中文版瘙痒患者生活质量问卷信效度及敏感性验证

Evaluation of reliability,validity and sensitivity of the Chinese version of pruritus-specific quality of life instrument

目的检验中文版瘙痒患者生活质量问卷(ItchyQoL)的信效度以及敏感性。方法对英文版ItchyQoL进行翻译、回译和文化调试,确定中文版问卷条目。2019年1-12月于北京大学第一医院皮肤科门诊纳入218例皮肤源性瘙痒患者进行调查研究。在患者入组时和入组后2周使用中文版ItchyQol问卷、皮肤病学生活质量指数(DLQI)、数值评定量尺(NRS)进行评估。采用验证性因子分析中文版ItchyQoL的结构效度,Cronbach′sα系数估计问卷内部一致性。采用Spearman相关系数分析中文版ItchyQoL与DLQI、NRS评分的相关性(聚合效度)以及中文版ItchyQoL、DLQI、NRS变化量的相关性(敏感性)。结果中文版ItchyQoL共计22个条目,包含“症状”、“功能活动”和“情绪”三个维度,这些维度的Cronbach′sα系数分别为0.946、0.883、0.953,提示内部一致性极好。在入组后2周时,NRS与ItchyQoL总分强相关(rs=0.700,P<0.01),与“情绪”、“功能活动”、“症状”维度评分均呈中度相关(rs分别为0.452、0.673、0.692,均P<0.01);DLQI与ItchyQoL总分强相关(rs=0.887,P<0.01),与“功能活动”、“症状”维度评分呈强相关(rs分别为0.886、0.750,均P<0.01),与“情绪”维度评分呈中度相关(rs=0.674,P<0.01)。与入组时比,2周后ItchyQoL问卷总分的变化量与NRS变化量呈中度相关(rs=0.642,P<0.01),与DLQI变化量呈强相关(rs=0.757,P<0.01);ItchyQoL问卷中“症状”与“功能活动”评分的变化量与NRS变化量分别呈中度相关(rs分别为0.648,0.549,均P<0.01),“情绪”评分变化量与NRS变化量呈弱相关(rs=0.225,P<0.01);ItchyQoL问卷中“症状”与“功能活动”评分的变化量与DLQI变化量均呈强相关(rs分别为0.755,0.703,均P<0.01),“情绪”评分变化量与DLQI变化量呈中度相关(rs=0.401,P<0.01)。而且,入组2周后不同NRS和DLQI评分组间患者中文版ItchyQoL问卷总分和各维度评分差异均有统计学意义(均P<0.05)。结论中文版ItchyQoL具有良好的信效度,可用于我国皮肤源性瘙痒患者生活质量的评估。

Objective To evaluate the reliability,validity and sensitivity of the Chinese version of pruritus-specific quality of life instrument(ItchyQoL).Methods Based on the English version of ItchyQoL,items of the Chinese version of ItchyQoL were determined after forward-backward translation and cultural adaption.Totally,218 patients with pruritus caused by skin diseases were enrolled from Department of Dermatology,Peking University First Hospital from January to December 2019,and a questionnaire survey was conducted.At the time of enrollment and 2 weeks after enrollment,the Chinese version of ItchyQoL,dermatology life quality index(DLQI)and numerical rating scale(NRS)were used to evaluate the effect of pruritus on the quality of life of patients.Confirmatory factor was used to assess the structural validity of the Chinese version of ItchyQoL,and Cronbach′sαcoefficient was used to estimate its internal consistency reliability.Spearman correlation coefficient was used to analyze correlations(convergent validity)of the Chinese version of ItchyQoL score with DLQI and NRS scores,and correlations(sensitivity)of changes in the Chinese version of ItchyQoL score with changes in DLQI and NRS scores.Results The Chinese version of ItchyQoL contained a total of 22 items,including 3 dimensions,i.e.,"symptoms","functions"and"emotions",with the Cronbach′sαcoefficients being 0.946,0.883 and 0.953 respectively,suggesting excellent internal consistency.At 2 weeks after enrollment,the NRS score was strongly correlated with the total ItchyQoL score(rs=0.700,P<0.01),and moderately correlated with the subscores of"emotions","functions"and"symptoms"(rs=0.452,0.673,0.692 respectively,all P<0.01);the DLQI score was also strongly correlated with the total ItchyQoL score(rs=0.887,P<0.01)and the subscores of"functions"and"symptoms"(rs=0.886,0.750 respectively,both P<0.01),and moderately correlated with the"emotions"subscore(rs=0.674,P<0.01).Compared with the scores at the time of enrollment,the change in the total ItchyQoL score after 2 weeks was moderately correlated with the change in the NRS score(rs=0.642,P<0.01),and strongly correlated with the change in the DLQI score(rs=0.757,P<0.01);the changes in"symptoms"and"functions"subscores were moderately correlated with the change in the NRS score(rs=0.648,0.549 respectively,both P<0.01),while there was a weak correlation between the changes in"emotions"subscore and NRS score(rs=0.225,P<0.01);the changes in"symptoms"and"functions"subscores were strongly correlated with the change in the DLQI score(rs=0.755,0.703 respectively,both P<0.01),while the change in"emotions"subscore was moderately correlated with the change in the DLQI score(rs=0.401,P<0.01).Moreover,the total score of the Chinese version of ItchyQoL and subscores of"symptoms","functions"and"emotions"all significantly differed among different NRS and DLQI score groups at 2 weeks after enrollment(all P<0.05).Conclusion The Chinese version of ItchyQoL has good reliability and validity,and can be used to evaluate the quality of life of patients with pruritus caused by skin diseases in China.