Department of Surgery, Holbaek Hospital, Holbaek, Denmark.
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Dis Colon Rectum. 2019 Mar;62(3):333-342. doi: 10.1097/DCR.0000000000001234.
There are no adequately validated tools to evaluate symptoms or disease-specific health-related quality of life in hemorrhoidal disease.
The purpose of this study was to assess validity, reliability, and responsiveness of a symptom score of patient-reported pain, itching, bleeding, soiling, and prolapse (Hemorrhoidal Disease Symptom Score). In addition, the study set out to assess reliability and responsiveness of an instrument to measure health-related quality of life in patients with hemorrhoids (Short Health ScaleHD), with 1 item in its 4 dimensions: symptom load, functional status, disease-specific worries, and general well-being.
This was a cross-sectional (validity and reliability) and longitudinal (responsiveness) study.
The study was conducted at a single center.
Cohort 1 included 295 patients with hemorrhoids to study validity and 60 patients with test-retest scores to study reliability. Cohort 2 included 128 and 121 patients operated for hemorrhoids to study responsiveness of the Hemorrhoidal Disease Symptom Score and the Short Health ScaleHD.
The study evaluated validity, reliability, and responsiveness. Patient-reported symptom load on a 7-point Likert scale was used as comparator, and receiver operating characteristics curve assessed discriminative validity. Interclass correlation assessed reliability. Receiver operating characteristics curve assessed responsiveness, meaning the ability to discriminate between patients with and without improvement after surgery.
The Hemorrhoidal Disease Symptom Score demonstrated the ability to discriminate between patients reporting high or low symptom load (area under the curve = 0.786 (95% CI, 0.725-0.848)). The Hemorrhoidal Disease Symptom Score and the Short Health ScaleHD demonstrated adequate reliability and responsiveness, with interclass correlation of 0.822 (95% CI, 0.715-0.891) and 0.763 (95% CI, 0.634-0.851) and area under the curve of 0.843 (95% CI, 0.756-0.929) and 0.840 (95% CI, 0.752-0.929).
We had no gold standard comparator to assess validity and responsiveness.
The findings suggest that the Hemorrhoidal Disease Symptom Score is valid, reliable, and responsive and that the Short Health ScaleHD is reliable and responsive. Used together, these tools provide a good overview of symptoms and their impact on patient well-being. See Video Abstract at http://links.lww.com/DCR/A770.
目前尚无充分验证的工具可用于评估痔病患者的症状或特定于疾病的健康相关生活质量。
本研究旨在评估患者报告的疼痛、瘙痒、出血、粪便污染和脱垂症状评分（痔病症状评分）的有效性、可靠性和反应性。此外，本研究旨在评估一种用于测量痔病患者健康相关生活质量的工具（短健康量表 HD）的可靠性和反应性，该工具的 4 个维度中有 1 个项目：症状负担、功能状态、疾病特异性担忧和总体健康状况。
这是一项横断面（有效性和可靠性）和纵向（反应性）研究。
研究在一家单中心进行。
队列 1纳入了 295 例痔病患者，以研究其有效性；纳入了 60 例接受测试-重测评分的患者，以研究其可靠性。队列 2纳入了 128 例和 121 例接受痔病手术的患者，以研究痔病症状评分和短健康量表 HD 的反应性。
本研究评估了有效性、可靠性和反应性。使用 7 分 Likert 量表评估患者报告的症状负担，以作为比较者，采用受试者工作特征曲线评估判别有效性。组内相关系数评估可靠性。受试者工作特征曲线评估反应性，即区分手术后症状改善和未改善患者的能力。
痔病症状评分能够区分报告高或低症状负担的患者（曲线下面积=0.786（95%CI，0.725-0.848））。痔病症状评分和短健康量表 HD 表现出足够的可靠性和反应性，组内相关系数分别为 0.822（95%CI，0.715-0.891）和 0.763（95%CI，0.634-0.851），曲线下面积分别为 0.843（95%CI，0.756-0.929）和 0.840（95%CI，0.752-0.929）。
我们没有金标准比较器来评估有效性和反应性。
研究结果表明，痔病症状评分具有有效性、可靠性和反应性，短健康量表 HD 具有可靠性和反应性。这两种工具一起使用，可很好地全面评估症状及其对患者健康状况的影响。详见视频摘要，网址：http://links.lww.com/DCR/A770。
