Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore.
BMJ Open. 2021 May 5;11(5):e041219. doi: 10.1136/bmjopen-2020-041219.
There are multiple instruments for measuring multimorbidity. The main objective of this systematic review was to provide a list of instruments that are suitable for use in studies aiming to measure the association of a specific outcome with different levels of multimorbidity as the main independent variable in community-dwelling individuals. The secondary objective was to provide details of the requirements, strengths and limitations of these instruments, and the chosen outcomes.
We conducted the review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO registration number: CRD42018105297). We searched MEDLINE, Embase and CINAHL electronic databases published in English and manually searched the between 1 January 2010 and 23 October 2020 inclusive. Studies also had to select adult patients from primary care or general population and had at least one specified outcome variable. Two authors screened the titles, abstracts and full texts independently. Disagreements were resolved with a third author. The modified Newcastle-Ottawa Scale was used for quality assessment.
Ninety-six studies were identified, with 69 of them rated to have a low risk of bias. In total, 33 unique instruments were described. Disease Count and weighted indices like Charlson Comorbidity Index were commonly used. Other approaches included pharmaceutical-based instruments. Disease Count was the common instrument used for measuring all three essential core outcomes of multimorbidity research: mortality, mental health and quality of life. There was a rise in the development of novel weighted indices by using prognostic models. The data obtained for measuring multimorbidity were from sources including medical records, patient self-reports and large administrative databases.
We listed the details of 33 instruments for measuring the level of multimorbidity as a resource for investigators interested in the measurement of multimorbidity for its association with or prediction of a specific outcome.
有多种用于测量多种合并症的工具。本系统评价的主要目的是提供一份适合用于研究的工具列表，这些研究旨在以社区居住个体为主要独立变量，测量特定结局与多种合并症不同水平之间的关联。次要目的是详细说明这些工具的要求、优势和局限性，以及所选结局。
我们根据系统评价和荟萃分析的首选报告项目（PROSPERO 注册号：CRD42018105297）进行了综述。我们在 MEDLINE、Embase 和 CINAHL 电子数据库中搜索了 2010 年 1 月 1 日至 2020 年 10 月 23 日之间发表的英文文献，并手动搜索了。研究还必须选择来自初级保健或一般人群的成年患者，并且至少有一个指定的结局变量。两名作者独立筛选标题、摘要和全文。意见分歧由第三名作者解决。使用改良的纽卡斯尔-渥太华量表进行质量评估。
确定了 96 项研究，其中 69 项研究的偏倚风险较低。总共描述了 33 种独特的工具。疾病计数和加权指数（如 Charlson 合并症指数）通常被使用。其他方法包括基于药物的工具。疾病计数是用于测量多种合并症研究的三个基本核心结局（死亡率、心理健康和生活质量）的常用工具。使用预后模型开发了新型加权指数的方法有所增加。用于测量多种合并症的数据来自医疗记录、患者自我报告和大型行政数据库等来源。
我们列出了 33 种用于测量多种合并症水平的工具的详细信息，以供对测量多种合并症及其与特定结局的关联或预测感兴趣的研究人员参考。
