Maunder R G, Cohen Z, McLeod R S, Greenberg G R
Department of Psychiatry, University of Toronto, Ontario, Canada.
Dis Colon Rectum. 1995 Nov;38(11):1147-61. doi: 10.1007/BF02048330.
Health-related quality of life (HRQOL) is a quantitative measurement of subjective perception of health state, including emotional and social aspects. It can be reliably measured with several valid instruments. Previous reviews of the literature suggested inadequate attention to HRQOL in studies of interventions in inflammatory bowel disease.
This study was undertaken to assess the current status of the quality of measurement of HRQOL in studies of inflammatory bowel disease and to review the clinical conclusions warranted by the literature.
Medicine was searched for articles relating to ulcerative colitis, Crohn's disease, or inflammatory bowel disease and quality of life since 1981. The articles found were reviewed for citations of further articles. The adequacy of HRQOL measure was assessed and graded, and the study design was categorized to assess the strength of the literature on the whole.
A trend was found toward higher quality of HRQOL measurement in the period 1988 to 1994 compared with 1981 to 1987. Most of the improvement was because of increased use of standardized and multidomain but unvalidated and unpublished questionnaires for measurement.
Confidence in the following clinical conclusions in studies of surgical interventions in inflammatory bowel disease is limited by study design: that pelvic pouch is not inferior to ileostomy, that specific domains of HRQOL are differentially affected by different surgical procedures, and (with less confidence) that surgery is helpful in Crohn's disease. Medical studies have demonstrated that high quality HRQOL measures can be integrated into randomized, prospective trials. Clinically equivalent treatments have shown differential effects or HRQOL: 9 mg daily of budesonide is superior to 15 mg, and hydrocortisone foam enemas are superior to prednisolone. Home parenteral nutrition has received modest support, limited again by study design. It is recommended that standard tests of HRQOL be used to increase comparability of studies and to increase the quality of this literature in general. In particular the Inflammatory Bowel Disease Questionnaire, Rating Form of Inflammatory Bowel Disease Concerns, and Direct Questioning of Objectives are recommended.
健康相关生活质量（HRQOL）是对健康状态主观感受的一种定量测量，包括情感和社会方面。它可以通过几种有效的工具进行可靠测量。先前的文献综述表明，在炎症性肠病干预研究中，对HRQOL的关注不足。
本研究旨在评估炎症性肠病研究中HRQOL测量质量的现状，并回顾文献所支持的临床结论。
检索自1981年以来与溃疡性结肠炎、克罗恩病或炎症性肠病及生活质量相关的医学文章。对所找到的文章进行进一步文章引用情况的综述。评估并分级HRQOL测量的充分性，并对研究设计进行分类以整体评估文献的力度。
发现与1981年至1987年相比，1988年至1994年期间HRQOL测量质量有提高的趋势。大部分改进是由于更多地使用标准化和多领域但未经验证和未发表的问卷进行测量。
在炎症性肠病手术干预研究中，以下临床结论的可信度受到研究设计的限制：盆腔袋不比回肠造口术差，HRQOL的特定领域受不同手术程序的影响不同，以及（可信度较低）手术对克罗恩病有帮助。医学研究表明，高质量的HRQOL测量可以纳入随机、前瞻性试验。临床等效治疗已显示出对HRQOL的不同影响：每日9毫克布地奈德优于15毫克，氢化可的松泡沫灌肠剂优于泼尼松龙。家庭肠外营养得到的支持有限，同样受研究设计的限制。建议使用HRQOL标准测试来提高研究的可比性并总体提高该文献的质量。特别是推荐使用炎症性肠病问卷、炎症性肠病关注评分表和目标直接询问法。
