Carlton Jill
a School of Health and Related Research, HEDS, ScHARR, University of Sheffield , Sheffield.
Strabismus. 2019 Jun;27(2):66-77. doi: 10.1080/09273972.2019.1601743. Epub 2019 Apr 23.
The Child Amblyopia Treatment Questionnaire (CAT-QoL) was developed using a "bottom-up" methodological approach. Interviews with children with amblyopia identified items (questions) and response levels to be tested in a draft questionnaire consisting of 11 items (sad, feeling on face, hurt, doing schoolwork, cross, how other children treat you, doing things, worried, upset with family, playing with friends, happy). This study describes the refinement of the descriptive system for the CAT-QoL instrument using the application of Rasch analysis. A multi-centre pilot study was conducted, and data collected from 342 participants. Participants were asked to self-complete the appropriate treatment version of the CAT-QoL questionnaire socio-demographic and clinical data were collected by the clinician using a standardised proforma. A "measure" of child's health was obtained from the parent by asking how they would rate their child's health over the previous week. Rasch analysis techniques were applied to refine the questionnaire. Rasch was used to examine response categories and collapse item response levels, identify poorly performing items, and explore local dependency of items. A total of 331 subjects were included in the study sample, however only 315 were accepted into the RUMM program as a number of subjects had missing questions responses on the CAT-QoL. RUMM also excluded a further 41 subjects as these demonstrated extreme responses. Disordered response categories were found for each item, requiring adjacent response levels to be combined. This was applied to all items, and the model fit was re-examined. Two items were found to have poor fit (cross and happy) and were removed from the measure and the model fit was re-examined. No statistically significant differential item functioning (DIF) was found for any item, using person factors of age, sex or general health. Two items showed some dependency (worried and upset with family), and the poorer fitting item was subsequently removed (upset with family). This resulted in a refined CAT-QoL instrument that consists of 8-items, each with three-level response scales. The refined CAT-QoL instrument includes the following items: sad, feeling on face, hurt, doing work at school, how other children treat you, doing things, worried and playing with friends. The CAT-QoL can be Rasch scored, with a range of 0-16 where a greater value indicates a worse quality of life (or greater impact of treatment on the individual). The CAT-QoL may be useful in determining how amblyopia treatment affects children, and offers an alternative to generic patient reported outcome measures.
儿童弱视治疗问卷（CAT-QoL）是采用“自下而上”的方法编制的。对弱视儿童进行访谈，确定了问卷初稿中要测试的项目（问题）和回答水平，该问卷初稿包含11个项目（悲伤、面部感受、疼痛、做功课、生气、其他孩子如何对待你、做事、担心、对家人不满、与朋友玩耍、开心）。本研究描述了通过应用拉施分析对CAT-QoL工具的描述系统进行优化的过程。开展了一项多中心试点研究，收集了342名参与者的数据。要求参与者自行完成CAT-QoL问卷的相应治疗版本，临床医生使用标准化表格收集社会人口学和临床数据。通过询问家长如何对孩子前一周的健康状况进行评分，从家长那里获得孩子健康状况的“衡量指标”。应用拉施分析技术对问卷进行优化。拉施分析用于检查回答类别并合并项目回答水平，识别表现不佳的项目，并探索项目的局部依赖性。研究样本共纳入331名受试者，但由于一些受试者在CAT-QoL问卷上有缺失的问题回答，只有315名被纳入RUMM程序。RUMM还排除了另外41名受试者，因为这些受试者表现出极端回答。发现每个项目的回答类别存在紊乱，需要合并相邻的回答水平。这应用于所有项目，并重新检查模型拟合情况。发现有两个项目拟合不佳（生气和开心），将其从测量中删除并重新检查模型拟合情况。使用年龄、性别或总体健康状况等个体因素，未发现任何项目存在统计学上显著的差异项目功能（DIF）。有两个项目显示出一定的依赖性（担心和对家人不满），随后删除了拟合较差的项目（对家人不满）。这产生了一个经过优化的包含8个项目的CAT-QoL工具，每个项目有三级回答量表。经过优化的CAT-QoL工具包括以下项目：悲伤、面部感受、疼痛、在学校学习、其他孩子如何对待你、做事、担心和与朋友玩耍。CAT-QoL可以进行拉施评分，范围为0至16，分数越高表明生活质量越差（或治疗对个体的影响越大）。CAT-QoL在确定弱视治疗对儿童的影响方面可能有用，并为一般患者报告的结局指标提供了一种替代方法。
