Department of Outpatient, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Xiangya School of Nursing, Central South University, Changsha, Hunan, China.
Sci Rep. 2018 Jan 17;8(1):962. doi: 10.1038/s41598-018-19268-3.
The study aims to develop and assess and validate a brief diabetic foot ulceration risk checklist among diabetic patients through a longitudinal study. Patients who had diabetes mellitus and had no foot ulceration and severe systematic disorders were recruited from eleven tertiary hospitals in nine provinces or municipalities of China. Internal consistency reliability, construct validity, concurrent validity, item property, and measurement invariance of the tool were assessed. The predictive capability of the tool was validated by the follow-up data using the receiver operating characteristic curve. At baseline, 477 valid cases were collected. Twelve items were remained after initial selection. Cronbach's alpha was 0.56. Confirmatory factor analysis showed that the model had acceptable goodness-of-fit yet local dependency between two items. Item response theory showed that most items had acceptable discrimination and difficulty parameters. Differential item functioning showed that tool had measurement invariance. 278 were followed up one year after the baseline. Follow-up showed that one-year incidence of ulceration among the patients was 3.6%, and the area under the receiver operating characteristic curve was 0.77 (95% confidence interval: 0.61-0.93). The cut-off point of the tool was 4, when sensitivity and specificity were 0.62 and 0.75 respectively. The checklist has good psychometric properties according to mixed evidences from classical and modern test theory, and has good predictive capability.
本研究旨在通过纵向研究开发并评估和验证一种用于糖尿病患者的简短糖尿病足溃疡风险清单。我们从中国九个省或直辖市的十一家三级医院招募了患有糖尿病且无足部溃疡和严重系统性疾病的患者。评估了工具的内部一致性信度、结构效度、同时效度、项目属性和测量不变性。使用接收器工作特征曲线通过随访数据验证了工具的预测能力。在基线时，共收集了 477 例有效病例。经过初步选择，保留了 12 个项目。克朗巴赫 α 系数为 0.56。验证性因子分析表明，该模型具有可接受的拟合优度，但两个项目之间存在局部依赖性。项目反应理论表明，大多数项目具有可接受的区分度和难度参数。差异项目功能显示工具具有测量不变性。在基线后一年对 278 例患者进行了随访。随访结果显示，患者的溃疡年发生率为 3.6%，接收器工作特征曲线下面积为 0.77（95%置信区间：0.61-0.93）。当工具的截断值为 4 时，敏感性和特异性分别为 0.62 和 0.75。根据经典和现代测试理论的混合证据，该清单具有良好的心理测量特性，具有良好的预测能力。
