糖尿病肾脏疾病PRO量表的初步修订

发布时间：2018-02-16 17:48

本文关键词： 糖尿病肾脏疾病 PRO量表修订　出处：《广州中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：应用经典测量理论对前期建立的糖尿病肾病患者报告结局量表(DNPR0)进行修订,以期形成一个比较成熟的可供临床应用的糖尿病肾脏疾病患者报告临床结局测量工具(DKDPR0),丰富糖尿病肾脏疾病病情及疗效评估的手段。方法：参照国内外PRO量表的修订原理,首先通过核心工作小组讨论对问卷外观及题干进行修订,形成DKDPR0-1。通过专家咨询以及对DKD患者、非糖尿病肾病患者、糖尿病无肾损害患者、健康志愿者的临床调查,对DKDPR0-1进行可行性分析、信度评价、效度评价、反应度评价。信度评价包括内部一致性信度、分半信度、重测信度考核。效度评价包括内容效度、标准关联效度、结构效度考核。通过专家重要性评分法、离散趋势法、条目分布考察法、克朗巴赫系数法、区分度分析法、相关系数法对DKDPR0-1条目进行筛选,根据专家咨询、前期研究以及本次调查增加部分条目、修订条目题干通过横断面调查对问卷应答尺度进行测试,修订后的量表命名为DKDPR0-2。结果：核心工作小组经过讨论,修订了问卷外观及题干语句,譬如调整字体大小及行距,修改语句冗长或使用术语的题目,拆分多重语义的题目,合并语义相近的题目,删除与DKD关联性弱的题目,修订后的量表命名为DKDPR0-1。DKDPR0-1可行性分析：纳入调查的80名DKD患者完成量表的时间为16.9±5.1分钟,接受率为88.9%,完成率为92.5-100%。信度考核：DKDPR0-1及其生理领域、心理领域、社会领域的Cronbach's a系数分别为0.886、0.853、0.873、0.674。DKDPR0-1及其生理领域、心理领域、社会领域分半信度分别为0.849、0.794、0.899、0.766。20名DKD患者两次调查结果配对t检验差异无显著性(P0.05), DKDPR0-1及其生理领域、心理领域、社会领域的重测信度系数分别为0.933、0.902、0.960、0.965(均P0.001)。效度考核：专家咨询的内容效度指数为0.91。DKDPRO-1与SF-36的效标关联系数为0.213,两者生理、心理、社会领域的效标关联系数分别为0.274、0.487、0.493。结构效度：相关系数法提示除了条目13、25、36、48,其余条目与所属领域的相关系数均大于与其它领域的相关系数。KMO值为0543, Bartlett球形检验P值0.001,17个公因子累计贡献率74.661%。不适合进行因子分析。反应度考核：DKD Ⅴ期患者与糖尿病无肾损害患者、DKD各期患者与健康志愿者量表总分均值相比差异均有统计学意义(均P0.05),量表能区分DKD Ⅴ期患者与糖尿病无肾损害患者以及DKD各期患者与健康志愿者。通过专家重要性评分法等6种方法删除DKDPRO-1生理领域7个条目：3、4、6、18、34、36、38,修订条目17、50、51题干,拟在今后第二轮专家咨询中增加3个条目：解泡沫尿、大便干结、治疗信心。应答尺度考核：问卷所选副词均值大都靠近2.5、5.0、7.5,中位数均在2-3、4.5-5.5、7.0-8.0范围内。结论：DKDPR0-1可行性较高,具有较好的内部一致性信度、分半信度、重测信度、内容效度、反应度,标准关联效度以及结构效度欠佳,有待优化。问卷所用副词能把症状、体征或情感体检的不同频率或程度区分开,但等距性欠佳。需全国多中心调研评价DKDPR0-2的性能。
[Abstract]:Objective: the application of classical measurement theory of pre established diabetic nephropathy patients report outcome scale (DNPR0) were revised, in order to form a more mature report for clinical application in patients with diabetic kidney disease clinical outcome measurement tools (DKDPR0), rich in assessing the diabetes kidney disease severity and efficacy method. Methods: according to the revised PRO scale principle at home and abroad, firstly through the core working group to discuss the revision of the questionnaire and the appearance of the stem, the formation of DKDPR0-1. through expert consultation and for DKD patients, patients with non diabetic nephropathy, diabetic patients without renal damage and clinical investigation of healthy volunteers, to conduct a feasibility analysis of DKDPR0-1 to evaluate the reliability, validity and response evaluation of reliability evaluation. Including internal consistency reliability, split half reliability, test-retest reliability assessment. The validity evaluation included content validity, criterion related validity, structure Assessment of the validity. The importance through the expert scoring method, discrete trend method, item distribution investigation method, Krone Bach coefficient method, discrimination analysis method, correlation coefficient method of DKDPR0-1 item selection, according to the expert consultation, preliminary studies and the investigation of some items, the revised entry stem through a cross-sectional survey of questionnaire response scale test the revised scale, named DKDPR0-2. core working group results: after discussion, revision of the questionnaire and the appearance of the stem of statements, such as adjust the font size and line spacing, modify or use the terms of the long sentence topic, split multiple semantic topics with similar semantic topics, delete and Title DKD weak relevance. The revised scale named DKDPR0-1.DKDPR0-1 feasibility analysis: 80 DKD patients were included in the investigation of the completed time was 16.9 + 5.1 minutes, the acceptance rate of 88.9%, the completion rate 92.5-100%. reliability assessment: DKDPR0-1 psychological and physiological field, field, social field Cronbach's a coefficients were 0.886,0.853,0.873,0.674.DKDPR0-1 and physiological domain, psychological domain, social domain split half reliability were the results of the two survey of 0.849,0.794,0.899,0.766.20 patients with DKD paired t test showed no significant difference (P0.05), DKDPR0-1 and physiological psychological field, social field. The test-retest reliability coefficients were 0.933,0.902,0.960,0.965 (P0.001). Assessment of the validity: the content validity index expert consultation for 0.91.DKDPRO-1 and SF-36 criterion related coefficient is 0.213, both physiological and psychological, the correlation coefficient were 0.274,0.487,0.493. standard structure validity of the social field effect: the correlation coefficients suggest that in addition to the entry 13,25,36,48, the correlation coefficient of the rest with the entry field were greater than the correlation coefficient of.KMO and other fields A value of 0543, Bartlett test P value 0.001,17 a common factor the cumulative contribution rate of 74.661%. is not suitable for factor analysis. The reaction degree assessment: Patients with diabetes DKD stage without renal damage in patients with DKD patients and healthy volunteers scale score had a significant difference (P0.05), the scale can distinguish patients with diabetes DKD stage without renal damage patients and DKD patients and healthy volunteers. 7 items removed by DKDPRO-1 physical domain experts importance rating method of 6 methods: 3,4,6,18,34,36,38, 17,50,51 revised entry stem, intends to increase 3 items in the second round of expert consultation: bubble urine, dry stool, treatment answer: the questionnaire assessment scale of confidence. The selected adverbs mean most close to 2.5,5.0,7.5, was in the range of 2-3,4.5-5.5,7.0-8.0. Conclusion: DKDPR0-1 has good high feasibility. The internal consistency reliability, split half reliability, test-retest reliability, content validity, responsiveness, criterion related validity and structure is unsatisfactory, needs to be optimized. The questionnaire can separate the adverbs of symptoms, signs or emotional examination of different frequency or degree, but are poor. For the multi center research evaluation DKDPR0-2 performance.

【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R259

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