Jomy Jane, Jani P, Sheikh F, Charide R, Mah J, Couban R J, Kligler B, Darzi A J, White B K, Hoppe T, Busse J W, Zeraatkar D
Faculty of Medicine, University of Toronto Temerty, Toronto, Ontario, Canada.
School of Medicine, McMaster University, Hamilton, Ontario, Canada.
BMJ Mil Health. 2025 Mar 21;171(2):155-165. doi: 10.1136/military-2022-002219.
Accurate measurement of health status is essential to assess veterans' needs and the effects of interventions directed at improving veterans' well-being. We conducted a systematic review to identify instruments that measure subjective health status, considering four components (ie, physical, mental, social or spiritual well-being).
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we searched CINAHL, MEDLINE, Embase, PsycINFO, Web of Science, JSTOR, ERIC, Social Sciences Abstracts and ProQuest in June 2021 for studies reporting on the development or evaluation of instruments measuring subjective health among outpatient populations. We assessed risk of bias with the Consensus-based Standards for the Selection of Health Measurement Instruments tool and engaged three veteran partners to independently assess the clarity and applicability of identified instruments.
Of 5863 abstracts screened, we identified 45 eligible articles that reported health-related instruments in the following categories: general health (n=19), mental health (n=7), physical health (n=8), social health (n=3) and spiritual health (n=8). We found evidence for adequate internal consistency for 39 instruments (87%) and good test-retest reliability for 24 (53%) instruments. Of these, our veteran partners identified five instruments for the measurement of subjective health (Military to Civilian Questionnaire (M2C-Q), Veterans RAND 36-Item Health Survey (VR-36), Short Form 36, Abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF) and Sleep Health Scale) as clear and very applicable to veterans. Of the two instruments developed and validated among veterans, the 16-item M2C-Q considered most components of health (mental, social and spiritual). Of the three instruments not validated among veterans, only the 26-item WHOQOL-BREF considered all four components of health.
We identified 45 health measurement instruments of which, among those reporting adequate psychometric properties and endorsed by our veteran partners, 2 instruments showed the most promise for measurement of subjective health. The M2C-Q, which requires augmentation to capture physical health (eg, the physical component score of the VR-36), and the WHOQOL-BREF, which requires validation among veterans.
准确测量健康状况对于评估退伍军人的需求以及旨在改善退伍军人福祉的干预措施的效果至关重要。我们进行了一项系统综述，以确定测量主观健康状况的工具，同时考虑四个组成部分（即身体、心理、社会或精神福祉）。
按照系统综述和荟萃分析的首选报告项目，我们于2021年6月在CINAHL、MEDLINE、Embase、PsycINFO、科学引文索引、JSTOR、教育资源信息中心、社会科学文摘和ProQuest中搜索有关门诊人群中测量主观健康状况工具的开发或评估的研究。我们使用基于共识的健康测量工具选择标准工具评估偏倚风险，并邀请三位退伍军人伙伴独立评估所确定工具的清晰度和适用性。
在筛选的5863篇摘要中，我们确定了45篇符合条件的文章，这些文章报告了以下类别的与健康相关的工具：总体健康（n = 19）、心理健康（n = 7）、身体健康（n = 8）、社会健康（n = 3）和精神健康（n = 8）。我们发现39种工具（87%）有足够的内部一致性证据，24种工具（53%）有良好的重测信度证据。其中，我们的退伍军人伙伴确定了五种测量主观健康状况的工具（从军人到平民问卷（M2C-Q）、退伍军人兰德36项健康调查（VR-36）、简短健康调查36项、世界卫生组织生活质量简表（WHOQOL-BREF）和睡眠健康量表）清晰且非常适用于退伍军人。在退伍军人中开发并验证的两种工具中，16项的M2C-Q考虑了健康的大多数组成部分（心理、社会和精神）。在未在退伍军人中验证的三种工具中，只有26项的WHOQOL-BREF考虑了健康的所有四个组成部分。
我们确定了45种健康测量工具，其中，在那些报告了足够心理测量特性并得到我们退伍军人伙伴认可的工具中，有2种工具在测量主观健康状况方面最有前景。M2C-Q需要补充以获取身体健康状况（例如VR-36的身体组成部分得分），而WHOQOL-BREF需要在退伍军人中进行验证。
