疼痛患者心理障碍评估的项目反应理论分析与应用
发布时间：2018-08-08 14:47
【摘要】：目的：本研究以疼痛患者为研究对象，揭示传统测验理论、单维项目反应理论与多维项目反应理论评估其心理障碍的异同，，探讨项目反应理论在临床心理评估中应用的可能性，分析影响疼痛患者心理障碍程度的因素，为构建疼痛管理系统，指导临床实践提供依据。 方法：本研究通过多中心合作，抽取北京、西安、重庆、兰州等地10家医疗机构就诊的具有疼痛症状的患者进行问卷调查。采用医院焦虑抑郁量表（HAD）、患病行为问卷（IBQ）评估患者的心理障碍，应用视觉模拟评分法（VAS）、疼痛强度简易描述量表（VRS）和简化的麦-吉疼痛问卷（SF-MPQ）评估患者的疼痛程度，并对患者的性别、居住环境、所患疾病种类等一般因素进行了调查。应用因素分析等方法探讨了HAD、IBQ的结构，应用内部一致性系数评估了信度，进而利用单维IRT模型（GRM和2PL）和多维IRT模型（Bi-factor模型）对其条目和测验的信息量等进行了分析，并对不同的分析方法进行了对比。同时，也初步评估了三种疼痛程度测量工具的实用性。在此基础上，我们进一步应用相关分析及多元方差分析，探讨了疼痛程度及其他一般因素对于患者心理障碍程度的影响，为临床诊疗过程提供参考。 结果： 1. HAD和IBQ各维度的单维性都不太理想，对比CTT、单维IRT和Bi-factor模型的分析结果，我们发现Bi-factor模型更适合这两个量表的结构和条目特征，心理测量学指标也更理想； 2.应用Bi-factor模型进行分析，患者心理症状之间的关系更为清晰，而且症状的独特特点也得以体现； 3.对于患者疼痛程度的评估VAS量表应用性更好，而SF-MPQ则在患者疼痛性质等方面可以提供更全面的信息； 4.与男性疼痛患者相比，女性疼痛患者情绪的抑制状态更为明显； 5.与居住在城市的疼痛患者相比，居住在乡镇或县城的疼痛患者情绪的主动状态更为明显，而且不恰当的患病行为更为明显； 6.在疼痛患者当中，居住在城市的女性癌症患者和居住在乡镇或县城的女性急性疼痛患者心理障碍程度更为严重，诊疗过程中需要耐心沟通。 结论：IRT可以应用于临床心理症状的评估；多维特征明显的临床量表采用多维模型分析效果更好；疼痛患者的心理障碍程度与疼痛程度密切相关；性别、居住环境和疾病种类在一定程度上影响患者的心理障碍程度。但由于时间和精力有限，本研究仅对疼痛管理综合系统进行了初步构建，对其它临床心理评估的适用性还需进一步的论证。
[Abstract]:Objective: to explore the similarities and differences of traditional test theory, single dimensional item response theory and multidimensional item response theory in evaluating psychological disorders in patients with pain, and to explore the possibility of applying item response theory in clinical psychological evaluation. To analyze the factors that affect the degree of psychological disorder of pain patients, and to provide basis for the construction of pain management system and the guidance of clinical practice. Methods: the patients with pain symptoms in 10 medical institutions in Beijing, Xi'an, Chongqing and Lanzhou were investigated by multi-center cooperation. The mental disorders of patients were assessed by (HAD), (Hospital anxiety and Depression scale), (IBQ), (VAS), pain intensity simple description scale (VRS) and simplified Mai Ji pain questionnaire (SF-MPQ), which were used to evaluate the degree of pain of the patients. The general factors such as sex, living environment and kinds of diseases were investigated. The structure of HAD-IBQ is discussed by means of factor analysis, the reliability is evaluated by internal consistency coefficient, and the information content of items and tests is analyzed by using GRM and 2PL model and Bi-factor model. Different analysis methods are compared. At the same time, the practicability of three pain measurement tools was also preliminarily evaluated. On this basis, we further applied correlation analysis and multivariate analysis of variance to explore the influence of pain and other general factors on the degree of psychological disorders of patients, and to provide reference for clinical diagnosis and treatment. Results: 1. Compared with the results of CTT, IRT and Bi-factor models, we found that the Bi-factor model is more suitable for the structure and item characteristics of the two scales, and the psychometrics index is also more ideal. 2. Using Bi-factor model, the relationship between psychological symptoms of patients is more clear, and the unique characteristics of symptoms can be reflected; 3. The evaluation of pain degree of patients using VAS scale is better, while SF-MPQ can provide more comprehensive information on the nature of patients pain. 4. Compared with male pain patients, female pain patients' emotional inhibition was more obvious; 5. 5%. Compared with the pain patients living in the city, the pain patients living in towns or counties have more active emotional state, and the inappropriate disease behavior is more obvious. 6. Among the patients with pain, the psychological disorders of female cancer patients living in cities and women living in towns or counties are more serious, and patient communication is needed in the diagnosis and treatment process. Conclusion the weight IRT can be used to evaluate the clinical psychological symptoms, the multi-dimensional clinical scale with obvious characteristics is more effective, the degree of psychological disorders of pain patients is closely related to the degree of pain, gender, The living environment and the type of disease affect the degree of psychological disorder to some extent. However, due to limited time and energy, this study only preliminarily constructed the pain management system, and the applicability of other clinical psychological evaluation needs further demonstration.
【学位授予单位】：第四军医大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：B841;R395
本文编号：2172125
[Abstract]:Objective: to explore the similarities and differences of traditional test theory, single dimensional item response theory and multidimensional item response theory in evaluating psychological disorders in patients with pain, and to explore the possibility of applying item response theory in clinical psychological evaluation. To analyze the factors that affect the degree of psychological disorder of pain patients, and to provide basis for the construction of pain management system and the guidance of clinical practice. Methods: the patients with pain symptoms in 10 medical institutions in Beijing, Xi'an, Chongqing and Lanzhou were investigated by multi-center cooperation. The mental disorders of patients were assessed by (HAD), (Hospital anxiety and Depression scale), (IBQ), (VAS), pain intensity simple description scale (VRS) and simplified Mai Ji pain questionnaire (SF-MPQ), which were used to evaluate the degree of pain of the patients. The general factors such as sex, living environment and kinds of diseases were investigated. The structure of HAD-IBQ is discussed by means of factor analysis, the reliability is evaluated by internal consistency coefficient, and the information content of items and tests is analyzed by using GRM and 2PL model and Bi-factor model. Different analysis methods are compared. At the same time, the practicability of three pain measurement tools was also preliminarily evaluated. On this basis, we further applied correlation analysis and multivariate analysis of variance to explore the influence of pain and other general factors on the degree of psychological disorders of patients, and to provide reference for clinical diagnosis and treatment. Results: 1. Compared with the results of CTT, IRT and Bi-factor models, we found that the Bi-factor model is more suitable for the structure and item characteristics of the two scales, and the psychometrics index is also more ideal. 2. Using Bi-factor model, the relationship between psychological symptoms of patients is more clear, and the unique characteristics of symptoms can be reflected; 3. The evaluation of pain degree of patients using VAS scale is better, while SF-MPQ can provide more comprehensive information on the nature of patients pain. 4. Compared with male pain patients, female pain patients' emotional inhibition was more obvious; 5. 5%. Compared with the pain patients living in the city, the pain patients living in towns or counties have more active emotional state, and the inappropriate disease behavior is more obvious. 6. Among the patients with pain, the psychological disorders of female cancer patients living in cities and women living in towns or counties are more serious, and patient communication is needed in the diagnosis and treatment process. Conclusion the weight IRT can be used to evaluate the clinical psychological symptoms, the multi-dimensional clinical scale with obvious characteristics is more effective, the degree of psychological disorders of pain patients is closely related to the degree of pain, gender, The living environment and the type of disease affect the degree of psychological disorder to some extent. However, due to limited time and energy, this study only preliminarily constructed the pain management system, and the applicability of other clinical psychological evaluation needs further demonstration.
【学位授予单位】：第四军医大学
【学位级别】：博士
【学位授予年份】：2012
【分类号】：B841;R395
【引证文献】
相关期刊论文 前1条
1 刘莉;谭秦东;郭春华;;右美托咪定对下腹部手术全麻患者苏醒期影响[J];解放军医药杂志;2015年02期
本文编号：2172125
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