肝病生存质量量表中文版的信度、效度测试

目的:为了评估肝病的生存质量量表(Liver Disease Quality of Life Questionnaire.LDQOL)1.0中文版的信度、效度。方法:采用横断面的研究,使用北京大学深圳医院的中国人病例,通过记录量表的完成率、完成量表的时间和未完成问题的维度所占的比例来考察LDQOL 1.0中文版的可行性;通过测试内在一致性(Cronbach's alpha)来检测LDQOL 1.0中文版的信度,同时也计算出各个维度的天花板效应和地板效应;通过计算LDQOL 1.0中文版的疾病特异性-12个维度与SF-36的8个维度之间的相关系数,来考察LDQOL 1.0中文版的效度.结果:总共有48例肝病患者纳入统计分析.平均年龄是39.3岁±2.6岁,75%是男性患者.完成量表的平均时间是33.5 min±12.2 min.性功能和性功能障碍这两个维度在未完成问题的比例中占有最大的比重,在LDQOL1.0中文版的疾病特异性-12个维度中,仅有1个维度的天花板效应是超过20%的,除了6个维度,其余维度的Cronbach's alpha系数均0.70.LDQOL 1.0中文版的疾病特异性-12个维度与SF-36的8个维度之间的相关系数基本验证了假设.结论:LDQOL 1.0中文版具有较好的信度和效度.     

世界卫生组织生存质量测定量表对维持性血液透析患者生存质量评价及其信度和效度

目的探讨维持性血液透析(MHD)患者的生存质量及世界卫生组织(WHO)生活质量量表(QOL)在MHD患者中使用的信度和效度。方法应用WHOQOL对西安市4家医院血液透析病人共101例进行调查。结果在信度研究中,Cronbachα值均高于0.900且总的Cronbachα值为0.922;在内容效度上,量表的各个领域及方面之间存在一定的相关性(精神支柱/宗教/个人信仰领域与一小部分领域和方面的相关性没有统计学意义),其中,各方面与其所属领域之间相关较强,而与其他领域相关较弱;在区分效度上,除环境领域外,其他领域得分两者差异均显著(P<0.05)。在24个方面中,有21个方面能区分开病人和正常人(P<0.05)。在QOL测定上,除环境领域的获得新信息、休闲娱乐活动、环境条件外,MHD患者在生理领域、心理领域、独立性领域、社会关系领域和精神支柱/宗教/个人信仰领域得分与常模差异显著(P<0.05)。结论 WHOQOL-100量表具有较高的信度和效度,可以较好地反映MHD患者的QOL,且MHD患者的QOL显著低于正常人。     

心力衰竭患者生存质量评价量表

生存质量（qualitity of life，QOL）研究在国外已进行了30余年，80年代中期开始进入我国并逐渐引起国内医学界的重视。1993年，WHO将生存质量定义为：个体根据其所处的文化背景和价值系统对自身生活的主观感受，它受个体的目标、期望值标准和个体关注点等因素的影响。生存质量量表是评价患者生存质量的工具，根据测试目的不同，生存质量测试量表通常分为普适性量表和特异性量表。     

老年功能性便秘患者的生存质量

长期便秘可使结肠憩室、肛周病变等发病率增加,增加高血压、冠心病等致死率,加大女性乳腺癌的发病危险性.研究显示,便秘在各个国家的发病率均较高[1-4],但便秘的就诊率呈年龄相关性上升,60岁时便秘发病率有比较陡峭的上升趋势.功能性便秘是指由于生活规律改变、情绪抑郁、饮食因素、排便习惯不良、药物作用等因素所致的便秘.     

脑卒中专门化生存质量量表中译本在冀南地区信度、效度及敏感度的研究

分别采用Kappa系数、Cronbach's α系数,Rankin量表、"准金标准"的相关分析,标化效应(SES)评价冀南地区脑卒中患者信度,辨别效度、效标效度及敏感度.结果随访发病后60例轻、中度脑卒中患者的Kappa值、Cronbach's α系数均＞0.8;Rankin1～Rankin4组Rankin得分逐渐下降,其中精力、家庭角色、活动能力、自理、社会角色、上肢功能、工作/劳动的Rankin平均得分在4组间有显著差异(P＜0.05).除"社会角色"与"视力"领域外,其余各领域均与相应效标有较好相关性(r=0.37～0.89,P＜0.01);除情绪、个性外,其他领域SES均＞0.5.认为脑卒中专门化生存质量量表中译本在冀南地区轻、中度脑卒中患者中具有良好的信度、效度及敏感度.     

慢性心力衰竭患者健康相关生存质量量表开发及测评方法

<正>生存质量(quality of life,QOL),又称生命质量、生活质量。20世纪80年代,有关QOL的研究被引进我国,并逐渐引起国内医学界的重视。目前在理论上尚无统一的QOL定义,比较公认的是1993年世界卫生组织QOL研讨会上的定义:不同的文化和价值体系中的个体,由他生存的标准、理     

慢性乙型肝炎患者中医生存质量量表(测试版)的信效度检验

目的:对慢性乙型肝炎(CHB)患者中医生存质量量表(测试版)行信效度检验。方法:400例CHB患者通过慢性乙型肝炎患者中医生存质量量表(测试版)的问卷调查。结果:1CHB患者中医生存质量量表(测试版)信度检验:全卷分半信度系数为0.997(P0.01);内部一致性分析结果显示:量表总分、肝经领域、肝络领域、情志领域、部候领域得分的Cronbach alpha系数分别为0.958、0.874、0.887、0.918、0.856。2CHB患者中医生存质量量表(测试版)效度检验:维度相关性分析显示各条目得分与其所在维度得分之间相关性均较大。各维度与总量表分的P相关系数各维度之间的P相关系数,各维度得分与总分之间的P相关系数均在0.84以上(P均0.01);各维度之间的P相关系数在0.580~0.781之间(P均0.01),其中部候维度与情志维度相关性较大,肝经维度与肝络维度相关性较大(P均0.01)。3主成分因子分析:72条条目中,除条目50、57、69因子负荷0.4外,其余均0.4,每个因子的组成条目都能够被比较合理地解释。量表中的每个条目都在其所属的因子上有较高的负荷值,而在其他因子上的负荷值较低。结论:CHB患者中医生存质量量表(测试版)有较强的可行性;量表所测定的内容具有同源性,信度佳,各维度间有充分的内部一致性;该量表结构效度好,符合心理测量学的要求。     

SF-12量表评价中国老年人生存质量的信度和效度分析

目的分析SF-12量表评价老年人群生存质量的信、效度。方法采用SF-12量表对养老机构及居家养老的451名老年人进行横断面调查,分析量表的信度与效度。结果量表总的Cronbachα系数为0.775;量表8个维度的集合效度和区分效度试验成功率均为100%;因子分析提取2个公因子,累积贡献率为59.0%,其中躯体活动功能(PF)、角色功能(RP)、躯体疼痛(BP)、社会功能(SF)、情绪功能(RE)、心理功能(MH)维度与理论结果假设相符,健康总评(GH)、活力(VT)维度与量表的理论结构假不符;量表与单条目的健康自评量表的效标效度检验,相关系数r=0.776,P=0.000。结论 SF-12量表具有较好的信度与效度,适用于中国文化背景下老年人生存质量的测量。     

建立慢性乙型肝炎患者中医生存质量量表的设想

慢性乙型肝炎（简称慢性乙肝）是一种严重危害人类健康的慢性传染病，目前尚无特效的根治方法，因而给患者带来了心理和经济上的双重压力，生存质量（quality of life，QOL）明显降低。“追求高质量的生活，不延长痛苦的生存”，这一观念正为越来越多的医生、患者及其家属所接受。     

WHOQOL HIV-BREF量表用于AIDS病人的信度和效度评价

目的评价WHOQOL HIV-BREF量表用于评价经高效抗反转录病毒治疗（HARRT）的艾滋病（AIDS）病人的信度、效度。方法 2008年7月-2009年6月,使用AIDS病人生存质量调查表,对102例确诊的AIDS病人进行调查,内容包括HIV-BREF量表、基本人口学资料以及AIDS相关症状等;采用相关分析、信度分析、因子分析和方差分析等统计方法考察量表的信度、效度和区分度。结果 HIV-BREF量表每个领域的分半信度和内部一致性信度系数〉0.60,重测信度系数〉0.50。每个条目跟相关领域的相关系数都〉0.54（有统计学意义）,大于该条目与其他领域的相关系数。因子分析提取的6个主成分分别代表了各个领域,累计贡献达到72.46%;其结果与量表的理论结构假设基本一致。HIV-BREF量表能够区分是否吸毒、不同感染阶段病人的生存质量,具有较好的区分度。结论 HIV-BREF量表有较好的信度、效度和区分度,在临床以及科研中,可用于评价AIDS病人的生存质量。     

Quality of Life After Subtotal Colectomy for Slow-Transit Constipation

PURPOSE: Subtotal colectomy reliably increases bowel-movement frequency in patients with slow-transit constipation, but its impact on quality of life is unknown. The purpose of this study was to assess the relationship between functional outcomes and quality of life after subtotal colectomy for slow-transit constipation. METHODS: We reviewed the charts and operative reports of all patients who underwent subtotal colectomy for slow-transit constipation from January 1992 to June 2001. We sent them a 54-question survey that inquired about bowel function and included a modified 36-item gastrointestinal quality-of-life index. Using Pearsons R, we correlated gastrointestinal quality-of-life index scores with specific functional outcomes. RESULTS: Of 112 patients (109 females), 28 had been lost to follow-up and 2 had died. In all, 75 surveys (67 percent) were returned. Most of these 75 patients (81 percent) were at least somewhat pleased with their bowel-movement frequency, but 41 percent cited abdominal pain; 21 percent, incontinence; and 46 percent, diarrhea at least some of the time. The overall mean gastrointestinal quality-of-life index score was 103 ± 22 of a maximum possible score of 144 (mean score for healthy controls, 126 ± 13). We found no correlation between frequency of bowel movements and gastrointestinal quality-of-life index score (R = –0.03). Abdominal pain, diarrhea, and incontinence each had a statistically significant negative impact on gastrointestinal quality-of-life index scores (P = 0.01). Patients who required permanent ileostomy had low gastrointestinal quality-of-life index scores (68 ± 24). The vast majority (93 percent) of patients stated they would undergo subtotal colectomy again if given a second chance. CONCLUSION: Subtotal colectomy for slow-transit constipation increases bowel-movement frequency; however, the persistence of abdominal pain and the development of postoperative incontinence or diarrhea adversely affect quality of life. Although most patients in the present study were satisfied with their results, quality-of-life scores should be used to assess postoperative outcome.     

功能性便秘患者的精神心理状况及生活质量评价

目的通过与健康对照者比较,分析功能性便秘(FC)患者的精神心理和生活质量状况,揭示对FC患者的生活质量评价的临床意义。方法应用一个普适量表(SAS、SDS)和一个疾病特殊量表(PAC-QOL)对60例FC患者和年龄、性别、体重指数相匹配的30例健康对照组进行问卷调查,对两者之间的精神心理评分、生活质量评分进行比较,同时对FC患者的精神心理评分与生活质量评分进行相关性分析。结果(1)FC患者与健康对照者在年龄、性别比例、体重指数之间无显著性差异。(2)FC患者SAS、SDS标准分显著高于健康对照组。(3)FC患者PAC-QOL评分分别为:躯体不适3.06±0.75,心理社会不适2.34±0.79,担心焦虑2.99±0.81,满意度3.22±0.40,总平均分2.85±0.50,均较基线水平明显升高。(4)SAS、SDS标准分与PAC-QOL评分有显著相关性。结论FC患者存在明显的精神心理异常,便秘严重降低了患者的生活质量。生活质量评分的高低比实验室指标更能反映患者的健康状况。诊治功能性便秘时应重视患者生活质量的评价状况。     

Successful Physical Therapy for Constipation Related to Puborectalis Dyssynergia Improves Symptom Severity and Quality of Life

Purpose  This study evaluated symptom severity and quality of life in patients with puborectalis dyssynergia before and after physical therapy. Methods  Twenty-two patients with puborectalis dyssynergia were prospectively enrolled into a multidisciplinary program for the treatment of pelvic floor and bowel disorders in this case series. All patients had functional constipation and evidence of puborectalis dyssynergia. Physical therapy and behavioral counseling were offered to all. Patients completed the Patient Health Questionnaire, the Patient-Assessment of Constipation Symptom Questionnaire, and the Patient-Assessment of Constipation Quality of Life Questionnaire. Results  Sixteen patients successfully completed the program. Symptom severity decreased after physical therapy (2.1 ± 0.7 vs. 1.3 ± 0.9, P = 0.007). Quality of life also improved significantly (2.6 ± 0.8 vs. 1.5 ± 1.0, P = 0.007). Patients reported less physical discomfort, fewer worries/concerns, and indicated satisfaction with treatment. The difference in symptom severity was highly correlated with improvement in quality of life (r = 0.7, P = .005). Conclusions  Successful physical therapy for patients with puborectalis dyssynergia is associated with improvements in constipation-related symptoms and in quality of life. Presented at the American Urogynecologic Society Meeting, West Hollywood, Florida, September 27–29, 2007.     

Patient Satisfaction and Health-Related Quality of Life After Treatment for Colon Cancer

Purpose Health-related quality of life has become an important outcome in cancer treatment. Detailed health-related quality of life measures were taken as part of a trial of follow-up of patients with colon cancer by general practitioners and surgeons. This study was designed as a longitudinal assessment of health-related quality of life after treatment for carcinoma of the colon and patient satisfaction with two different settings of follow-up (general practitioners vs. surgeons). Methods A total of 338 patients were recruited into randomized (n = 203) and patient preference (n = 135) follow-up groups. Prospectively assessed physical and mental health-related quality of life measures and patient satisfaction are reported during two years. Results Elderly and less educated patients prefer follow-up by general practitioners over surgeons. Overall, physical health-related quality of life is reduced early after treatment; however, this returns to normal levels at one year. Mental quality of life, anxiety, and depression are at or above population levels throughout the two-year follow-up period. There were no differences in physical or psychologic health-related quality of life measures between general practitioner and surgeon groups at any time during follow-up. Overall, more advanced Dukes stage is associated with a trend to improved mental health-related quality of life. Patients’ ability to choose the setting of follow-up has no influence on health-related quality of life compared with random allocation to general practitioner or surgeon. Patients are equally highly satisfied with follow-up by general practitioner or surgeon. Conclusions After recovery from treatment for colon cancer, health-related quality of life is similar to the general population. Good health-related quality of life outcomes and high patient satisfaction are as well provided by general practitioners in the community setting as by surgeon review. Supported by the National Health and Medical Research Council of Australia, Cancer Council of South Australia. Reprints are not available.     

脑卒中生存质量量表中译本信度和效度及敏感度的初步研究

目的　引进并修订了Williams等编制的脑卒中生存质量量表 (SS QOL) ,并在我国脑卒中人群中进行信度、效度和敏感度的初步研究。方法　信度检验用加权kappa系数和Cronbach’sα系数来评价。采用人为推理判断方法评价内容效度 ;以Rankin量表分级作为外在效标来评估辨别效度 ;采用聚类分析方法考核量表的结构效度 ;通过相关分析考察量表的效标效度。各领域敏感度通过标准化效应大小 (SES)来评估 91例患者。结果　 3个月时实际随访评定 80例。SS QOL中译本各领域的重测信度和评定者间信度的kappa系数均在 0 .82～ 1.0 0之间 ;内容一致信度的Cronbach’sα系数在 0 .76以上 ,显示了良好的信度。以Rankin量表为外在效标的分组中 ,得分具有显著差异 ,具有良好的辨别效度。通过聚类分析将 12个领域聚为 6类。除“社会角色 (0 .10 )”和“视力 (0 .17)”领域外 ,SS QOL中译本各领域均显示了与对应的“准金标准”呈适度的相关性 (相关系数 0 .30～ 0 .84 ,P <0 .0 0 1)。大多数领域显示了理想的敏感度。结论　SS QOL中译本在轻、中度脑卒中患者中具有良好的信度、效度及敏感度 ,可用于脑卒中结局测量。     

Validity and reliability of the Japanese version of the Patient Assessment of Constipation Quality of Life questionnaire

Background

This study aimed to provide a psychometric evaluation of the Japanese version of the Patient Assessment of Constipation Quality of Life questionnaire (JPAC-QOL).

Methods

Data for scoring were collected prospectively from patients with constipation who visited our center from 2008 to 2010, and analyzed retrospectively. Reliability of the JPAC-QOL was evaluated using Cronbach’s alpha to calculate internal consistency, and a test–retest study was performed to evaluate reproducibility. For concurrent validity assessment, the JPAC-QOL scores were compared with Constipation Scoring System (CSS) scores. In assessing responsiveness, the JPAC-QOL scores before and after treatments were compared in patients whose modified CSS (mCSS) scores decreased by >50 %.

Results

Internal consistency was assessed in 295 patients (165 women; mean age 67.0 years). Cronbach’s alpha was >0.7 for the overall score and all four subscales, showing a strong internal consistency. The intraclass correlations for the 145 patients available for the test–retest study were >0.7 for the overall score and for all subscales except satisfaction. The JPAC-QOL scores were significantly associated with the CSS scores in 284 patients, demonstrating concurrent validity in all four subscales and the overall score. The mean JPAC-QOL score improved significantly after treatment in the 72 patients whose mCSS scores decreased by >50 %, indicating good responsiveness in all four subscales and in the overall score.

Conclusions

Our study data confirmed the validity and reliability of the JPAC-QOL and demonstrated it ready for use in evaluating the symptom-specific QOL in Japanese patients with constipation.     

中文版SF-36量表用于中国老年军人生活质量调查的信度与效度评价

目的 探讨美国简明健康测量量表SF-36用于中国老年军人生活质量测量的可能性。方法 采用分层、整体抽样法，使用SF-36量表中文版对西安地区934例老年军人的生活质量进行测定，参照国际生活质量评价项目的标准程序，进行正式的心理测量学试验。结果 本次研究中，SF-36量表中文版的分半信度为0．892；同质性信度系数除社会功能、心理健康2个维度，其它6个维度变化范围为0．70～0．93，满足群组比较的要求。除社会功能、心理健康维度外，其它6个维度条目的维度相关性一致；因子分析产生的8个共因子与理论结构基本一致，结构效度的累积方差贡献为68．56％。结论 SF-36健康调查量表可用于中国老年人的调查，同时提示在精神和心理方面的个别语句经进一步修订后，将提高调查的可行性及相关方面的信度和效度。     

Quality-of-Life Assessment of Patients After Ileal Pouch-Anal Anastomosis for Slow-Transit Constipation With Rectal Inertia

PURPOSE: Severe idiopathic constipation with rectal inertia represents a challenging medical problem that, in extremis, might warrant surgery. We studied a group of patients who have undergone proctocolectomy and ileal pouch-anal anastomosis for this problem. The purpose was to assess the functional success of this procedure and its impact on the social function of the patients. METHODS: Patients with functional, intractable constipation have one motion or less per week and are laxative-dependent. The indication for surgery was based on failure of long-term medical therapy. The selection criteria were normal colonoscopy, normal anal manometry and pudendal nerve latency test, and abnormal transit study and abnormal videoproctography. The functional outcome after surgery was assessed by anal manometry and stool frequency. Quality of life was analyzed using the Rand health survey 1.0 consisting of a comprehensive questionnaire used preoperatively and postoperatively with emphasis on physical function, role limitation because of functional/emotional problems, social function, pain, and general health. RESULTS: Fifteen patients (14 females) underwent ileal pouch-anal anastomosis over a seven-year period (1993–1999). The mean age was 41 (range, 25–47) years. All had a temporary defunctioning loop ileostomy fashioned, and there were no anastomotic leaks. Two patients required pouch excision within 18 months because of intractable pelvic pain. The mean stool frequency was eight (range, 3–12) per day at the first follow-up. At the second follow-up, this had improved to five (range, 2–6) per day. The mean resting and squeeze anal pressures preoperatively were 82 cm H2O and 104 mmHg, respectively, and were unchanged after surgery. Significant improvement in lifestyle scores were recorded in the categories of physical function, social function, and pain at the first follow-up and in all categories at the second follow-up (P < 0.05). CONCLUSION: Restorative proctocolectomy is an option in selected patients and leads to progressive improvement in quality of life.     

Long-Term Functional Assessment of Antegrade Colonic Enema for Combined Incontinence and Constipation Using a Modified Marsh and Kiff Technique

Purpose Constipation and fecal incontinence can severely affect quality of life for patients, particularly when simultaneously present. Malone antegrade colonic enema enables periodic colonic emptying, thus preventing uncontrolled passage of feces and constipation. Methods Eleven patients with fecal incontinence and severe constipation or perineal colostomy after Miles’ operation underwent a modified Marsh and Kiff ileostomy for antegrade colonic enema. Before and after surgery, the patients were fully evaluated for gastrointestinal functions, including gallbladder and stomach emptying time, H₂-breath test, colonic transit time, dynamic defecography, and anorectal manometry. The severity of incontinence and constipation was scored preoperatively and postoperatively by using the American Medical System score and Cleveland Clinic Constipation scale, respectively, whereas the quality of life was measured by the Gastrointestinal Quality of Life Index. The surgical technique involved division of the terminal ileum 10 to 15 cm from the ileocecal valve, anastomosis and intussusception of the ileum with the cecum, narrowing of the ileal conduit with a linear stapler, and a small, introflexed ileostomy with an advanced skin flap. Results During the postoperative period, the mean American Medical System score decreased significantly from 77 to 11 (P < 0.01) and the mean Cleveland Clinic Constipation score from 23 to 8.5 (P < 0.01) with a significant improvement of quality of life. Antegrade colonic enema did not affect gallbladder, gastric, or orocecal transit time, which remained comparable with baseline. Colonic scintigraphy showed that antegrade colonic enema was efficient to clean the whole colon and rectum, leaving only 24 (range, 6–40) percent of the initial radioactivity after 30 minutes. Ileal manometry confirmed the presence of a high-pressure zone, preventing accidental reflux. Conclusions Modified Marsh and Kiff technique is a safe and effective surgical option to treat patients with combined fecal incontinence and severe constipation and those with perineal colostomy after Miles. It should be recommended as a last option before colostomy. Presented in part as a poster at the meeting of the EACP and ECCP, Bologna, Italy, September 15 to 17, 2005. Reprints are not available.