Measuring Quality of Life in Veterans with Deployment-Related PTSD

描述（由申请人提供）： 该项目将导致改善措施的发展与创伤后应激障碍（PTSD）的退伍军人的健康相关的生活质量（HRQOL）。因为我们的工作将建立在更大的国家HRQOL项目的基础上，并与之相联系，结果不仅将改善对患有创伤后应激障碍的退伍军人的测量，而且还将允许在诊所环境和疾病组之间比较结果。我们将开发和验证一个简短的形式的措施，将使它与传统的自我管理技术。此外，还将创建算法，以促进将所产生的措施适应计算机化的适应性测试（CAT）环境，这将简化该工具在临床实践中的使用，并减轻应答者的负担。虽然用于测试PTSD临床干预疗效的主要结局指标是症状的减轻，但也包括越来越多的健康相关生活质量（HRQOL）指标。在创伤后应激障碍退伍军人的临床研究中，最常用的HRQOL测量是医学结局研究简表健康调查（SF-36）。SF-36是一种“通用”HRQOL工具，不包含反映退伍军人部署相关PTSD所经历的生活质量问题的特定领域/项目。本研究的目的是设计更敏感的措施部署相关的PTSD HRQOL的退伍军人，包含这样的项目/域。本研究的短期目标是：1）确定最重要的HRQOL问题，关注和随后的领域/结构（如痛苦，疼痛，社会角色的变化），HRQOL措施应评估退伍军人与部署相关的PTSD。2)开发新的项目库和/或从现有的NIH资助的工具（例如，PROMIS/神经QOL），代表一维域/结构，解决退伍军人面临的独特问题与部署相关的创伤后应激障碍。3)现场测试新创建和改编的项目池与退伍军人与部署相关的PTSD样本。4)运用项目反应理论（IRT）方法校准测量领域/结构的试题库，以支持计算机自适应测试（CAT）的发展。5)从校准的项目库中创建简短的表格，用于患有部署相关PTSD的退伍军人。6)进行基于经典测试理论的验证研究，以检查收敛/并发效度，内部一致性信度和测试-重测信度。这项为期三年的前瞻性研究将分三个阶段采用混合方法研究设计。在研究的第1阶段，将使用患者和提供者的焦点小组来了解部署后相关的PTSD问题在PROMIS/Neuro-QOL中的代表性如何不足。这些定性数据将用于确认或反驳每个PROMIS/Neuro-QOL域/结构的重要性，以补充现有的概念结构与部署后相关的PTSD特定感兴趣领域，并充实与该人群特别相关的HRQOL的详细结构。在第二阶段，现有的HRQOL项目库和针对部署相关PTSD独特性质的新项目库将在退伍军人的大样本中进行现场测试。在第三阶段，将根据IRT对现场测试数据进行心理测量分析，将开发一个简短形式的项目库，并将创建用于未来开发计算机化自适应测试（CAT）的算法。

DESCRIPTION (provided by applicant): This project will result in the development of improved measures of health related quality of life (HRQOL) for veterans with post traumatic stress disorder (PTSD). Because our work will be built on and linked to work of larger national HRQOL projects, the results will not only improve measurement for veterans with PTSD but will also allow for comparison of results across clinic settings and disease groups. We will develop and validate a short form of the measure that will enable using it with traditional self-administered techniques. In addition, algorithms will be created to facilitate the adaptation of the resultant measures into a computerized adapted testing (CAT) environment, which will streamline the use of the tool in clinical practice and reduce respondent burden. While the primary outcome measure used to test the efficacy of clinical interventions in PTSD is the reduction of symptoms, increasingly measures of health related quality of life (HRQOL) are also included. The most commonly used HRQOL measure employed in clinical studies of veterans with PTSD is the Medical Outcomes Study Short Form Health Survey (SF-36). The SF-36 is a "generic" HRQOL instrument that does not contain specific domains/items reflecting quality of life issues experienced by veterans with deployment-related PTSD. The goal of this study is to design more sensitive measures of deployment-related PTSD HRQOL for veterans that do contain such items/domains. The short term objectives of this study are to: 1) Identify the most important HRQOL issues, concerns and subsequent domains/constructs (e.g. distress, pain, social role changes) that a HRQOL measure should assess in Veterans with deployment-related PTSD. 2) Develop new items pools and/or adapt item banks from existing NIH funded tools (e.g., PROMIS/Neuro QOL) that represent unidimensional domains/constructs that address the unique issues facing Veterans with deployment-related PTSD. 3) Field test newly created and adapted item pools with a sample of Veterans with deployment-related PTSD. 4) Use Item Response Theory (IRT) methodology to calibrate item banks measuring the domains/constructs to support the development of computer adaptive testing (CAT). 5) Create short forms from the calibrated item banks for use with Veterans with deployment-related PTSD. 6) Conduct a Classic Test Theory-based validation study of calibrated short forms to examine convergent/concurrent validity, internal consistency reliability, and test-re-test reliability. This three-year prospective study will employ a mixed methods research design in three phases. In Phase 1 of the study, focus groups of patients and providers will be used to see how post deployment- related PTSD issues are underrepresented in PROMIS/Neuro-QOL. This qualitative data will serve to confirm or refute the importance of each PROMIS/Neuro-QOL domain/construct, to supplement the existing conceptual structure with post deployment-related PTSD specific areas of interest, and to flesh out the detailed constructs of HRQOL that are particularly relevant for this population. In Phase 2, both the existing HRQOL item banks and the new item pools targeted at the unique nature of deployment- related PTSD will be field tested in a large sample of veterans. In Phase 3, psychometric analysis of the field test data will be conducted based on IRT, a short form of the item banks will be developed, and algorithms for future development of a computerized adaptive test (CAT) will be created.