中文版脑瘫患儿生活质量问卷的维度结构和项目分析

The dimensional structure and an item analysis of the cerebral palsy quality of life questionnaire for children(Chinese version)

目的采用Rasch模型中的多维项目反应模型和单维Rasch模型分析中文版脑瘫患儿生活质量问卷(CPQOL)的维度结构和项目特性。方法以2008年9月至2014年6月在上海市松江区方松街道社区卫生服务中心、复旦大学附属儿科医院康复中心等5家医疗康复机构接受康复干预的4~12岁的脑瘫患儿家庭为研究对象,共纳入90例脑瘫患儿及其家长。采用中文版CPQOL问卷评价90例脑瘫患儿的生活质量,最终收集140人次CPQOL问卷。通过多维项目反应模型分析CPQOL各个分区间的相关性,确定量表各分区间是否具有良好的内部一致性,通过合并或拆分分别进行主维度和次维度的单维Rasch分析,以此形成修订版的CPQOL问卷的主问卷和附加问卷。结果多维项目反应模型分析显示,CPQOL问卷中社会福祉和受容度、功能、参与能力与躯体健康、情绪健康与自尊4个分区间的相关系数均大于0.90,表明以上4个分区具有很好的内部一致性,可以作为主维度进行分析,其余3个分区间的相关系数相对较低,可分别作为次维度进行分析。采用单维Rasch分析形成了由40个项目组成的修订版CPQOL主问卷,8个项目组成的疼痛与残障影响附加问卷,6个项目组成的获得服务附加问卷以及3个项目组成的家庭健康附件问卷,与原版65个项目相比,被删除的8个项目集中于患儿与兄弟姐妹的关系、提供喘息服务、社区和学校的服务等项目。结论采用中文版CPQOL问卷符合目前关于生活质量评价的概念框架,但在上海市或者国内其他城市脑瘫患儿中开展生活质量评估还需根据文化背景特征进行适当的调整。

Objective To analyze the dimensional structure and the item characteristics of the Chinese version of the cerebral palsy quality of life questionnaire for children(CPQOL-child).Methods Multi-dimensional and single-dimensional item response models were used.Ninety children aged 4 to 12 with cerebral palsy were evaluated using the CPQOL-child.The internal consistency was determined by analyzing the correlations among the different dimensions using a multi-dimensional response model.Dimensions were merged or split based on a one-dimensional Rasch analysis of the primary and secondary dimensions to revise the main and additional questionnaires.Results The multi-dimensional item response model analysis found greater than 0.90 correlation among the four dimensions of social well-being and tolerance,function,participation ability and physical health,and emotional health and self-esteem,showing that they have good internal consistency and could be analyzed as the primary dimension.The correlation coefficients relating the other three dimensions were relatively low and could be analyzed as secondary dimensions.A single-dimension Rasch analysis was used to form a revised CPQOL main questionnaire consisting of 40 items,with three additional questionnaires for pain and disability impact consisting of 8 items,for access to services consisting of 6 items,and for family health consisting of 3 items.Compared with the original 65 items,the 8 items deleted were mainly about relationships between children and with siblings,providing respite services,as well as community and school services.Conclusions Applying the Chinese version of the CPQOL-Child in Shanghai requires appropriate adjustments based on the children′s cultural background.