用于手术和创伤性疤痕的患者报告结局工具：对其开发、内容和心理测量学验证的系统评价
Patient-Reported Outcome Instruments for Surgical and Traumatic Scars: A Systematic Review of their Development, Content, and Psychometric Validation.
作者信息
Mundy Lily R, Miller H Catherine, Klassen Anne F, Cano Stefan J, Pusic Andrea L
机构信息
College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY, USA.
School of Medicine, University of Washington, 4333 Brooklyn Avenue Northeast, Seattle, WA, USA.
出版信息
Aesthetic Plast Surg. 2016 Oct;40(5):792-800. doi: 10.1007/s00266-016-0642-9. Epub 2016 Jun 29.
BACKGROUND
Patient-reported outcomes (PROs) are of growing importance in research and clinical care and may be used as primary outcomes or as compliments to traditional surgical outcomes. In assessing the impact of surgical and traumatic scars, PROs are often the most meaningful. To assess outcomes from the patient perspective, rigorously developed and validated PRO instruments are essential.
METHODS
The authors conducted a systematic literature review to identify PRO instruments developed and/or validated for patients with surgical and/or non-burn traumatic scars. Identified instruments were assessed for content, development process, and validation under recommended guidelines for PRO instrument development.
RESULTS
The systematic review identified 6534 articles. After review, we identified four PRO instruments meeting inclusion criteria: patient and observer scar assessment scale (POSAS), bock quality of life questionnaire for patients with keloid and hypertrophic scarring (Bock), patient scar assessment questionnaire (PSAQ), and patient-reported impact of scars measure (PRISM). Common concepts measured were symptoms and psychosocial well-being. Only PSAQ had a dedicated appearance domain. Qualitative data were used to inform content for the PSAQ and PRISM, and a modern psychometric approach (Rasch Measurement Theory) was used to develop PRISM and to test POSAS. Overall, PRISM demonstrated the most rigorous design and validation process, however, was limited by the lack of a dedicated appearance domain.
CONCLUSIONS
PRO instruments to evaluate outcomes in scars exist but vary in terms of concepts measured and psychometric soundness. This review discusses the strengths and weaknesses of existing instruments, highlighting the need for future scar-focused PRO instrument development.
LEVEL OF EVIDENCE IV
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .
背景
患者报告结局（PROs）在研究和临床护理中的重要性日益增加，可作为主要结局或作为传统手术结局的补充。在评估手术和创伤性瘢痕的影响时，PROs往往最具意义。为了从患者角度评估结局，严格开发和验证的PRO工具至关重要。
方法
作者进行了一项系统的文献综述，以确定为手术和/或非烧伤性创伤瘢痕患者开发和/或验证的PRO工具。根据PRO工具开发的推荐指南，对确定的工具进行内容、开发过程和验证评估。
结果
系统综述共识别出6534篇文章。经过筛选，我们确定了四项符合纳入标准的PRO工具：患者和观察者瘢痕评估量表（POSAS）、瘢痕疙瘩和增生性瘢痕患者生活质量问卷（Bock）、患者瘢痕评估问卷（PSAQ）以及患者报告的瘢痕影响测量量表（PRISM）。所测量的共同概念包括症状和心理社会幸福感。只有PSAQ有一个专门的外观领域。定性数据用于为PSAQ和PRISM提供内容信息，并且采用现代心理测量方法（拉施测量理论）来开发PRISM并测试POSAS。总体而言，PRISM展示了最严谨的设计和验证过程，然而，它因缺乏专门的外观领域而受到限制。
结论
存在用于评估瘢痕结局的PRO工具，但在测量概念和心理测量稳健性方面存在差异。本综述讨论了现有工具的优缺点，强调了未来专注于瘢痕的PRO工具开发的必要性。
证据水平IV：本刊要求作者为每篇文章指定证据水平。有关这些循证医学评级的完整描述，请参阅目录或在线作者指南www.springer.com/00266 。
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