普查版视疲劳量表的研制及评价

Development of an asthenopia survey questionnaire for general surveys

目的设计能够用于人群普查的视疲劳量表。方法横断面研究。本研究按3个阶段纳入受试者:(1)量表调整阶段:2016年5月采用方便抽样法在温州市公共场所抽取150名有视疲劳主诉的受试者,采用专业版视疲劳量表(ASQ-19)进行调查并对量表进行调整。(2)量表验证阶段:2016年6月至2017年5月纳入温州医科大学附属眼视光医院门诊患者200例,依据门诊诊断分为视疲劳组和对照组,采用调整后的视疲劳量表进行调查,对量表进行验证。(3)量表重测阶段:2022年7月,连续纳入符合纳入标准的温州医科大学附属眼视光医院门诊患者64例,采用调整后的视疲劳量表进行调查,并于1周后再次调查。在量表调整阶段采用因子分析和使用反馈对ASQ-19的计分模式和条目进行调整,并于验证和重测阶段对调整后的量表进行信度、效度、准确度和受试者依从性等分析。结果共纳入403名受试者,发放456份量表,最终收回379名受试者的432份有效量表,量表有效率94.7%。量表调整阶段共纳入140名受试者(140份有效量表),其中男性56名,女性84名;年龄为(35.2±12.4)岁。量表验证阶段先纳入186名受试者(186份有效量表),包括视疲劳组62名,对照组124名。量表重测阶段则纳入53名受试者(106份有效量表),其中男性20名,女性33名;年龄为(22.8±4.9)岁。经过因子分析,调整后的量表采用“强度”计分模式,即症状程度分别为“没有”“轻度”“中度”“较重”“严重”,分别对应0、1、2、3和4分,总分44分;根据评估结果最终保留ASQ-19的11个条目(编号1、2、3、5、6、8、10、15、17、18、19)形成普查版视疲劳量表(ASQ-11)。ASQ-11的克龙巴赫α系数为0.89,折半信度为0.82,重测Pearson相关系数为0.90(P<0.001);结构效度为51.26%,判别效度t值为9.19(P<0.001);受试者平均用时(2.82±0.43)min;受试者工作特征曲线的截断值为8.5时,灵敏度为74.19%,特异度为80.65%。结论ASQ-11条目较少、完成耗时短、易于受试者配合,适合用于人群视疲劳筛查或自评,便于开展视疲劳相关的临床及流行病学调查研究。

Objective To design a visual fatigue questionnaire that can be used for population surveys.Methods This was a cross-sectional study that involved three stages of subjects′recruitment.In the first stage,by convenience sampling,150 individuals who complained of visual fatigue were selected at public places in Wenzhou City in May 2016.The 19-Item Asthenopia Survey Questionnaire(ASQ-19)was used to conduct the survey,and the questionnaire was adjusted.In the second stage,200 outpatient participants were recruited from Wenzhou Medical University Affiliated Eye and Optometry Hospital from June 2016 to May 2017 and were divided into a visual fatigue group and a control group based on clinical diagnosis.The adjusted visual fatigue questionnaire was used for validation.In the third stage,64 outpatient participants who met the inclusion criteria were continuously recruited from the Wenzhou Medical University Affiliated Eye and Optometry Hospital in July 2022.They were tested using the adjusted visual fatigue questionnaire and retested one week later.During the questionnaire adjustment stage,factor analysis and feedback were used to adjust the scoring method and items of the ASQ-19 questionnaire.The adjusted questionnaire was then analyzed for reliability,validity,accuracy,and subject acceptance during the validation and retest stages.Results A total of 403 participants were included,and 456 questionnaires were distributed.Eventually,432 valid questionnaires were collected from 379 participants,resulting in a valid response rate of 94.7%.During the questionnaire adjustment phase,there were 140 valid questionnaires from 140 participants consisting of 56 males and 84 females with an average age of(35.2±12.4)years.In the questionnaire validation phase,there were 186 valid questionnaires from 186 participants.Sixty-two participants had visual fatigue and 124 were controls.During the questionnaire retesting phase,53 participants yielded 106 valid questionnaires.The group consisted of 20 males and 33 females with an average age of(22.8±4.9)years.After factor analysis,the symptom severity graded as none,mild,moderate,severe,and very severe was scored as 0,1,2,3,and 4 points,respectively.The total score was 44,and the final questionnaire consisted of 11 items(numbered 1,2,3,5,6,8,10,15,17,18,and 19).The 11-Item Asthenopia Survey Questionnaire(ASQ-11)had a Cronbach′sαcoefficient of 0.89,a split-half reliability of 0.82,and a test-retest Pearson correlation coefficient of 0.90(P<0.001).The structural validity was 51.26%,and the discriminative validity was a t-value of 9.19(P<0.001).On average,it took(2.82±0.43)minutes for participants to complete the questionnaire.The receiver operating characteristic curve had a cutoff value of 8.5,with a sensitivity of 74.19%and a specificity of 80.65%.Conclusion The ASQ-11,with fewer items and a shorter completion time,is easy for participants to use and is suitable for screening or self-assessment of visual fatigue in the general population.Additionally,it is convenient for clinical and epidemiological studies related to visual fatigue.