门诊环境中慢性阻塞性肺疾病（COPD）患者结局指标的比较。
Comparison of outcome measures for patients with chronic obstructive pulmonary disease (COPD) in an outpatient setting.
作者信息
Harper R, Brazier J E, Waterhouse J C, Walters S J, Jones N M, Howard P
机构信息
School of Health and Related Research (ScHARR), University of Sheffield, UK.
出版信息
Thorax. 1997 Oct;52(10):879-87. doi: 10.1136/thx.52.10.879.
BACKGROUND
To assist clinicians and researchers in choosing outcome measures for patients with chronic obstructive pulmonary disease attending routine outpatient clinics, a comparative assessment was undertaken of four questionnaires designed to reflect the patients' perception of their physical and emotional health in terms of their feasibility, validity, reliability, and responsiveness to health change.
METHODS
Two condition specific questionnaires, the St George's Respiratory Questionnaire (SGRQ) and Guyatt's Chronic Respiratory Questionnaire (CRQ), and two generic questionnaires, the Short Form-36 Health Survey (SF-36) and Euroqol (EQ), were compared for their discriminative and evaluative properties. Spirometric tests and a walking test were also performed. One hundred and fifty six adults who were clinically judged to have COPD and who attended an outpatient chest clinic were assessed at recruitment and six and 12 months later. Patients were also asked whether their health had changed since their last assessment.
RESULTS
Completion rates and consistency between items for dimensions of the SGRQ were lower than for dimensions of the other questionnaires. The distributions of responses were skewed for certain dimensions in all questionnaires except the CRQ. Validity was supported for all instruments insofar as patients' scores were associated with differences in disease severity. The generic questionnaires better reflected other health problems. All instruments were reliable over time. The condition specific questionnaires were more responsive between baseline and first follow up visit but this difference did not persist. While certain dimensions of the SF-36 were responsive to patient perceived changes, this did not apply to the derived single index of the EQ. The rating scale of the EQ, however, provided a quick and easy indicator of change.
CONCLUSIONS
Evidence from this study supports the CRQ and the SF-36 as comprehensive outcome measures for patients with longstanding COPD.
背景
为帮助临床医生和研究人员为在常规门诊就诊的慢性阻塞性肺疾病患者选择结局指标，对四份旨在从可行性、有效性、可靠性以及对健康变化的反应性方面反映患者对其身心健康认知的问卷进行了比较评估。
方法
比较了两份特定疾病问卷，即圣乔治呼吸问卷（SGRQ）和盖亚特慢性呼吸问卷（CRQ），以及两份通用问卷，即简明健康调查问卷（SF - 36）和欧洲五维度健康量表（EQ）的鉴别和评估特性。还进行了肺功能测试和步行测试。对156名临床诊断为慢性阻塞性肺疾病且在门诊胸科就诊的成年人在招募时、6个月和12个月后进行了评估。患者还被问及自上次评估以来其健康状况是否发生了变化。
结果
SGRQ各维度的完成率和项目间一致性低于其他问卷的维度。除CRQ外，所有问卷中某些维度的回答分布存在偏态。所有工具的有效性均得到支持，因为患者得分与疾病严重程度差异相关。通用问卷能更好地反映其他健康问题。所有工具随时间推移都具有可靠性。特定疾病问卷在基线和首次随访之间反应性更强，但这种差异并未持续。虽然SF - 36的某些维度对患者感知到的变化有反应，但这不适用于EQ的派生单一指标。然而，EQ的评分量表提供了一个快速简便的变化指标。
结论
本研究的证据支持CRQ和SF - 36作为长期慢性阻塞性肺疾病患者的综合结局指标。
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