Andersen Kenneth G, Christensen Karl B, Kehlet Henrik, Bidstup Pernille E
Section for Surgical Pathophysiology.
Department of Breast Surgery, Rigshospitalet, University of Copenhagen.
Clin J Pain. 2015 Sep;31(9):794-802. doi: 10.1097/AJP.0000000000000156.
Persistent postsurgical pain, musculoskeletal pain, sensory disturbances, and lymphedema are major clinical problems after treatment for breast cancer. However, there is little evidence on how these sequelae affects physical function. The aim this study was to develop and validate a procedure-specific tool for assessing the impact of pain and other sequelae on physical function after breast cancer treatment.
A literature review, patient and expert interviews were used to identify dimensions of physical function and sequelae. A questionnaire was developed and tested using cognitive interviews, and field tested among 389 patients treated for primary breast cancer without recurrence (response rate 81%). Median follow-up was 14 months. Using item response theory we identified 5 cause scales of reduced physical functioning: pain after surgery, musculoskeletal pain, sensory disturbances, lymphedema, and other causes. Convergent validity was assessed using the Quick-Dsability of Arm, Shoulder, and Hand Scale (Q-DASH).
About half of the patients reported decreased physical function. All 5 scales displayed good fit, unidimensionality, monotonicity, local independence, and lack of differential item functioning. Cronbach coefficient α ranged from 0.88 (other causes) to 0.96 (sensory disturbances) for the 5 scales. For the Q-DASH α was 0.91. Each scale revealed different information on causes of reduced function.
The present scales displayed good psychometric qualities, and may be used to evaluate the impact of specific sequelae after breast cancer treatment on physical functioning, as well as to monitor and target interventions to optimize pain treatment and rehabilitation.
乳腺癌治疗后，术后持续性疼痛、肌肉骨骼疼痛、感觉障碍和淋巴水肿是主要的临床问题。然而，关于这些后遗症如何影响身体功能的证据很少。本研究的目的是开发并验证一种针对特定手术的工具，用于评估疼痛和其他后遗症对乳腺癌治疗后身体功能的影响。
通过文献综述、患者及专家访谈来确定身体功能和后遗症的维度。编制了一份问卷，通过认知访谈进行测试，并在389例接受原发性乳腺癌治疗且无复发的患者中进行实地测试（应答率81%）。中位随访时间为14个月。使用项目反应理论，我们确定了身体功能下降的5个原因量表：术后疼痛、肌肉骨骼疼痛、感觉障碍、淋巴水肿和其他原因。使用手臂、肩部和手部快速残疾量表（Q-DASH）评估收敛效度。
约一半的患者报告身体功能下降。所有5个量表均显示出良好的拟合度、单维度性、单调性、局部独立性和无项目功能差异。这5个量表的克朗巴赫系数α范围为0.88（其他原因）至0.96（感觉障碍）。Q-DASH的α系数为0.91。每个量表都揭示了关于功能下降原因的不同信息。
目前的量表显示出良好的心理测量学质量，可用于评估乳腺癌治疗后特定后遗症对身体功能的影响，以及监测和针对干预措施以优化疼痛治疗和康复。
