Kaambwa Billingsley, Gill Liz, McCaffrey Nicola, Lancsar Emily, Cameron Ian D, Crotty Maria, Gray Len, Ratcliffe Julie
Flinders Health Economics Group, Repatriation General Hospital, Flinders University, A Block, 202-16 Daws Road, Daw Park, SA 5041, Adelaide, Australia.
John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Sydney Medical School Northern, Royal North Shore Hospital, The University of Sydney, St Leonards, NSW 2065, Sydney, Australia.
Health Qual Life Outcomes. 2015 Sep 30;13:164. doi: 10.1186/s12955-015-0357-7.
This study examined the relationships between a newly developed older person-specific non-preference-based quality of life (QoL) instrument (Older People's Quality of Life brief questionnaire (OPQoL-brief)) and two generic preference-based instruments (the EQ-5D-3L Level (EQ-5D-3 L) and the Adult Social Care Outcomes Toolkit (ASCOT) in a community-dwelling population of Australian older people receiving aged care services.
We formulated hypotheses about the convergent validity between the instruments (examined by Wilcoxon-Mann Whitney, Kruskal Wallis and Spearman's correlation tests) and levels of agreement (assessed using intra class correlation (ICC) and modified Bland-Altman plots based on normalized Z EQ-5D-3 L and ASCOT utilities and OPQoL-Brief summary scores).
The utilities/summary scores for 87 participants (aged 65-93 years) were moderately but positively correlated. Moderate convergent validity was evident for a number of instrument dimensions with the strongest relationship (r = 0.57) between 'enjoy life' (OPQoL-Brief) and 'social contact' (ASCOT). The overall ICC was 0.54 and Bland-Altman scatter plots showed 3-6% of normalized Z-scores were outside the 95% limits of agreement suggesting moderate agreement between all three instruments (agreement highest between the OPQoL-Brief and the ASCOT).
Our results suggest that the OPQoL-Brief, the ASCOT and the EQ-5D_3L are suitable for measuring quality of life outcomes in community-dwelling populations of older people. Given the different constructs underpinning these instruments, we recommend that choice of instrument should be guided by the context in which the instruments are being applied. Currently, the OPQoL-Brief is not suitable for use in cost-utility analyses as it is not preference-based. Given their different perspectives, we recommend that both the ASCOT and the EQ-5D are applied simultaneously to capture broader aspects of quality of life and health status within cost-utility analyses within the aged care sector. Future research directed towards the development of a new single preference-based instrument that incorporates both health status and broader aspects of quality of life within quality adjusted life year calculations for older people would be beneficial.
本研究调查了一种新开发的针对老年人的非基于偏好的生活质量（QoL）工具（老年人生活质量简表（OPQoL-brief））与两种通用的基于偏好的工具（EQ-5D-3L量表（EQ-5D-3L）和成人社会护理结果工具包（ASCOT））在接受老年护理服务的澳大利亚社区居住老年人群体中的关系。
我们对这些工具之间的收敛效度（通过Wilcoxon-Mann Whitney检验、Kruskal Wallis检验和Spearman相关性检验进行考察）和一致性水平（使用组内相关系数（ICC）以及基于标准化Z EQ-5D-3L和ASCOT效用值与OPQoL-简表汇总得分的改良Bland-Altman图进行评估）提出假设。
87名参与者（年龄在65 - 93岁之间）的效用值/汇总得分呈中度但正相关。在一些工具维度上存在中度收敛效度，其中“享受生活”（OPQoL-简表）与“社交接触”（ASCOT）之间的关系最强（r = 0.57）。总体ICC为0.54，Bland-Altman散点图显示3 - 6%的标准化Z分数超出了95%的一致性界限，表明这三种工具之间存在中度一致性（OPQoL-简表与ASCOT之间的一致性最高）。
我们的结果表明，OPQoL-简表、ASCOT和EQ-5D_3L适用于测量社区居住老年人群体的生活质量结果。鉴于这些工具所基于的不同结构，我们建议工具的选择应根据其应用背景来指导。目前，OPQoL-简表不适合用于成本效用分析，因为它不是基于偏好的。鉴于它们的不同视角，我们建议在老年护理领域的成本效用分析中同时应用ASCOT和EQ-5D，以涵盖生活质量和健康状况的更广泛方面。未来针对开发一种新的单一基于偏好的工具的研究将是有益的，该工具在老年人的质量调整生命年计算中纳入健康状况和生活质量的更广泛方面。
