Measuring Quality of Life in Patients with Schizophrenia An Update
Measuring Quality of Life in Patients with Schizophrenia An Update
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DOI：
10.2165/11594470-000000000-00000
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发表时间：
2012-01-01
影响因子：
4.4
通讯作者：
Voruganti, Lakshmi N. P.
中科院分区：
文献类型：
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作者：
Awad, A. George;Voruganti, Lakshmi N. P.
1997 年，我们在 PharmacoEconomics 上发表了一篇关于精神分裂症患者生活质量 (QOL) 测量的综述。本文的目的是提供更新，并重新审视 QOL 的构建及其应用于精神分裂症的测量的发展。自我们上一篇文章以来，有关精神分裂症生活质量的出版物数量显着增长。不幸的是，随着研究兴趣的显着增加，人们也开始担心生活质量概念对临床护理和健康政策决策的局限性和缺乏影响。先前概述的一些担忧（例如对生活质量的统一定义缺乏共识）仍然是一个问题。然而，我们认为统一的定义可能是不可能的，相反，最好有几个定义，这可能会丰富概念并扩大其用途。我们在 1997 年审查的一些量表仍在使用，而其他量表现在很少或从未使用。具有更好心理测量学的新量表已经推出，但大多数都没有理论或概念基础。另一方面，在过去的几年里，量表领域总体上一直在发生变化，并且正在朝着基于项目反应理论、项目库和计算机自适应测试的新的量表开发方法发展。不幸的是，这并没有扩展到精神分裂症的生活质量。精神分裂症 QOL 的理论和概念模型仍然缺乏，这似乎让人认为该结构缺乏良好的理论和科学基础。本次综述发现的主要差距之一是公认的 QOL 测量对临床管理或政策决策缺乏影响。大多数出版物仍然关注测量而不是如何处理数据。由于缺乏将生活质量数据整合到临床护理中的策略，以及未能为政策决策做出贡献，特别是在成本分析或资源分配方面，人们认为精神分裂症中的生活质量构建没有那么有用。显然，为了让精神分裂症的生活质量重获希望，研究人员必须采取超越测量的下一步：制定可靠的策略，将生活质量数据整合到临床实践中。此外，需要更有针对性的研究来证明生活质量的作用，不仅作为结果本身，而且作为其他结果的贡献者，例如坚持药物治疗、更高的满意度、更少的资源利用率等。由于生活质量的自我评价不是在真空中发生的，而是与人类所有生物、心理社会和环境方面的总体经验相关，因此还必须特别关注重要的神经生物学维度，例如情感和认知。两者都受到疾病本身及其治疗的显着影响。
In 1997, we published a review in PharmacoEconomics about quality of life (QOL) measurement in patients with schizophrenia. The objective of this article is.to provide an update, as well as to revisit the development of the construct of QOL and its measurement as applied to schizophrenia. Since our previous article, there has been significant growth in the number of publications about QOL in schizophrenia. Unfortunately, alongside this significant increase in research interest, a number of concerns have also risen about the limitations and lack of impact the concept of QOL has on clinical care and health-policy decision making. A number of concerns previously outlined (such as lack of consensus on a uniform definition of QOL) continue to be an issue. However, we believe that a uniform definition may not be possible, and instead, it may be preferable to have several definitions, which may enrich the concept and broaden its usefulness.Some of the scales we reviewed in 1997 continue to be in use, while others are now rarely or never used. New scales with better psychometrics have been introduced, but most are without theoretical or conceptual foundation. On the other hand, the field of scaling in general has been changing over the past few years and is moving towards a new approach for scale development, based on item response theory, item banks and computer adaptive testing. Unfortunately, this has not extended to QOL in schizophrenia. There continues to be a dearth of theoretical and conceptual models for QOL in schizophrenia, which seems to create the perception that the construct lacks a good theoretical and scientific foundation.One of the major gaps identified in this review is the recognized lack of impact of QOL measurements on clinical management or policy decision making. The majority of publications continue to focus on measurement rather than what to do with the data. The lack of strategies to integrate QOL data in clinical care, as well as the failure to contribute to policy decisions, particularly in cost analysis or resource allocations, has created the perception that the construct of QOL in schizophrenia is not that useful. It is evident that, for QOL in schizophrenia to regain its promise, researchers must take the ultimate next step beyond measurement: to develop credible strategies for integrating QOL data in clinical practice. Additionally, more focused research is needed to demonstrate the role of QOL, not only as an outcome in itself but also as a contributor to other outcomes, such as adherence to medications, more satisfaction, less resource utilization and so on.Since self-appraisal of QOL does not happen in a vacuum but relates to the total human experience in all its biological, psychosocial and environmental aspects, particular attention must also be focused on important neurobiological dimensions such as affect and cognition. Both are significantly affected by the illness itself and its treatment.