Moore Currie, Busby Amanda, Flanagan Rebecca, Ellis-Caird Helen, Awan Faizan, Paul Tarsem, Fielding Catherine, McCafferty Kieran, van der Veer Sabine N, Farrington Ken, Wellsted David
School of Health and Society, University of Salford.
School of Life and Medical Sciences, University of Hertfordshire.
Clin Kidney J. 2025 Jan 28;18(3):sfaf029. doi: 10.1093/ckj/sfaf029. eCollection 2025 Mar.
Needling is a key step in haemodialysis. Research suggests that needling experience is sub-optimal; however, no validated measure exists to inform improvements. We addressed this by developing the Needling Patient Reported Experience Measure (NPREM).
We used mixed methods and co-production. All participants were adults with working fistulas/grafts from eight UK kidney centres. Phase 1 involved developing concepts and items: in interviews ( = 41), we explored patients' needling experience and identified key aspects of needling using thematic analysis. This informed the 98-item NPREM(v0.1). Phase 2 was piloting the measure: cognitive interviews ( = 16) assessed face validity. Items were amended or removed, yielding a 48-item NPREM(v0.2). A pilot survey ( = 183) examined initial psychometric properties. NPREM(v0.2) showed good internal consistency (Cronbach's alpha = 0.95). Review of analyses resulted in a 35-item NPREM(v0.3). Phase 3 involved evaluating the measure's dimensionality, validity and reliability: patients ( = 468) completed the NPREM(v0.3), Vascular Access Quality of Life (VASQoL), EuroQol 5-Dimension-5-Level (EQ-5D-5L) and Patient Activation Measure (PAM), with a sub-set completing a follow-up NPREM ( = 99). Items were evaluated with 28 items retained in the NPREM(v1.0). Confirmatory factor analysis confirmed a unidimensional model fit (comparative fit index = 0.899). Validity of the NPREM(v1.0) was good [convergent: VASQoL (= 0.60) and overall experience (= 0.79); divergent: EQ-5D (= -0.31), EQ-5D visul analogue scale (= 0.24) and PAM (= 0.17)]. Test-retest scores were strongly correlated (= 0.88), demonstrating high reliability. Known-groups validity was demonstrated between centre scores [range 5.21 (standard deviation 1.20) to 5.94 (0.75)].
The NPREM measures patient experience of needling for haemodialysis. It offers kidney services a means of assessing needling experience, informing patient-focused clinical and service improvements.
穿刺是血液透析的关键步骤。研究表明，穿刺体验并不理想；然而，目前尚无经过验证的衡量方法来指导改进。我们通过开发穿刺患者报告体验量表（NPREM）来解决这一问题。
我们采用了混合方法和共同生产的方式。所有参与者均为来自英国8个肾脏中心的成年患者，其动静脉内瘘/移植物功能良好。第一阶段涉及概念和条目的开发：在访谈（n = 41）中，我们探讨了患者的穿刺体验，并通过主题分析确定了穿刺的关键方面。这为包含98个条目的NPREM（v0.1）提供了依据。第二阶段是对该量表进行预试验：认知访谈（n = 16）评估了表面效度。对条目进行了修改或删除，产生了一个包含48个条目的NPREM（v0.2）。一项预试验调查（n = 183）检验了其初步的心理测量特性。NPREM（v0.2）显示出良好的内部一致性（克朗巴哈系数α = 0.95）。对分析结果的审查产生了一个包含35个条目的NPREM（v0.3）。第三阶段涉及评估该量表的维度、效度和信度：患者（n = 468）完成了NPREM（v0.3）、血管通路生活质量量表（VASQoL）、欧洲五维度五水平健康量表（EQ-5D-5L）和患者激活量表（PAM），其中一部分患者（n = 99）完成了后续的NPREM。对条目进行评估后，NPREM（v1.0）保留了28个条目。验证性因素分析证实了单维度模型拟合（比较拟合指数 = 0.899）。NPREM（v1.0）的效度良好[收敛效度：VASQoL（r = 0.60）和总体体验（r = 0.79）；区分效度：EQ-5D（r = -0.31）、EQ-5D视觉模拟量表（r = 0.24）和PAM（r = 0.17）]。重测分数高度相关（r = 0.88），表明信度很高。中心得分之间显示出已知组效度[范围为5.21（标准差1.20）至5.94（0.75）]。
NPREM可衡量血液透析穿刺的患者体验。它为肾脏服务提供了一种评估穿刺体验的方法，有助于以患者为中心的临床和服务改进。
