Davis A M, Wright J G, Williams J I, Bombardier C, Griffin A, Bell R S
University Musculoskeletal Oncology Unit, University of Toronto, Ontario, Canada.
Qual Life Res. 1996 Oct;5(5):508-16. doi: 10.1007/BF00540024.
Patients undergoing limb salvage surgery for bone and soft tissue sarcoma of the extremities experience significant physical disability as a result of life-preserving treatment. The existing health status measures do not adequately evaluate physical function from the patient's perspective. This paper presents the developmental studies (item selection, reduction, reliability, validity and responsiveness) of a new measure, The Toronto Extremity Salvage Score (TESS). Patients with bone and soft tissue sarcoma (76 upper and 83 lower extremity) were randomly selected and mailed the TESS. Patients rated the severity and importance of physical disabilities; the response options included a 'not applicable' category and open-ended questions that allowed patients to suggest additional items for inclusion in the questionnaire. Therefore, patient perceptions were used to determine item content. Difficulty and importance frequencies were calculated and items rated 'totally unimportant' or 'not applicable' by 30% of the sample were eliminated. Extra items identified 30% of the time were added to the questionnaire. Internal consistency was evaluated by Cronbach's alpha. Test-retest reliability and validity were evaluated on subsequent patient samples. The intraclass correlation coefficient (ICC) was calculated for test-retest reliability and correlations with The Musculoskeletal Tumour Society Rating Scale (MSTS) were calculated for construct validity. Standardized effect sizes were calculated as a measure of responsiveness. Fifty upper extremity and sixty-six lower extremity patients responded to the mailed questionnaire. No items were eliminated based on importance or not applicable ratings. Sporting activities were identified as additional items in both the upper and lower extremity questionnaire. High internal consistency was demonstrated: 0.94 for the lower and 0.92 for the upper extremity questionnaires respectively. Test-retest reliability was evaluated at multiple time-points and the intraclass correlation coefficient was greater than 0.87 in all instances. Construct validity was shown by a moderate correlation with the MSTS. The effect sizes were large demonstrating responsiveness. The use of patients' perceptions in determining the content of the TESS has resulted in a reliable and valid measure that is able to detect change over time.
接受肢体挽救手术治疗四肢骨肉瘤和软组织肉瘤的患者，由于保肢治疗而出现严重身体残疾。现有的健康状况评估方法无法从患者角度充分评估身体功能。本文介绍了一种新的评估工具——多伦多肢体挽救评分（TESS）的开发研究（项目选择、精简、信度、效度和反应度）。随机选取骨肉瘤和软组织肉瘤患者（上肢76例，下肢83例），并向其邮寄TESS问卷。患者对身体残疾的严重程度和重要性进行评分；回答选项包括“不适用”类别以及开放式问题，这些问题允许患者提出其他应纳入问卷的项目。因此，通过患者的看法来确定项目内容。计算困难程度和重要性的频率，将样本中30%认为“完全不重要”或“不适用”的项目剔除。将30%的时间里识别出的额外项目添加到问卷中。通过Cronbach's alpha评估内部一致性。在后续患者样本中评估重测信度和效度。计算组内相关系数（ICC）以评估重测信度，并计算与肌肉骨骼肿瘤学会评分量表（MSTS）的相关性以评估结构效度。计算标准化效应大小作为反应度的衡量指标。50例上肢患者和66例下肢患者回复了邮寄的问卷。基于重要性或不适用评分，没有项目被剔除。体育活动被确定为上肢和下肢问卷中的额外项目。显示出高内部一致性：下肢问卷为0.94，上肢问卷为0.92。在多个时间点评估重测信度，所有情况下组内相关系数均大于0.87。与MSTS的中度相关性表明了结构效度。效应大小较大，表明具有反应度。在确定TESS内容时使用患者的看法，产生了一种可靠且有效的评估工具，能够检测随时间的变化。
