Guyatt G H, Feeny D H, Patrick D L
McMaster University, Hamilton, Ontario, Canada.
Ann Intern Med. 1993 Apr 15;118(8):622-9. doi: 10.7326/0003-4819-118-8-199304150-00009.
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 during a period of 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 during a period of time, even if those changes are small. Health-related quality of life measures should also 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 provide a summary of HRQL; and specific instruments that focus on problems associated with single 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 for different circumstances. Investigations in HRQL have led to instruments suitable for detecting minimally important effects in clinical trials, for 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测量健康相关生活质量（HRQL）对于指导患者管理和政策决策的重要性。自我填写或由访谈者管理的问卷可用于测量某一时刻患者之间生活质量的横断面差异（鉴别性工具），或一段时间内患者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的人。反应灵敏的评估性测量能够检测一段时间内HRQL的重要变化，即使这些变化很小。健康相关生活质量测量还应具有可解释性 —— 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：提供HRQL总结的通用工具；以及关注与单一疾病状态、患者群体或功能领域相关问题的特定工具。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，可能适用于不同的情况。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、测量人群健康状况以及为政策决策提供信息的工具。
