SF-36量表第2版应用于住院慢性心力衰竭患者的信效度分析

Reliability and validity of SF-36 （v. 2） scale in hospitalized patients with chronic heart failure Reliability and validity of SF-36 （v. 2） scale in hospitalized patients with chronic heart failure

目的：探讨中文版SF-36量表第2版用于评价住院慢性心力衰竭患者生命质量的适用性。方法于2013年9月—2014年12月,采用目的抽样的方法选取年龄在18周岁以上、精神正常、能够自我表达的某三级甲等医院心内科住院并经临床医师诊断为慢性心力衰竭的患者（ NYHA Ⅰ～Ⅳ级）作为调查对象,共159例。对调查对象进行问卷调查,内容包括一般情况调查和SF-36量表第2版。通过内部一致性信度、折半信度、结构效度等指标来评定SF-36量表第2版的测量学性能。结果共发问卷159份,收回有效问卷159份。 SF-36量表第2版生理职能（ PF）、生理职能（ RP）、躯体疼痛（ BP）、总体健康（GH）、活力（VT）、社会功能（SF）、情感职能（RE）和精神健康（MH）8个维度,得分转换分分别为（41.57±24.86）,（48.35±21.64）,（69.18±25.68）,（31.28±16.01）,（48.90±19.53）,（45.05±22.76）,（59.43±24.31）,（57.55±19.03）分；地板效应分别为2.5%,4.4%,3.1%,4.4%,3.1%,6.3%,0.6%,1.3%；天花板效应分别为0.0%,3.8%,21.4%,0.0%,0.0%,1.9%,3.1%,0.0%。所有条目集合效度均达到标准（r≥0.4）,总成功率为100.00%；区分效度RP、BP、RE和SF维度成功率达到100.00%,其余PF、GH、VT、MH 4个维度分别为95.71%,85.71%,89.29%,94.29%,总区分效度成功率94.69%。内部一致性信度范围为0.738～0.919,折半信度范围在0.808～0.963。因子分析产生两个公因子,分别代表生理健康和心理健康,累计方差贡献为61.66%。结论 SF-36量表第2版作为第1版修订版,问题和答案布局更友好,地板效应和天花板效应降低,评价住院慢性心力衰竭患者生命质量有较好的信效度,可用于住院慢性心力衰竭患者的生命质量评价。

Objective To evaluate the applicability of the Chinese version of SF-36 （ v. 2 ） scale for evaluating the quality of life of hospitalized patients with chronic heart failure. Methods From September 2013 to December 2014, 159 patients with chronic heart failure（NYHA I-IV）, who were older than 18 years, clear mind and well self-expressed, were selected as participants. Questionnaire surveys included general survey and SF-36（v. 2） scale. Internal consistency reliability, binary reliability and construct validity were all analyzed as indicators to evaluate SF-36 （ v. 2 ） scale. Results A total of 159 questionnaires were issued and 159 valid questionnaires were recovered. The eight dimensions of SF-36（v. 2） scale including physical function （PF）, role-physical （RP）, bodily pain （BP）, general health （GH）, social function （SF）, vitality （VT）, role-emotion（RE）, and mental health （MH） score conversion were （41.57 ±24.86）, （48.35 ±21.64）, （69.18 ± 25. 68）, （31. 28 ± 16. 01）, （48. 90 ± 19. 53）, （45. 05 ± 22. 76）, （59. 43 ± 24. 31）, （57. 55 ± 19. 03）; the floor effects were 2. 5%, 4. 4%, 3. 1%, 4. 4%, 3. 1%, 6. 3%, 0. 6%, 1. 3%; the ceiling effects were 0. 0%, 3. 8%, 21. 4%, 0. 0%, 0. 0%, 1. 9%, 3. 1%, 0. 0%. The item-convergent validity all achieved the standard （r≥0. 4）, and the total scaling success rate of item-convergent was 100. 00%; the dimensions′success rates of item-discriminant validity of RP, BP, RE and SF were all 100%, the rest of four dimensions were PF 95. 71%, GH 85. 71%, VT 89. 29%, MH 94. 29%, and the total success rate was 94. 69%. Internal consistency reliability ranged from 0. 738 to 0. 919; the binary reliability ranged from 0. 808 to 0. 963. Within factors analysis, two common factors were confirmed, separately representing physical health and mental health, altogether making contribution of 61. 66% cumulative variance. Conclusions As the revision of SF-36（v. 1）, SF-36（v. 2） scale seemed more friendly in layout for questions and answers, the floor and ceiling effects significantly reduced. Additionally, it also shows good reliability and validity in the evaluation of quality of life of hospitalized patients with chronic heart failure, and the SF-36（v. 2） scale can be used to evaluate the quality of life （ QOL） of patients with chronic heart failure.