Alonso J, Black C, Norregaard J C, Dunn E, Andersen T F, Espallargues M, Bernth-Petersen P, Anderson G F
Health Services Research Unit, Institut Municipal d'Investigació Mèdica, Barcelona, Spain.
Med Care. 1998 Jun;36(6):868-78. doi: 10.1097/00005650-199806000-00010.
Patient-based health status measures have an important role to play in the assessment of health care outcomes. Among these measures, global assessments increasingly have been used, although the understanding of the performance of these indicators and the determinants of patients responses is underdeveloped. In this study, the performance of a single-item global indicator of visual function in cataract patients of four international settings was compared.
Visual acuity and ocular comorbidity was assessed by patients' ophthalmologist using Snellen-type charts in patients referred for a first cataract surgery in the United States, Manitoba (Canada), Denmark, and Barcelona (Spain). Patients also were interviewed by telephone and asked to report overall trouble with vision on a single-item indicator ("great deal," "moderate," "a little," "none") and to complete the Visual Functioning Index (VF-14), a scale of visual function ranging from 0 (worst function) to 100 (best level of function), along with other questions including the degree the patient was bothered by symptoms as measured by the Cataract Symptom Score (CSS). A total of 1,407 patients completed the clinical examination and the preoperative interview.
Distribution of overall trouble with vision varied across the sites, with the proportion of patients reporting a great deal of trouble ranging from 21.7% to 37.9%. In all sites, patients reporting more trouble with vision tended to show a poorer age-adjusted and sex-adjusted visual acuity. The proportion of patients reporting great deal of trouble with vision was higher in the groups with worse visual acuity (P < 0.001). In multivariate analysis, after controlling for clinical and sociodemographic factors, the patients from Manitoba (OR = 0.32, 95% CI = 0.20, 0.51) and those from Barcelona (OR = 0.33, 95% CI = 0.20, 0.56) were less likely to report a great deal of trouble with their vision (P < 0.01) than the Danish and US patients. No such differences were found among the US patients from three sites.
There is international variation in the self-reporting of global vision-related functional capacity that is not explained by clinical or sociodemographic factors, which may be because of cultural differences. International comparisons of patient-based health outcomes should not rely only on single-item indicators until there is convincing evidence of their cross-cultural equivalence.
基于患者的健康状况测量在医疗保健结果评估中发挥着重要作用。在这些测量方法中，整体评估的应用越来越广泛，尽管对这些指标的表现以及患者反应的决定因素的了解尚不完善。在本研究中，比较了四个国际地区白内障患者视觉功能单项整体指标的表现。
在美国、加拿大马尼托巴省、丹麦和西班牙巴塞罗那，由患者的眼科医生使用斯内伦式视力表对首次接受白内障手术的患者进行视力和眼部合并症评估。还通过电话对患者进行访谈，要求他们根据单项指标（“很多”“中等”“一点”“没有”）报告视力方面的总体问题，并完成视觉功能指数（VF - 14），这是一个视觉功能量表，范围从0（最差功能）到100（最佳功能水平），同时回答包括患者受症状困扰程度（通过白内障症状评分（CSS）衡量）等其他问题。共有1407名患者完成了临床检查和术前访谈。
各地区视力总体问题的分布情况不同，报告有很多问题的患者比例在21.7%至37.9%之间。在所有地区，报告视力问题较多的患者往往年龄和性别调整后的视力较差。视力较差组中报告视力有很多问题的患者比例更高（P < 0.001）。在多变量分析中，在控制了临床和社会人口学因素后，马尼托巴省的患者（OR = 0.32，95% CI = 0.20，0.51）和巴塞罗那的患者（OR = 0.33，95% CI = 0.20，0.56）报告视力有很多问题的可能性低于丹麦和美国患者（P < 0.01）。在美国三个地区的患者中未发现此类差异。
全球视力相关功能能力的自我报告存在国际差异，这种差异无法用临床或社会人口学因素来解释，这可能是由于文化差异。在没有令人信服的跨文化等效性证据之前，基于患者的健康结果的国际比较不应仅依赖单项指标。
