Heyland D K, Guyatt G, Cook D J, Meade M, Juniper E, Cronin L, Gafni A
Department of Medicine, Queen's University, Kingston, ON, Canada.
Crit Care Med. 1998 Mar;26(3):591-8. doi: 10.1097/00003246-199803000-00037.
To present a framework for describing/measuring quality of life (QOL) and health-related quality of life (HRQL), and to assess the frequency and methodologic rigor of QOL studies in the adult critical care literature.
Computerized bibliographic search of published research, manual search of key intensive care unit (ICU) journals, and citation review of relevant articles.
We manually searched Critical Care Medicine, American Journal of Respiratory and Critical Care Medicine, and Intensive Care Medicine for the period January 1992 to July 1995 to assess the frequency of published QOL studies. Combined with a computerized bibliographic search, we found 64 studies that met our criteria that reported on patient-related outcomes (other than mortality) after hospital discharge.
We abstracted data on the nature of each study, the instruments used to measure QOL, and the methodologic rigor of the QOL assessments. We evaluated each study using criteria we developed to assess the validity of HRQL measurements.
In our manual search, we found 1,073 articles relevant to the practice of adult critical care. Of these, 19 (1.7%)/1073 included QOL measurements. Combined with our comprehensive search strategy, we found 64 papers that evaluated QOL in ICU patients. These papers dealt primarily with issues of: prognosis (32 [50%]), resource allocation (23 [36%]), and clinical prediction (9 [14%]). We found no randomized trials that included post-ICU QOL as an outcome. With respect to the validity of the HRQL assessments, 63/64 (98%) studies evaluated aspects of patients' lives that we considered important. Thirty-three (52%) studies were limited in scope to specific aspects of HRQL, and 31 (48%) studies covered broad areas of HRQL. In these 64 studies, there were 108 different instruments used. The reliability and validity of the instruments used were reported in 7 (6%) and 15 (14%) cases, respectively. For 81 (75%) instruments, the investigators either explained the results or used informative, qualitative descriptors whose interpretation was self-evident. Overall, three (5%) of the included studies met all four methodologic criteria to assess the validity of HRQL assessments.
QOL assessments occur infrequently in the ICU literature and are of limited methodologic quality. More studies using valid and reliable instruments are necessary to document the long-term QOL of critically ill patients, especially those at risk of a "poor" outcome.
提出一个用于描述/衡量生活质量（QOL）和健康相关生活质量（HRQL）的框架，并评估成人重症监护文献中QOL研究的频率和方法的严谨性。
对已发表研究进行计算机化文献检索、对重点重症监护病房（ICU）期刊进行人工检索以及对相关文章进行引文回顾。
我们人工检索了1992年1月至1995年7月期间的《重症医学》《美国呼吸与重症医学杂志》和《重症监护医学》，以评估已发表QOL研究的频率。结合计算机化文献检索，我们发现64项符合我们标准的研究，这些研究报告了出院后与患者相关的结局（死亡率除外）。
我们提取了每项研究的性质、用于衡量QOL的工具以及QOL评估方法的严谨性等数据。我们使用自己制定的标准评估每项研究，以评估HRQL测量的有效性。
在我们的人工检索中，我们发现1073篇与成人重症监护实践相关的文章。其中，19篇（1.7%）/1073篇包含QOL测量。结合我们的全面检索策略，我们发现64篇评估ICU患者QOL的论文。这些论文主要涉及以下问题：预后（32篇[50%]）、资源分配（23篇[36%]）和临床预测（9篇[14%]）。我们未发现将ICU后QOL作为结局的随机试验。关于HRQL评估的有效性，64项研究中的63项（98%）评估了我们认为重要的患者生活方面。33项（52%）研究的范围限于HRQL的特定方面，31项（48%）研究涵盖了HRQL的广泛领域。在这64项研究中，使用了108种不同的工具。分别有7例（6%）和15例（14%）报告了所使用工具的信度和效度。对于81种（75%）工具，研究者要么解释了结果，要么使用了信息丰富、定性描述清晰的术语，其解释一目了然。总体而言，纳入研究中有3项（5%）符合评估HRQL评估有效性的所有四项方法学标准。
QOL评估在ICU文献中出现频率较低，且方法学质量有限。需要更多使用有效且可靠工具的研究来记录危重症患者的长期QOL，尤其是那些有“不良”结局风险的患者。
