修订创伤特定生活质量量表的编制与验证。
Development and validation of a revised trauma-specific quality of life instrument.
机构信息
From the Center for Surgery and Public Health, Brigham and Women's Hospital (J.P.H.-E., S.S.A.R., A.T., A.H.H.), Harvard Medical School and Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Surgery (T.D.-C.), Medical College of Wisconsin, Milwaukee, Milwaukee; Division of Trauma, Critical Care and Acute Care Surgery (K.B.), Department of Surgery, Oregon Health and Science University, Portland, Oregon; Division of Trauma, Burn and Surgical Critical Care (D.N., A.S.), Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Division of Trauma and Critical Care Surgery (G.K.), Department of Surgery, Duke University School of Medicine, Durham, North Carolina; and Division of Trauma, Emergency Surgery, and Surgical Critical Care (G.V.), Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
出版信息
J Trauma Acute Care Surg. 2020 Apr;88(4):501-507. doi: 10.1097/TA.0000000000002505.
BACKGROUND
The National Academies of Science has called for routine collection of long-term outcomes after injury. One of the main barriers for this is the lack of practical trauma-specific tools to collect such outcomes. The only trauma-specific long-term outcomes measure that applies a biopsychosocial view of patient care, the Trauma Quality-of-Life (T-QoL), has not been adopted because of its length, lack of composite scores, and unknown validity. Our objective was to develop a shorter version of the T-QoL measure that is reliable, valid, specific, and generalizable to all trauma populations.
METHODS
We used two random samples selected from a prospective registry developed to follow long-term outcomes of adult trauma survivors (Injury Severity Score ≥9) admitted to three level I trauma centers. First, we validated the original T-QoL instrument using the 12-Item Short-Form Health Survey (SF-12) version 2.0 and Breslau post-traumatic stress disorder screening (B-PTSD) tools. Second, we conducted a confirmatory factor analysis to reduce the length of the original T-QoL instrument, and using a different sample, we scored and performed internal consistency and validity assessments of the revised T-QoL (RT-QoL) components.
RESULTS
All components of the original T-QoL were significantly correlated negatively with the B-PTSD and positively with the SF-12 mental and physical composite scores. After confirmatory factor analysis, a three-component structure using 18 items (six items/component) most appropriately represented the data. Each component in the revised instrument demonstrated a high level of internal consistency (Cronbach's α ≥0.8) and correlated negatively with the B-PTSD and positively with the SF-12, demonstrating concurrent validity. In addition, each of the RT-QoL components was able to distinguish between individuals based on their work status, with those who have returned to work reporting better health.
CONCLUSION
This more practical RT-QoL measure greatly increases the ability to evaluate long-term outcomes in trauma more efficiently and meaningfully, without sacrificing the validity and psychometric properties of the original instrument.
LEVEL OF EVIDENCE
Prognostic and epidemiological, level III.
背景
美国国家科学院呼吁常规收集损伤后的长期结果。主要障碍之一是缺乏实用的创伤专用工具来收集此类结果。唯一适用于患者护理的生物心理社会观点的创伤专用长期结果测量工具——创伤生活质量量表（T-QoL），由于其长度、缺乏综合评分和未知的有效性而未被采用。我们的目标是开发一种更短的 T-QoL 测量工具，该工具具有可靠性、有效性、特异性，并可推广到所有创伤人群。
方法
我们使用从一个前瞻性登记处中随机抽取的两个样本，该登记处旨在跟踪三个 I 级创伤中心收治的成年创伤幸存者（损伤严重程度评分≥9）的长期结果。首先，我们使用 12 项简短健康调查（SF-12）版本 2.0 和布雷斯劳创伤后应激障碍筛查（B-PTSD）工具验证了原始 T-QoL 工具。其次，我们进行了验证性因子分析以缩短原始 T-QoL 工具的长度，并使用不同的样本对修订后的 T-QoL（RT-QoL）成分进行评分和进行内部一致性和有效性评估。
结果
原始 T-QoL 的所有成分与 B-PTSD 呈显著负相关，与 SF-12 心理和身体综合评分呈显著正相关。在验证性因子分析后，使用 18 个项目（每个项目 6 个）的三成分结构最能代表数据。修订后的工具中每个组成部分的内部一致性水平都很高（Cronbach's α≥0.8），与 B-PTSD 呈负相关，与 SF-12 呈正相关，表明具有同时有效性。此外，RT-QoL 的每个组成部分都能够根据个体的工作状态来区分，那些已经返回工作的人报告了更好的健康状况。
结论
这种更实用的 RT-QoL 测量方法极大地提高了更有效地、更有意义地评估创伤长期结果的能力，同时又不牺牲原始工具的有效性和心理测量特性。
证据水平
预后和流行病学，III 级。
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