Guyatt G H
Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
J Rheumatol. 1995 Jun;22(6):1188-90.
Clinicians and policymakers are recognizing the importance of measuring health related quality of life (HRQL) to inform patient management and policy decisions. Self or interviewer administered questionnaires can be used to measure cross sectional differences in quality of life between patients at a point in time (discriminative instruments) or longitudinal changes in HRQL within patients over time (evaluative instruments). Both discriminative and evaluative instruments must be valid (really measuring what they are supposed to measure) and have a high ratio of signal to noise (reliability and responsiveness, respectively). Reliable discriminative instruments are able to reproducibly differentiate between persons. Responsive evaluative measures are able to detect important changes in HRQL over time, even if those changes are small. HRQL should be interpretable--that is, clinicians and policymakers must be able to identify differences in scores that correspond to trivial, small, moderate, and large differences. Two basic approaches to quality of life measurement are available: generic instruments that attempt to provide a summary of health related quality of life; and specific instruments that focus on problems associated with individual disease states, patient groups, or areas of function. Generic instruments include health profiles and instruments that generate health utilities. The approaches are not mutually exclusive. Each approach has its strengths and weaknesses and may be suitable under different circumstances. Investigations in HRQL have led to instruments suitable for detecting minimally important effects in clinical trials, measuring the health of populations, and for providing information for policy decisions.
临床医生和政策制定者逐渐认识到，衡量健康相关生活质量（HRQL）对于指导患者管理和政策决策具有重要意义。可使用自评或访谈式问卷来衡量某一时间点患者之间生活质量的横断面差异（鉴别性工具），或衡量患者随时间推移HRQL的纵向变化（评估性工具）。鉴别性和评估性工具都必须有效（真正测量其应测量的内容），并且具有高信噪比（分别为可靠性和反应性）。可靠的鉴别性工具能够可重复地区分不同个体。反应灵敏的评估性测量能够检测出HRQL随时间的重要变化，即使这些变化很小。HRQL应该是可解释的——也就是说，临床医生和政策制定者必须能够识别出与微小、小、中等和大差异相对应的分数差异。生活质量测量有两种基本方法：通用工具，试图提供健康相关生活质量的总结；以及特定工具，专注于与个体疾病状态、患者群体或功能领域相关的问题。通用工具包括健康概况和生成健康效用的工具。这些方法并非相互排斥。每种方法都有其优缺点，可能在不同情况下适用。对HRQL的研究已产生了适用于在临床试验中检测最小重要效应、衡量人群健康以及为政策决策提供信息的工具。
