Wood P H
Br J Rheumatol. 1983 Aug;22(3 Suppl):24-33. doi: 10.1093/rheumatology/xxii.suppl_1.24.
This paper endeavours to show that the major problems in evaluation research are logical rather than methodological, exemplifying the situation by consideration of the radiographic features of rheumatoid arthritis and their value as endpoint measures. The objectives of intervention are only rarely specified with sufficient precision to permit outcome to be assessed in a practical and yet valid manner. This gives rise to difficulty in establishing the nature and validity of the relationship between an attribute, such as erosions seen on radiographs, and the underlying state to be assessed. Relationships can be considered at two levels--the ability of the attribute to act as a surrogate in detection of the underlying state (i.e. at a particular point in time), and the the potential of the surrogate to reveal changes in the underlying state as its course unfolds. Despite a number of serious limitations, radiographic changes emerge as one of the most promising candidates to serve as an outcome measure in rheumatoid arthritis.
本文旨在表明，评估研究中的主要问题是逻辑性问题而非方法性问题，并通过考虑类风湿关节炎的放射学特征及其作为终点指标的价值来举例说明这种情况。干预目标很少能被精确设定，从而无法以切实可行且有效的方式评估结果。这就导致在确定诸如X线片上所见的侵蚀等属性与待评估的潜在状态之间关系的性质和有效性时存在困难。这种关系可在两个层面上进行考量——该属性在检测潜在状态（即在特定时间点）时作为替代指标的能力，以及该替代指标在潜在状态的病程发展过程中揭示其变化的潜力。尽管存在一些严重局限性，但放射学变化仍是类风湿关节炎中最有希望作为结局指标的候选指标之一。
