Ren X S, Kazis L, Lee A, Miller D R, Clark J A, Skinner K, Rogers W
Center for Health Quality, Outcomes, and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA 01730, USA.
Med Care. 1998 Feb;36(2):155-66. doi: 10.1097/00005650-199802000-00005.
This study compared the performance of generic measures of Medical Outcome Study Short Form 36-Item Health Survey physical functioning and role limitations with disease-specific measures of physical functioning and role limitations using specific disease attributions for chronic lung disease, chronic low back pain, and osteoarthritis of the knee.
Data were analyzed from the Veterans Health Study among patients receiving Veteran's Administration ambulatory care. Patients identified as having one of the three study conditions were included in the study (n = 932).
The study revealed that the generic physical functioning and role limitations scales had higher correlations with other generic SF-36 scales, whereas disease-specific attribution measures had larger R2 values in explaining variability in symptom-based disease severity and larger t statistic values in discriminating the impacts of patients taking medications and having surgery.
The generic measures of physical functioning and role limitations were more applicable in assessing a broad array of health-related quality-of-life issues, whereas disease-specific measures of physical functioning and role limitations were more useful in evaluating clinical management and limitations associated with specific disease conditions. The results of the study suggest that the use of disease-specific attribution assessments was more cost-efficient than the development of new disease-specific instruments. Disease-specific attribution could be used to complement generic measures in assessing patient outcomes.
本研究比较了医学结局研究简明健康调查36项量表中身体功能和角色受限的通用测量指标与针对慢性肺病、慢性下腰痛和膝骨关节炎采用特定疾病归因法得出的身体功能和角色受限的疾病特异性测量指标的表现。
对接受退伍军人事务部门诊治疗的患者进行退伍军人健康研究数据分析。被确定患有三种研究疾病之一的患者纳入研究（n = 932）。
研究表明，通用身体功能和角色受限量表与其他通用SF-36量表的相关性更高，而疾病特异性归因测量指标在解释基于症状的疾病严重程度变异性方面的R2值更大，在区分服药和接受手术患者的影响方面的t统计量值更大。
身体功能和角色受限的通用测量指标在评估一系列广泛的健康相关生活质量问题时更适用，而身体功能和角色受限的疾病特异性测量指标在评估临床管理及与特定疾病状况相关的受限情况时更有用。研究结果表明，使用疾病特异性归因评估比开发新的疾病特异性工具更具成本效益。在评估患者结局时，疾病特异性归因可用于补充通用测量指标。
