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Design of Visualized Self-assessment Questionnaire for Patients with Knee Osteoarthritis
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摘要:
目的 制定《图示化膝关节炎患者自我评估问卷》, 旨在促进膝关节炎患者的自我评估, 协助疾病的长期管理。 方法 检索PubMed、中国知网等多个国内外文献数据库, 参考现有关节炎评分量表及患者临床主诉, 建立问卷的维度与条目池。邀请90名骨科医生对条目的可理解性、重要性、可行性等进行评分。召开共15名资深骨科专家参与的咨询会, 基于骨科医生的评分排序结果优化问卷, 并对77例膝关节炎患者进行预调查, 征集对问卷的意见与反馈, 再次召开专家咨询会, 进一步优化问卷条目与图案, 形成问卷初稿。 结果 问卷初始条目池包括疼痛、炎症及功能3个维度共38个条目。90名骨科医生问卷应答率100%, 量表题干及使用意愿评分排名前75%的条目共26个。专家咨询会优化形成16个条目, 经参考患者反馈意见后, 修改为疼痛、炎症及功能3个维度14个条目的问卷初稿。 结论 《图示化膝关节疼痛患者自我评估问卷》是中国首个自主开发的膝关节炎评估问卷。其制定广泛基于骨科专家及患者意见, 可行性高, 是一种简便、全面、量化的膝关节炎患者自我评估问卷, 具有较高的临床应用价值。 Abstract:Objective To design a visualized self-assessment questionnaire for patients with knee osteoarthritis in order to facilitate patient self-assessment and long-term management of this condition. Methods Several databases including PubMed and China National Knowledge Infrastructure (CNKI) were searched for existing scales on osteoarthritis that reflect patients' complaints, based on which a pool of dimensions and items was generated. Ninety orthopedists were invited to rate the intelligibility, importance, and feasibility of these items. Then an expert consultation meeting consisting of 15 senior orthopedic specialists was convoked to optimize the questionnaire based on the rating results. A pilot investigation was conducted in 77 patients with knee osteoarthritis, from whom opinions and feedback were collected for further optimization of the items and graphs in a following expert consultation meeting to formulate the first draft of the questionnaire. Results The initial pool of items covered 38 items in 3 dimensions, namely, pain, inflammation, and function. The response rate of the 90 orthopedists was 100%, while 26 items were ranked within the top 75% regarding items expression and usage intention. The number of items was streamlined to 16 after the first round of specialist consultation meeting, and further reduced to 14 items in the first draft on the basis of patient feedback, still in the 3 dimensions of pain, inflammation, and function. Conclusions The visualized self-assessment questionnaire for patients with knee osteoarthritis is the first independently developed knee osteoarthritis assessment scale in China. It is a simple, comprehensive, and quantitative self-assessment tool for patients with knee osteoarthritis based on expert and patient opinions, with high feasibility and clinical significance. -
Key words:
- knee osteoarthritis /
- questionnaire design /
- visualization /
- assessment
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表 1 90名骨科医生对问卷题干评分结果
题干 题干
得分题干得分
排序使用意愿
得分使用意愿
得分排序肿胀程度*$^\dagger $ 1558 1 19 2 局部发热程度*$^\dagger $ 1459 10 19 2 乏力程度*$^\dagger $ 1400 19 13 16 晨僵时间*$^\dagger $ 1417 17 13 16 晨僵程度*$^\dagger $ 1479 4 17 6 白天中僵硬程度*$^\dagger $ 1386 22 9 23 静息痛*$^\dagger $ 1494 2 8 28 行走痛*$^\dagger $ 1486 3 18 4 上楼梯是否疼痛*$^\dagger $ 1472 6 26 1 下楼梯是否疼痛*$^\dagger $ 1440 12 18 4 日间痛*$^\dagger $ 1424 16 12 20 夜间痛*$^\dagger $ 1464 8 10 21 负重时疼痛*$^\dagger $ 1373 25 13 16 天气变化时是否疼痛$^\dagger $ 1327 31 15 11 下楼*$^\dagger $ 1456 11 16 10 上楼*$^\dagger $ 1471 7 17 6 就坐$^\dagger $ 1330 30 8 28 从坐位站起*$^\dagger $ 1427 15 17 6 站立 1354 29 5 35 向地面弯腰*$^\dagger $ 1357 28 9 23 是否行走速度正常*$^\dagger $ 1388 21 10 21 上下车*$^\dagger $ 1410 18 9 23 穿脱袜子* 1371 26 6 33 出入浴缸 1304 34 2 37 在床上从躺到起* 1364 27 5 35 下蹲*$^\dagger $ 1476 5 14 14 从蹲而起*$^\dagger $ 1462 9 13 16 上厕所*$^\dagger $ 1384 23 8 28 做轻松/繁重的家务 1284 36 6 33 能否跪着$^\dagger $ 1292 35 9 23 床上翻身是否困难$^\dagger $ 1321 32 9 23 能否快走/追公交车 1243 38 2 37 上下公交车/火车是否困难 1312 33 7 32 在平坦地面行走(速度)*$^\dagger $ 1383 24 15 11 是否需要使用助行器械(拐棍、
小推车、轮椅、拐杖)*$^\dagger $1428 14 14 14 是否比去年同等气温条件下要多
穿衣服以保暖$^\dagger $1260 37 8 28 绞锁症状频率(突然卡住不能动)*$^\dagger $ 1400 19 17 6 膝关节弯曲角度*$^\dagger $ 1430 13 15 11 *题干评分结果排序前75%的条目；$^\dagger $使用意愿评分结果排序前75%的条目 
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表 2 患者对问卷条目评分结果(n=77，x±s)
条目 生活密切度 题干可理解性 选项可理解性 题干准确性 选项准确性 总体评价 静息痛 5.57±1.01 5.81±1.05 5.55±0.94 5.57±0.88 5.68±0.97 5.56±0.80 启动痛 5.55±1.11 5.55±1.19 5.39±0.95 5.39±1.03 5.43±0.89 5.48±0.85 运动痛 5.55±1.03 5.92±1.11 5.52±0.95 5.70±0.87 5.52±1.07 5.53±0.82 天气变化时疼痛 5.79±0.99 5.88±1.04 5.62±1.11 5.77±1.04 5.66±0.95 5.60±0.92 关节畏寒 5.40±1.29 5.48±1.37 5.32±1.24 5.26±1.08 5.49±1.12 5.38±1.24 关节肿胀程度 5.40±1.30 5.39±1.39 5.38±1.24 5.38±1.14 5.39±1.35 5.34±1.34 局部皮温 4.65±1.35 4.82±1.38 4.86±1.30 4.88±1.40 4.75±1.45 4.94±1.32 晨僵时间 4.90±1.47 4.94±1.58 4.75±1.27 4.87±1.52 4.75±1.38 4.73±1.46 蹲起 5.47±1.32 5.43±1.30 5.16±1.15 5.30±1.31 5.27±1.22 5.43±1.13 上楼梯 5.42±1.36 5.68±1.09 5.48±1.12 5.58±1.14 5.74±1.15 5.53±1.11 下楼梯 5.42±1.48 5.69±1.37 5.57±1.19 5.62±1.28 5.97±1.04 5.56±1.22 一次性站立时间 5.12±1.17 5.10±1.34 5.36±1.10 5.22±1.28 5.39±1.34 5.43±1.22 一次性步行距离 5.23±1.23 5.40±1.29 5.26±1.23 5.40±1.30 5.39±1.30 5.19±1.32 一次性步行时间 5.13±1.22 5.38±1.24 5.21±1.24 5.19±1.41 5.19±1.30 5.26±1.28 需要助行器械 4.69±1.80 4.86±1.64 5.16±1.18 5.10±1.27 5.31±1.32 5.18±1.28 做家务 5.52±1.19 5.44±1.28 5.31±1.16 5.47±1.31 5.21±1.17 5.23±1.12
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表 3 《图示化膝关节炎患者自我评估问卷》初稿维度与条目
维度 疼痛 炎症 功能 条目 静息痛 关节肿胀程度 蹲起 启动痛 局部皮温 上下楼梯 运动痛 晨僵时间 一次性站立时间 天气变化时疼痛 一次性步行距离 关节畏寒 需要助行器械 做家务
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