Lee Minji K, Yost Kathleen J, McDonald Jennifer S, Dougherty Ryne W, Vine Roanna L, Kallmes David F
Division of Health Care Policy and Management, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, 200 First St SW, Rochester MN 55905, USA.
Department of Health Sciences Research, Mayo Clinic, 200 First St SW, Rochester MN 55905, USA.
Spine J. 2017 Jun;17(6):821-829. doi: 10.1016/j.spinee.2017.01.002. Epub 2017 Jan 10.
The majority of validation done on the Roland-Morris Disability Questionnaire (RMDQ) has been in patients with mild or moderate disability. There is paucity of research focusing on the psychometric quality of the RMDQ in patients with severe disability.
To evaluate the psychometric quality of the RMDQ in patients with severe disability.
STUDY DESIGN/SETTING: Observational clinical study.
The sample consisted of 214 patients with painful vertebral compression fractures who underwent vertebroplasty or kyphoplasty.
The 23-item version of the RMDQ was completed at two time points: baseline and 30-day postintervention follow-up.
With the two-parameter logistic unidimensional item response theory (IRT) analyses, we derived the range of scores that produced reliable measurement and investigated the minimal clinically important difference (MCID).
Scores for 214 (100%) patients at baseline and 108 (50%) patients at follow-up did not meet the reliability criterion of 0.90 or higher, with the majority of patients having disability due to back pain that was too severe to be reliably measured by the RMDQ. Depending on methodology, MCID estimates ranged from 2 to 8 points and the proportion of patients classified as having experienced meaningful improvement ranged from 26% to 68%. A greater change in score was needed at the extreme ends of the score scale to be classified as having achieved MCID using IRT methods.
Replacing items measuring moderate disability with items measuring severe disability could yield a version of the RMDQ that better targets patients with severe disability due to back pain. Improved precision in measuring disability would be valuable to clinicians who treat patients with greater functional impairments. Caution is needed when choosing criteria for interpreting meaningful change using the RMDQ.
对罗兰-莫里斯残疾问卷（RMDQ）进行的大多数验证研究针对的是轻度或中度残疾患者。针对严重残疾患者中RMDQ心理测量质量的研究较少。
评估严重残疾患者中RMDQ的心理测量质量。
研究设计/地点：观察性临床研究。
样本包括214例因疼痛性椎体压缩骨折接受椎体成形术或后凸成形术的患者。
在两个时间点完成23项版本的RMDQ：基线和干预后30天随访。
通过双参数逻辑单维项目反应理论（IRT）分析，我们得出了产生可靠测量的分数范围，并研究了最小临床重要差异（MCID）。
214例（100%）患者的基线分数和108例（50%）患者的随访分数未达到0.90或更高的可靠性标准，大多数患者因背痛导致残疾严重，RMDQ无法可靠测量。根据方法不同，MCID估计值在2至8分之间，被归类为有意义改善的患者比例在26%至68%之间。使用IRT方法时，在分数量表的极端两端需要更大的分数变化才能被归类为达到MCID。
用测量严重残疾的项目取代测量中度残疾的项目，可能会产生一个更适合因背痛导致严重残疾患者的RMDQ版本。提高残疾测量的精度对治疗功能障碍更严重患者的临床医生有价值。在选择使用RMDQ解释有意义变化的标准时需要谨慎。
