Barnett Carolina, Bril Vera, Kapral Moira, Kulkarni Abhaya, Davis Aileen M
From the Division of Neurology (C.B., V.B.), Department of Medicine, University of Toronto and University Health Network; Institute of Health Policy, Management and Evaluation (C.B., M.K., A.K., A.M.D.), University of Toronto; Department of Medicine (M.K.), University of Toronto and University Health Network; Department of Neurosurgery (A.K.), Sick Kids Hospital, Toronto; Division of Health Care and Outcomes Research (A.M.D.), Krembil Institute, University Health Network, Toronto; and Department of Physical Therapy and Graduate Department of Rehabilitation Science (A.M.D.), University of Toronto, Canada.
Neurology. 2016 Aug 30;87(9):879-86. doi: 10.1212/WNL.0000000000002971. Epub 2016 Jul 8.
We aimed to develop a measure of myasthenia gravis impairment using a previously developed framework and to evaluate reliability and validity, specifically face, content, and construct validity.
The first draft of the Myasthenia Gravis Impairment Index (MGII) included examination items from available measures enriched with newly developed, patient-reported items, modified after patient input. International neuromuscular specialists evaluated face and content validity via an e-mail survey. Test-retest reliability was assessed in stable patients at a 3-week interval and interrater reliability was evaluated in the same day. Construct validity was assessed through correlations between the MGII and other measures and by comparing scores in different patient groups.
The first draft was assessed by 18 patients, and 72 specialists answered the survey. The second draft had 7 examination and 22 patient-reported items. Field testing included 200 patients, with 54 patients completing the reliability studies. Test-retest reliability of the total score was good (intraclass correlation coefficient 0.92; 95% confidence interval 0.79-0.94), as was interrater reliability of the examination component (intraclass correlation coefficient 0.81; 95% confidence interval 0.79-0.94). The MGII correlated well with comparison measures, with higher correlations with the MG-activities of daily living (r = 0.91) and MG-specific quality of life 15-item scale (r = 0.78). When assessing different patient groups, the scores followed expected patterns.
The MGII was developed using a patient-centered framework of myasthenia-related impairments and incorporating patient input throughout the development process. It is reliable in an outpatient setting and has demonstrated construct validity. Responsiveness studies are under way.
我们旨在使用先前开发的框架制定一项重症肌无力损伤测量指标，并评估其信度和效度，特别是表面效度、内容效度和结构效度。
重症肌无力损伤指数（MGII）的初稿包括现有测量指标中的检查项目，并新增了患者报告项目，这些项目在纳入患者反馈后进行了修改。国际神经肌肉专家通过电子邮件调查评估表面效度和内容效度。在病情稳定的患者中，以3周为间隔评估重测信度，并在同一天评估评分者间信度。通过MGII与其他测量指标之间的相关性以及比较不同患者组的得分来评估结构效度。
18名患者对初稿进行了评估，72名专家回复了调查。第二稿有7项检查项目和22项患者报告项目。现场测试纳入了200名患者，其中54名患者完成了信度研究。总分的重测信度良好（组内相关系数0.92；95%置信区间0.79 - 0.94），检查部分的评分者间信度也良好（组内相关系数0.81；95%置信区间0.79 - 0.94）。MGII与比较测量指标相关性良好，与重症肌无力日常生活活动（r = 0.91）和重症肌无力特异性生活质量15项量表（r = 0.78）的相关性更高。在评估不同患者组时，得分符合预期模式。
MGII是使用以患者为中心的重症肌无力相关损伤框架开发的，并在整个开发过程中纳入了患者反馈。它在门诊环境中具有可靠性，并已证明具有结构效度。正在进行反应度研究。
