Bessette L, Sangha O, Kuntz K M, Keller R B, Lew R A, Fossel A H, Katz J N
Department of Medicine, Laval University, Ste-Foy, Quebec, Canada.
Med Care. 1998 Apr;36(4):491-502. doi: 10.1097/00005650-199804000-00005.
The authors evaluated the relative responsiveness to change of generic versus disease-specific and unweighted versus weighted health status measures in carpal tunnel syndrome (CTS).
Data were obtained from 196 subjects followed in a prospective community-based cohort study in Maine who underwent carpal tunnel release (The Maine Carpal Tunnel Syndrome Study). Patients were evaluated before and 6 months after surgery. The disease-specific, unweighted severity score was derived from the validated Carpal Tunnel Syndrome Assessment Questionnaire. Patients were asked to rate the importance of each symptom included in the severity score. Each severity question was weighted by its importance, creating a disease-specific weighted score. Generic instruments were the SF-36, SF-12, and a Quality of Life Rating Scale. Sensitivity to change was calculated with the standardized response mean (SRM, mean change/standard deviation of change) as well as the effect size (ES, mean change/standard deviation of baseline values). The ability of the instruments to distinguish clinically important differences was assessed by correlating the changes in scores with global ratings on satisfaction and perceived improvement as external criteria.
The disease-specific weighted score (SRM: 1.56, ES: 1.99) was more responsive than the unweighted score (SRM: 1.36, ES: 1.57). The Quality of Life Rating Scale, SF-36, and SF-12 subscales were less sensitive to change, with standardized response means and effect sizes that ranged from -0.23 to 0.88. The ability to distinguish clinically important differences was higher for the two disease-specific scales. The coefficients of correlation with the external criteria ranged from 0.50 to 0.56 for the unweighted score and 0.56 to 0.62 for the weighted score and were significantly stronger than the correlations between external measures and the most responsive subscale of the SF-36 (Bodily Pain subscale, r = 0.36). The SF-12 health survey performed as well as the SF-36 in term of responsiveness and ability to distinguish clinically important change.
Disease-specific measures were superior to generic measures in capturing clinical change after carpal tunnel release, and a weighted score was slightly more responsive than the unweighted score. The SF-12 showed comparable psychometric properties compared with the longer 36-item Short-Form Survey.
作者评估了在腕管综合征（CTS）中，通用健康状况测量指标与疾病特异性健康状况测量指标，以及未加权与加权健康状况测量指标对变化的相对反应性。
数据来自缅因州一项基于社区的前瞻性队列研究中随访的196名接受腕管松解术的受试者（缅因州腕管综合征研究）。在手术前和术后6个月对患者进行评估。疾病特异性未加权严重程度评分来自经过验证的腕管综合征评估问卷。要求患者对严重程度评分中包含的每种症状的重要性进行评分。每个严重程度问题根据其重要性进行加权，从而得出疾病特异性加权评分。通用测量工具包括SF-36、SF-12和生活质量评定量表。使用标准化反应均值（SRM，平均变化/变化的标准差）以及效应量（ES，平均变化/基线值的标准差）来计算对变化的敏感性。通过将评分变化与作为外部标准的满意度和感知改善的总体评分进行关联，评估测量工具区分临床重要差异的能力。
疾病特异性加权评分（SRM：1.56，ES：1.99）比未加权评分（SRM：1.36，ES：1.57）对变化的反应性更强。生活质量评定量表、SF-36和SF-12分量表对变化的敏感性较低，标准化反应均值和效应量范围为-0.23至0.88。两种疾病特异性量表区分临床重要差异的能力更高。未加权评分与外部标准的相关系数范围为0.50至0.56，加权评分为0.56至0.62，且显著强于外部测量与SF-36最敏感分量表（身体疼痛分量表，r = 0.36）之间的相关性。SF-12健康调查在反应性和区分临床重要变化的能力方面与SF-36表现相当。
在腕管松解术后捕捉临床变化方面，疾病特异性测量指标优于通用测量指标，且加权评分比未加权评分的反应性略高。与更长的36项简短形式调查问卷相比，SF-12显示出相当的心理测量特性。
