Feinstein A R, Josephy B R, Wells C K
Ann Intern Med. 1986 Sep;105(3):413-20. doi: 10.7326/0003-4819-105-3-413.
Indexes of functional disability are being used increasingly to rate the status of patients studied in clinical research or treated in clinical practice. To determine why so many indexes have been developed and to evaluate their scientific quality, we reviewed the construction and other attributes of 43 indexes that offer ratings for activities of daily living. The six most prominent problems, and some proposed solutions, are as follows: Ratings for the magnitude of performed tasks will be misleading unless the patient's effort or collaboration is suitably considered. Each patient's preferences should be sought to determine which types of disability are the most important goals of therapy. Special transition indexes should be developed if subtle or overt changes are not discerned from the repeated use of single-state indexes. Hierarchical scale arrangements can avoid the loss of descriptive power that occurs when multiple variables are aggregated merely as summations. Documentary evidence can be required to demonstrate the anticipated achievements of an index. New indexes can be constructed if the high statistical "reliability" and "validity" of established indexes are not accompanied by satisfactory clinical "sensibility."
功能残疾指标越来越多地用于评估临床研究中所研究患者或临床实践中所治疗患者的状况。为了确定为何开发了如此多的指标并评估其科学质量，我们回顾了43个为日常生活活动提供评分的指标的构建及其他属性。六个最突出的问题及一些建议的解决方案如下：除非适当地考虑患者的努力或配合，否则对所执行任务量的评分将产生误导。应征求每位患者的偏好，以确定哪种类型的残疾是治疗的最重要目标。如果从单状态指标的重复使用中未发现细微或明显变化，则应开发特殊的过渡指标。分层量表安排可以避免当多个变量仅作为总和进行汇总时出现的描述力丧失。可以要求提供文献证据来证明一个指标的预期成果。如果既定指标的高统计“可靠性”和“有效性”未伴随着令人满意的临床“敏感性”，则可以构建新的指标。
