An Exploratory Study of Response Shift in Health-Related Quality of Life and Utility Assessment Among Patients with Osteoarthritis Undergoing Total Knee Replacement Surgery in a Tertiary Hospital in Singapore
An Exploratory Study of Response Shift in Health-Related Quality of Life and Utility Assessment Among Patients with Osteoarthritis Undergoing Total Knee Replacement Surgery in a Tertiary Hospital in Singapore
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DOI：
10.1016/j.jval.2011.11.011
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发表时间：
2012-01-01
期刊：
影响因子：
4.5
通讯作者：
Thumboo, Julian
中科院分区：
文献类型：
--
作者：
Zhang, Xu-Hao;Li, Shu-Chuen;Thumboo, Julian
目的：探讨反应偏移（RS）对全膝关节置换术患者健康相关生活质量（HRQOL）和效用评估的影响。研究方法：接受全膝关节置换术的患者接受访谈，通过使用SF-36的六维健康状态简表和EuroQol五维问卷在基线时（前测1）和SF-36的六维健康状态简表在术后6个月（前测2）和18个月（后测）确定其HRQOL。RS通过使用“然后测试”方法进行研究，方法是在手术后18个月联系参与者，并要求他们在基线（然后测试1）、6（然后测试2）和手术后18个月评估他们的HRQOL。RS被计算为给定时间点的预测试和随后测试分数之间的分数差。采用单因素和多元线性回归分析探讨RS与外部变量之间的关系。结果如下：74例受试者（63%应答率，中位年龄68岁），中位（分位数范围）六维健康状态简表，源自SF-36，基线时的then测试评分（0.48 [0.42-0.49]）和6个月时（0.72 [0.66-0.79]）与各自的术前评分有显著差异（基线时0.61 [0.58-0.68]，P = 0.000; 6个月时0.69 [0.63-0.72]，P = 0.000），在两个时间点均显示RS。基线时的RS（0.14 [0.08-0.20]）显著大于6个月时的RS（-0.05 [0.14至0.00]，P = 0.000）。EuroQol五维问卷预测和基线时的测试评分也存在显著差异（0.69 [0.17-0.73] vs. -0.18 [-0.23至0.00]，P = 0.000）。基线时的RS不受评估的人口统计学或医学变量的影响。受教育年限越长的受试者，6个月时的RS越大（多元线性回归方差为16%，P < 0.01）。结论：术前和术后6个月，RS存在并影响接受全膝关节置换术的患者的HRQOL和效用评估。
Objective: To investigate the influence of response shift (RS) on health-related quality of life (HRQOL) and utility assessment among patients undergoing total knee replacement. Methods: Consenting patients undergoing total knee replacement were interviewed to determine their HRQOL by using the six-dimensional health state short form, derived from SF-36, and the EuroQol five-dimensional questionnaire at baseline (pretest 1) and the six-dimensional health state short form, derived from SF-36, at 6 (pretest 2) and 18 months after surgery (post-test). RS was studied by using a "then-test" approach by contacting participants 18 months after surgery and asking them to evaluate their HRQOL at baseline (then-test 1) and at 6 (then-test 2) and 18 months after surgery. RS was calculated as the score difference between pretest and then-test scores for a given time point. Relationships between RS and external variables were explored by using univariate and multiple liner regression analyses. Results: In 74 subjects (63% response rate, median age 68 years), median (interquantile range) six-dimensional health state short form, derived from SF-36, scores for then-tests at baseline (0.48 [0.42-0.49]) and at 6 months (0.72 [0.66-0.79]) after surgery were significantly different from respective pretest scores (0.61 [0.58-0.68] at baseline, P = 0.000; 0.69 [0.63-0.72] at 6 months, P = 0.000), showing RS at both time points. RS at baseline (0.14 [0.08-0.20]) was significantly larger than that at 6 months (-0.05 [0.14 to 0.00], P = 0.000). EuroQol five-dimensional questionnaire pretest and then-test scores at baseline also differed significantly (0.69 [0.17-0.73] vs. -0.18 [-0.23 to 0.00], P = 0.000). RS at baseline was not affected by assessed demographic or medical variables. RS at 6 months was greater in subjects with more years of education (16% of variance in multiple liner regression, P < 0.01). Conclusion: RS was present and impacted HRQOL and utility assessment among patients undergoing total knee replacement before and 6 months after surgery.