纵向多分类项目反应理论评估阿尔茨海默病生命质量的反应转移
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摘要
目的探讨阿尔茨海默病(Alzheimer's disease,AD)患者在入院治疗后的生命质量测评中是否发生反应转移(response shift,RS),分析反应转移的类型并评估生命质量的真实改变。方法采用SF-12量表分别在住院前和出院后一个月对238名60岁以上的AD患者进行生命质量的评价,从量表条目水平,运用纵向多分类项目反应理论(Longitudinal Polytomous Item Response Theory,LPIRT)探讨患者生命质量测评中的反应转移现象。结果条目2(2)发生了内在评价标准的改变(G=9.90,P<0.05),考虑到该改变后,维度生理功能(physical functioning,PF)在两次测量间没有发生改变(-0.039,■=0.03,P>0.05)。条目6(1)的内在评价标准(G=26.58,P<0.05)和价值观(G=20.67,P<0.05)均发生了反应转移;条目6(3)的内在评价标准发生了变化(G=8.58,P<0.05)。考虑条目6(1)(3)中的改变后,维度心理健康(mental health,MH)的真实改变为发生恶化(-8.824,■=5236.83,P<0.001)。结论 AD患者在入院治疗后可能发生两种类型的反应转移,评价患者生命质量变化时应考虑反应转移。
Objective To detect response shifts(RS)and true changes in quality of life(QOL)in patients with Alzheimer's Disease(AD)after discharge.Methods The life quality of 238 patients with AD aged 60 years or older prior to hospitalization and one month after discharge was measured by using 12-item Short Form(SF-12).RS was detected by Longitudinal Polytomous Item Response Theory(LPIRT)in item level.Results The results showed recalibration(G=9.90,P<0.05)of item 2(2).With RS taken into account,the true change estimated in the domain of physical functioning was not statistically significant(-0.039,■=0.03,P>0.05).Reprioritization(G=20.67,P<0.05)and recalibration(G=26.58,P<0.05)on item 6(1)of the domain of MH were detected.Recalibration(G=8.58,P<0.05)was detected in item 6(3).With RS taken into account,the true changes of the domain of mental health deteriorated(-8.824,■=5236.83,P<0.001).Conclusion Two types of reaction metastases may occur in AD patients after admission,and response shifts should be considered when evaluating changes in patient quality of life.
Objective To detect response shifts(RS)and true changes in quality of life(QOL)in patients with Alzheimer's Disease(AD)after discharge.Methods The life quality of 238 patients with AD aged 60 years or older prior to hospitalization and one month after discharge was measured by using 12-item Short Form(SF-12).RS was detected by Longitudinal Polytomous Item Response Theory(LPIRT)in item level.Results The results showed recalibration(G=9.90,P<0.05)of item 2(2).With RS taken into account,the true change estimated in the domain of physical functioning was not statistically significant(-0.039,■=0.03,P>0.05).Reprioritization(G=20.67,P<0.05)and recalibration(G=26.58,P<0.05)on item 6(1)of the domain of MH were detected.Recalibration(G=8.58,P<0.05)was detected in item 6(3).With RS taken into account,the true changes of the domain of mental health deteriorated(-8.824,■=5236.83,P<0.001).Conclusion Two types of reaction metastases may occur in AD patients after admission,and response shifts should be considered when evaluating changes in patient quality of life.
引文
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[11] 李鲁.社会医学[M].4版.北京:人民卫生出版社,2012.
[12] Schwartz CE,Bode R,Repucci N,et al.The clinical significance of adaptation to changing health:A meta-analysis of response shift[J].Quality of Life Research,2006,15(9):1533-1550.
[13] Barclay-Goddard R,Epstein JD,Mayo NE.Response shift:a brief overview and proposed research priorities[J].Quality of Life Research,2009,18(3):335-346.
[14] Verdam MG,Oort FJ,Sprangers MA.Using structural equation modeling to detect response shifts and true change in discrete variables:an application to the items of the SF-36[J].Quality of Life Research,2016,25(6,SI):1361-1383.
[2] Sprangers MA,Schwartz CE.Integrating response shift into health-related quality of Life research:a theoretical model[J].Social Science & Medicine,1999,48(11):1507-1515.
[3] 傅丽,关颖,邓娟,等.HABILITATION护理模式对轻中度阿尔茨海默病患者生活质量的影响[J].护理实践与研究,2016,13(19):26-29.
[4] 王卓,慕江兵,刘蕊,等.社区护理干预对老年性痴呆患者生存质量的影响[J].现代预防医学,2010,37(5):840-841,844.
[5] 刘盼盼.社区高血压患者生命质量评价中的反应转移现象[D].杭州:浙江大学,2009.
[6] Guilleux A,Blanchin M,Vanier A,et al.RespOnse shift ALgorithm in item response theory(ROSALI)for response shift detection with missing data in longitudinal patient-reported outcome studies[J].Quality of Life Research,2015,24(3):553-564.
[7] McKhann GM,Knopman DS,Chertkow H,et al.The diagnosis of dementia due to Alzheimer’s disease:recommendations from the National Institute on Aging-Alzheimer’s Association workgroups on diagnostic guidelines for Alzheimer’s disease[J].Alzheimer’s & Dementia,2011,7(3):263-269.
[8] 廖远航.简易智能精神状态检查量表在老年痴呆患者中的应用研究[J].世界最新医学信息文摘,2018,18(11):26-27.
[9] 肖惠敏,邝惠容.SF-12量表评价中国老年人生存质量的信度和效度分析[J].中国老年学杂志,2014,34(4):1018-1020.
[10] Ware JE,Kosinski MA,Keller SD.How to Score the SF-12 Physical and Mental Health Summary Scale[M].2nd ed.Boston:The Health Institute,1995:21-23.
[11] 李鲁.社会医学[M].4版.北京:人民卫生出版社,2012.
[12] Schwartz CE,Bode R,Repucci N,et al.The clinical significance of adaptation to changing health:A meta-analysis of response shift[J].Quality of Life Research,2006,15(9):1533-1550.
[13] Barclay-Goddard R,Epstein JD,Mayo NE.Response shift:a brief overview and proposed research priorities[J].Quality of Life Research,2009,18(3):335-346.
[14] Verdam MG,Oort FJ,Sprangers MA.Using structural equation modeling to detect response shifts and true change in discrete variables:an application to the items of the SF-36[J].Quality of Life Research,2016,25(6,SI):1361-1383.
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