Handscomb L, Hall D A, Hoare D J, Shorter G W
National Institute for Health Research Nottingham Hearing Biomedical Research Unit, Otology and Hearing Group, Division of Clinical Neuroscience, University of Nottigham, 113 The Ropewalk, Nottingham, NG1 5DU, UK.
UCL Ear Institute, 332 Gray's Inn Road, London, WC1X 8EE, UK.
Health Qual Life Outcomes. 2016 Sep 6;14(1):124. doi: 10.1186/s12955-016-0524-5.
People with troublesome tinnitus often experience emotional distress. Therefore a psychometrically sound instrument which can evaluate levels of distress and change over time is necessary to understand this experience. Clinical Outcomes in Routine Evaluation (CORE-OM) is a measure of emotional distress which has been widely used in mental health research. Although originally designed as a 4-factor questionnaire, factor analyses have not supported this structure and a number of alternative factor structures have been proposed in different samples. The aims of this study were to test the factor structure of the CORE-OM using a large representative tinnitus sample and to use it to investigate levels of emotional distress amongst people with a range of tinnitus experience.
The CORE-OM was completed by 342 people experiencing tinnitus who self-rated their tinnitus on a 5-point scale from 'not a problem' to 'a very big problem'. Confirmatory factor analysis was used to test all ten factor models which have been previously derived across a range of population samples. Model fit was assessed using fit criterion and theoretical considerations. Mean scores on the full questionnaire and its subscales were compared between tinnitus problem categories using one-way ANOVA.
The best fitting model included 33 of the 34 original items and was divided into three factors: negatively worded items, positively worded items and risk. The full questionnaire and each factor were found to have good internal consistency and factor loadings were high. There was a statistically significant difference in total CORE-OM scores across the five tinnitus problem categories. However there was no significant difference between those who rated their tinnitus 'not a problem', and 'a small problem' or 'a moderate problem.'
This study found a 3-factor structure for the CORE-OM to be a good fit for a tinnitus population. It also found evidence of a relationship between emotional distress as measured by CORE-OM and perception of tinnitus as a problem. Its use in tinnitus clinics is to be recommended, particularly when emotional distress is a target of therapy.
患有令人困扰的耳鸣的人常常会经历情绪困扰。因此，需要一种心理测量上可靠的工具来评估困扰程度及其随时间的变化，以便理解这种体验。常规评估中的临床结果（CORE-OM）是一种情绪困扰测量工具，已在心理健康研究中广泛使用。尽管它最初设计为一个4因素问卷，但因素分析并不支持这种结构，并且在不同样本中提出了许多替代因素结构。本研究的目的是使用一个具有代表性的大型耳鸣样本测试CORE-OM的因素结构，并使用它来调查不同耳鸣经历人群的情绪困扰水平。
342名耳鸣患者完成了CORE-OM问卷，他们根据从“不是问题”到“非常大的问题”的5级量表对自己的耳鸣进行自评。使用验证性因素分析来测试先前在一系列人群样本中得出的所有10种因素模型。使用拟合标准和理论考量来评估模型拟合度。使用单因素方差分析比较耳鸣问题类别之间完整问卷及其子量表的平均得分。
最佳拟合模型包括34个原始项目中的33个，分为三个因素：负面措辞项目、正面措辞项目和风险。发现完整问卷及其每个因素都具有良好的内部一致性，因素负荷较高。在五个耳鸣问题类别中，CORE-OM总分存在统计学上的显著差异。然而，将耳鸣评为“不是问题”的人与评为“小问题”或“中等问题”的人之间没有显著差异。
本研究发现CORE-OM的3因素结构非常适合耳鸣人群。它还发现了CORE-OM测量的情绪困扰与将耳鸣视为问题的认知之间存在关联的证据。建议在耳鸣诊所使用该工具，特别是当情绪困扰是治疗目标时。
