印度白内障手术即时护理患者报告结局测量工具的开发。
Development of a rapid point-of-care patient reported outcome measure for cataract surgery in India.
机构信息
Department of Ophthalmology and Visual Sciences, University of Michigan, 1000 Wall Street, Ann Arbor, MI, 48103, USA.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA.
出版信息
Health Qual Life Outcomes. 2018 Jan 30;16(1):25. doi: 10.1186/s12955-018-0855-5.
BACKGROUND
For patient undergoing cataract surgery in India, existing patient-reported outcome (PRO) measures are either not culturally relevant, have not been adequately validated, or are too long to be used in a busy clinical setting. We sought to develop and validate a brief and culturally relevant point-of-care PRO measure to address this need.
METHODS
Twelve items from the Indian Visual Functioning Questionnaire (IND-VFQ) were selected based on preliminary data. Patients 18 years and older were prospectively recruited at Aravind Eye Care System in Madurai, India. Clinical and sociodemographic data were collected and the 12-item short-form IND-VFQ (SF-IND-VFQ) was administered pre- and post-operatively to 225 patients; Factor analysis and Rasch modeling was performed to assess its psychometric properties.
RESULTS
One item that did not fit a unidimensional scale and had poor fit with the Rasch model was eliminated from the questionnaire. The remaining 11 items represented a single construct (no residual correlations> 0.1) and were largely unaffected by differential item functioning. Five items had disordered thresholds resolved by collapsing the response scale from four to three categories. The survey had adequate reliability (0.80) and good construct (infit range, 0.77-1.29; outfit range, 0.56-1.30) and content (item separation index, 5.87 logits) validity. Measurement precision was fair (person separation index, 1.97). There was evidence that items were not optimally targeted to patients' visual ability (preoperatively, - 1.92 logits; overall, - 3.41 logits), though the survey measured a very large effect (Cohen's d 1.80). In a subset of patients, the average time to complete the questionnaire was 2 min 6.3 s.
CONCLUSIONS
The SF-IND-VFQ is a valid, reliable, sensitive, and rapidly administered point-of-care PRO measure to assess changes in visual functioning in patients undergoing cataract surgery in India.
背景
对于在印度接受白内障手术的患者，现有的患者报告结局（PRO）测量方法要么与文化无关，要么没有经过充分验证，要么太长而无法在繁忙的临床环境中使用。我们试图开发和验证一种简洁且具有文化相关性的即时 PRO 测量方法来满足这一需求。
方法
根据初步数据，从印度视觉功能问卷（IND-VFQ）中选择了 12 个项目。在印度马杜赖的 Aravind 眼科护理系统前瞻性招募了 18 岁及以上的患者。收集临床和社会人口统计学数据，并在术前和术后对 225 名患者进行 12 项简短印度视觉功能问卷（SF-IND-VFQ）评估；进行因子分析和 Rasch 建模以评估其心理测量特性。
结果
一个不符合单维尺度且与 Rasch 模型拟合不良的项目从问卷中删除。问卷剩下的 11 个项目代表一个单一的结构（没有剩余的相关性>0.1），并且受差异项目功能的影响不大。五个项目的阈值混乱，通过将响应量表从四到三类别合并来解决。该调查具有足够的可靠性（0.80）和良好的结构（infit 范围，0.77-1.29；outfit 范围，0.56-1.30）和内容（项目分离指数，5.87 对数）有效性。测量精度为中等（人员分离指数，1.97）。有证据表明，项目并没有针对患者的视觉能力进行最佳定位（术前，-1.92 对数；总体，-3.41 对数），尽管该调查测量了非常大的效果（Cohen's d 1.80）。在患者的一个子集中，完成问卷的平均时间为 2 分 6.3 秒。
结论
SF-IND-VFQ 是一种有效、可靠、敏感且快速的即时 PRO 测量方法，可用于评估在印度接受白内障手术的患者的视觉功能变化。
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