Holm Anne, Cordoba Gloria, Siersma Volkert, Brodersen John
Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, PO box 2099, 1014, Copenhagen, Denmark.
Health Qual Life Outcomes. 2017 Mar 24;15(1):57. doi: 10.1186/s12955-017-0629-5.
Urinary tract infection (UTI) is a common condition in primary care. Patient-reported outcome measures (PROMs) are crucial in the evaluation of interventions to improve diagnosis, treatment and prognosis of UTI. The aim of this study was to identify an existing condition-specific PROM to measure symptom severity, bothersomeness and impact on daily activities for adult patients with suspected urinary tract infection in primary care; or, in the absence of such a PROM, to test items identified from existing PROMs for coverage and relevance in single and group interviews and to psychometrically validate the resulting PROM.
The literature was searched for existing PROMs covering the three domains. Items from the identified PROMs were tested in single and group interviews. The resulting symptom diary was psychometrically validated using the partial credit Rasch model for polytomous items in a cohort of 451 women participating in two studies regarding UTI.
No existing PROM fulfilled the inclusion criteria. Content validation resulted in one domain concerning symptom severity (18 items), one concerning bothersomeness (18 items), and one concerning impact on daily activities (7 items). Psychometrical validation resulted in four dimensions in each of the first two domains and one dimension in the third domain.
Domains were not unidimensional, which meant that we identified dimensions of patient-experienced UTI that differed substantially from those previously found. We recommend that future studies on UTI, in which PROMs are to be used, should ensure high content validity of their outcome measures and unidimensionality of the included dimensions.
尿路感染（UTI）是基层医疗中的常见病症。患者报告结局测量（PROMs）对于评估改善尿路感染诊断、治疗和预后的干预措施至关重要。本研究的目的是确定一种现有的特定病症PROM，以测量基层医疗中疑似尿路感染成年患者的症状严重程度、困扰程度以及对日常活动的影响；或者，在没有此类PROM的情况下，测试从现有PROM中识别出的条目在单人访谈和小组访谈中的涵盖范围和相关性，并对所得的PROM进行心理测量学验证。
检索文献以查找涵盖这三个领域的现有PROM。从已识别的PROM中选取的条目在单人访谈和小组访谈中进行测试。使用部分计分Rasch模型对多分类条目的心理测量学验证结果进行分析，该模型应用于451名参与两项关于UTI研究的女性队列。
没有现有的PROM符合纳入标准。内容验证产生了一个关于症状严重程度的领域（18个条目）、一个关于困扰程度的领域（18个条目）和一个关于对日常活动影响的领域（7个条目）。心理测量学验证在前两个领域各产生四个维度，在第三个领域产生一个维度。
各领域并非单维的，这意味着我们识别出的患者经历的UTI维度与先前发现的维度有很大不同。我们建议，未来在使用PROM的UTI研究中，应确保其结局测量具有高内容效度且所纳入维度具有单维性。
