VAS).
Agreement between patient and proxy respondents was substantial for the mobility (K = 0.61) and personal care items (K = 0.67) and moderate for the usual activities (K = 0.50), pain/discomfort (K = 0.42), and anxiety/depression items (K = 0.47). The mean difference between proxy and patient-reported scores for the VAS (0.74, 95% confidence interval: -2.73, 4.21) and the EQ-5D summary score (-0.02, 95% confidence interval: -0.07, 0.03) was small, but the limits of agreement were wide (-34.22 to 35.71 for VAS and -0.55 to 0.51 for summary score), suggesting no systematic bias.
Although proxy and patient responses for the EQ-5D VAS may differ, the differences show random variability rather than systematic bias. Group comparisons using proxy responses are unlikely to be biased, but proxy responses should be used with caution when assessing individual patient recovery.
健康相关生活质量代表了患者的体验和期望，应从患者处收集。在创伤中，从患者处收集信息可能具有挑战性，特别是在认知障碍普遍存在的亚组中，这增加了对代理报告的依赖。本研究评估了损伤后 12 个月患者和代理报告健康相关生活质量的一致性。
维多利亚州创伤登记处和维多利亚州骨科创伤结局登记处在损伤后 12 个月收集 EQ-5D 数据。提取了从患者和代理处收集数据的病例。使用 Kappa（K）系数比较个体 EQ-5D 项目中患者和代理的反应，使用 Bland-Altman 图和 Wilcoxon 符号秩检验比较 EQ-5D 总分和视觉模拟量表（VAS）的反应。
患者和代理受访者在移动性（K=0.61）和个人护理项目（K=0.67）方面的一致性较高，在日常活动（K=0.50）、疼痛/不适（K=0.42）和焦虑/抑郁项目（K=0.47）方面的一致性中等。VAS（0.74，95%置信区间：-2.73，4.21）和 EQ-5D 总分（-0.02，95%置信区间：-0.07，0.03）代理和患者报告得分之间的平均差异较小，但一致性范围较宽（VAS 为-34.22 至 35.71，总分范围为-0.55 至 0.51），表明没有系统偏差。
尽管 EQ-5D VAS 的代理和患者反应可能有所不同，但差异表现出随机变异性而非系统偏差。使用代理反应进行的组间比较不太可能存在偏差，但在评估个体患者康复情况时，应谨慎使用代理反应。
