Melbourne Medical School, Western Precinct, University of Melbourne, Melbourne, Victoria, Australia.
Physiotherapy, Western Health, Melbourne, Victoria, Australia.
BMJ Open Respir Res. 2019 Jun 2;6(1):e000398. doi: 10.1136/bmjresp-2018-000398. eCollection 2019.
Patient-reported outcome measures (PROMs) are a vital component of patient-centred care. Community-acquired pneumonia (CAP) is a significant contributor to morbidity, mortality and health service costs globally, but there is a lack of consensus regarding PROMs for this condition.
We searched MEDLINE, EMBASE and Cochrane Collaboration for studies, both interventional and observational, of adult recovery from CAP that applied at least one validated PROM instrument and were published before 31 December 2017. The full text of included studies was examined and data collected on study design, PROM instruments applied, constructs examined and the demographic characteristics of the populations measured. For all CAP-specific PROM instruments identified, content validity was assessed using the COnsensus based Standards for selection of health Measurement INstruments guidelines (COSMIN).
Forty-two articles met the inclusion criteria and applied a total of 17 different PROM instruments including five (30%) classified as CAP specific, six (35%) as generic and six (35%) that measured functional performance or were specific to another disease. The 36-Item Short Form Survey (SF-36) was the most commonly used instrument (15 articles). Only one of 11 (9%) patient cohorts assessed using a CAP-specific instrument had a mean age ≥70 years. The CAP-Sym and CAP-BIQ questionnaires had sufficient content validity, though the quality of evidence for all CAP-specific instruments was rated as very low to low.
PROM instruments used to measure recovery from CAP are inconsistent in constructs measured and have frequently been developed and validated in highly selective patient samples that are not fully representative of the hospitalised CAP population. The overall content validity of all available CAP-specific instruments is unclear, particularly in the context of elderly hospitalised populations. Based on current evidence, generic health instruments are likely to be of greater value for measuring recovery from CAP in this group.
患者报告的结局测量（PROM）是患者为中心的护理的重要组成部分。社区获得性肺炎（CAP）是导致发病率、死亡率和全球卫生服务成本增加的一个重要原因，但对于这种疾病的 PROM 缺乏共识。
我们检索了 MEDLINE、EMBASE 和 Cochrane 协作数据库，以寻找在 2017 年 12 月 31 日之前发表的关于成人 CAP 恢复的研究，这些研究既包括干预性研究，也包括观察性研究，且应用了至少一种经过验证的 PROM 工具。我们对纳入研究的全文进行了检查，并收集了研究设计、应用的 PROM 工具、检查的结构以及所测量人群的人口统计学特征的数据。对于确定的所有 CAP 特异性 PROM 工具，使用基于共识的健康测量仪器选择标准（COSMIN）评估其内容效度。
42 篇文章符合纳入标准，共应用了 17 种不同的 PROM 工具，其中 5 种（30%）为 CAP 特异性，6 种（35%）为通用型，6 种（35%）为功能性表现或针对其他疾病的特异性。36 项简明健康调查量表（SF-36）的应用最为广泛（15 篇文章）。在使用 CAP 特异性工具评估的 11 个患者队列中，只有 1 个（9%）的平均年龄≥70 岁。CAP-Sym 和 CAP-BIQ 问卷具有足够的内容效度，尽管所有 CAP 特异性仪器的证据质量均被评为极低或低。
用于测量 CAP 恢复的 PROM 工具在测量的结构上不一致，并且经常在高度选择性的患者样本中开发和验证，这些样本不能完全代表住院 CAP 人群。所有现有 CAP 特异性工具的总体内容效度尚不清楚，特别是在老年住院人群的背景下。根据现有证据，通用健康工具可能更有助于评估该人群 CAP 的恢复情况。
