Liu David T, Phillips Katie M, Speth Marlene M, Besser Gerold, Mueller Christian A, Sedaghat Ahmad R
Department of Otorhinolaryngology, Head and Neck Surgery, Medical University of Vienna, Vienna, Austria.
Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Int Forum Allergy Rhinol. 2022 Feb;12(2):191-199. doi: 10.1002/alr.22878. Epub 2021 Aug 26.
Even with a high-quality instrument, such as the 22-item Sino-Nasal Outcome Test (SNOT-22), patients can be overwhelmed by repeated completion of questionnaires, leading to nonadherence and reduced data quality. The aim of this study was to evaluate whether the SNOT-22 could be made more concise without losing the valuable information that it provides.
A modern psychometric approach, item response theory (IRT), was used on a sample of 800 patients with chronic rhinosinusitis (CRS). The SNOT-22 was refined based on: (1) the item information criteria, retaining only items with above-average information; and (2) the total test information, retaining only the most discriminating items to cover at least 30% of the information within each subdomain. The preliminary validity and reliability of these refined scales were assessed using Cronbach's alpha and Pearson's correlation.
Using an IRT approach, we find that it may be possible to shorten the SNOT-22 to an 11-item and six-item version based on psychometric properties. Item information functions of the shortened 11-item and six-item scales demonstrate that both versions accurately covered the CRS symptom-severity continuum. Preliminary reliability and validity analysis showed that both refined scales had good to excellent reliability (Cronbach's alpha ≥ 0.80) and were highly associated with the original full-length scale (r ≥ 0.90).
IRT provides data-driven opportunities for the continuous development and refinement of the SNOT-22. While patient and provider input must be accounted for too, our results show that future revisions of the SNOT-22 could include significantly fewer items.
即使使用高质量的工具，如包含22个条目的中文版鼻-鼻窦结局测试（SNOT-22），患者仍可能因反复填写问卷而不堪重负，导致不依从并降低数据质量。本研究的目的是评估SNOT-22能否在不丢失其提供的有价值信息的情况下变得更简洁。
对800例慢性鼻-鼻窦炎（CRS）患者样本采用现代心理测量方法——项目反应理论（IRT）。基于以下两点对SNOT-22进行优化：（1）项目信息标准，仅保留信息高于平均水平的项目；（2）总测试信息，仅保留最具区分度的项目以涵盖每个子领域内至少30%的信息。使用克朗巴哈系数（Cronbach's alpha）和皮尔逊相关性评估这些优化量表的初步效度和信度。
采用IRT方法，我们发现基于心理测量特性，有可能将SNOT-22缩短为11项和6项版本。缩短后的11项和6项量表的项目信息函数表明，两个版本均准确涵盖了CRS症状严重程度连续体。初步的信度和效度分析表明，两个优化量表均具有良好到优秀的信度（克朗巴哈系数≥0.80），并且与原始全长量表高度相关（r≥0.90）。
IRT为SNOT-22的持续开发和优化提供了数据驱动的机会。虽然也必须考虑患者和提供者的意见，但我们的结果表明，SNOT-22未来的修订版可能包含显著更少的项目。
