Bakker C, Rutten M, van Santen-Hoeufft M, Bolwijn P, van Doorslaer E, Bennett K, van der Linden S
Department of Internal Medicine, University of Limburg, Maastricht, The Netherlands.
J Rheumatol. 1995 Aug;22(8):1536-43.
To compare in patients with fibromyalgia (FM) utilities derived by rating scale and standard gamble methods; to gain insight into construct validity by relating utility values to other outcome measures; to assess the sensitivity to change of utilities.
A total of 73 patients with FM were randomized into one of 3 groups: low impact fitness training, biofeedback, or controls. At baseline and after 6 mo the Maastricht Utility Measurement Questionnaire was applied. By means of both the rating scale and standard gamble method patients were asked to value their own health status. Construct validity of patient utility measurements was evaluated by Spearman correlation and multiple regression of baseline values with pain, stiffness, patient's global assessment, Sickness Impact Profile (SIP), modified Health Assessment Questionnaire and Arthritis Impact Measurement Scale (AIMS). Sensitivity to change was assessed against changes in these outcomes.
Rating scale utilities correlated significantly (p < 0.05) with patient's global assessment (rs = 0.53), pain (rs = -0.47), SIP (rs = -0.43), and with 9 of 11 dimensions of the AIMS (rs ranging from 0.23 to 0.62). Standard gamble utilities correlated significantly with mobility, pain, and arthritis impact of the AIMS scale (rs from 0.22 to 0.36) and with pain by visual analog scale (rs = -0.24) and patient's global assessment (rs = 0.32). Multiple regression analysis showed that patient's global assessment explained 41% (rating scale) and 10% (standard gamble) of total variance in baseline utilities. Also, 16% of the variance in change in rating scale utility values was explained by changes in patient's global assessment. In contrast, variance of changes in standard gamble utility values was not explained significantly by changes in other disease outcomes.
Rating scale utilities correlated more strongly with disease outcome measures than standard gamble utilities. Also, construct validity for the rating scale was better than for the standard gamble. In FM, utility measurement is sensitive to the method chosen to elicit patient priorities.
比较通过评分量表和标准博弈法得出的纤维肌痛（FM）患者的效用值；通过将效用值与其他结局指标相关联来深入了解结构效度；评估效用值对变化的敏感性。
总共73例FM患者被随机分为3组之一：低强度健身训练组、生物反馈组或对照组。在基线期和6个月后应用马斯特里赫特效用测量问卷。通过评分量表和标准博弈法，要求患者对自身健康状况进行估值。通过Spearman相关性分析以及基线值与疼痛、僵硬、患者整体评估、疾病影响概况（SIP）、改良健康评估问卷和关节炎影响测量量表（AIMS）的多元回归分析来评估患者效用测量的结构效度。根据这些结局指标的变化评估对变化的敏感性。
评分量表效用值与患者整体评估（rs = 0.53）、疼痛（rs = -0.47）、SIP（rs = -0.43）以及AIMS的11个维度中的9个维度（rs范围为0.23至0.62）显著相关（p < 0.05）。标准博弈效用值与AIMS量表的活动能力、疼痛和关节炎影响显著相关（rs为0.22至0.36），与视觉模拟量表的疼痛（rs = -0.24）和患者整体评估（rs = 0.32）显著相关。多元回归分析表明，患者整体评估解释了基线效用值总方差的41%（评分量表）和10%（标准博弈）。此外，患者整体评估的变化解释了评分量表效用值变化方差的16%。相比之下，标准博弈效用值变化的方差未被其他疾病结局指标的变化显著解释。
评分量表效用值与疾病结局指标的相关性比标准博弈效用值更强。此外，评分量表的结构效度优于标准博弈。在FM中，效用测量对用于引出患者优先事项的方法敏感。
