Measuring Quality of Life in Veterans with Deployment-Related PTSD

描述(由申请人提供)： 该项目将为患有创伤后应激障碍(PTSD)的退伍军人制定更好的健康相关生活质量(HRQOL)衡量标准。由于我们的工作将建立在更大的国家HRQOL项目的基础上并与其联系起来，因此结果不仅将改善患有创伤后应激障碍的退伍军人的测量，还将允许比较不同临床环境和疾病组的结果。我们将开发和验证该措施的简短形式，使其能够与传统的自我管理技术一起使用。此外，将创建算法，以促进将所产生的措施适应于计算机化的适应测试(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。虽然用于测试临床干预对创伤后应激障碍疗效的主要结果衡量标准是症状的减少，但与健康相关的生活质量(HRQOL)的衡量标准也越来越多地包括在内。在对患有创伤后应激障碍的退伍军人的临床研究中，最常用的HRQOL测量工具是医学结果研究简表健康调查(SF-36)。SF-36是一个“通用的”HRQOL工具，不包含反映患有与部署相关的创伤后应激障碍的退伍军人所经历的生活质量问题的特定领域/项目。本研究的目的是为确实包含此类项目/领域的退伍军人设计与部署相关的创伤后应激障碍HRQOL的更敏感的测量。这项研究的短期目标是：1)确定最重要的HRQOL问题、关切和随后的领域/结构(例如，痛苦、痛苦、社会角色变化)，HRQOL测量应该评估患有部署相关创伤后应激障碍的退伍军人。2)开发新的题库和/或从NIH资助的现有工具(例如PROMIS/Neuro QOL)中调整题库，这些工具代表一维域/结构，解决退伍军人面临的与部署相关的创伤后应激障碍的独特问题。3)现场测试新创建和调整的项目库，对患有部署相关创伤后应激障碍的退伍军人样本进行测试。4)使用项目反应理论(IRT)方法对测量领域/结构的题库进行校准，以支持计算机自适应测试(CAT)的发展。5)根据校准的题库创建简短的表格，供患有部署相关创伤后应激障碍的退伍军人使用。6)基于经典测试理论对已校准的简表进行效度研究，以检验收敛/并发效度、内部一致性信度和重测信度。这项为期三年的前瞻性研究将采用三个阶段的混合方法研究设计。在研究的第一阶段，患者和提供者的焦点群体将被用来看看部署后相关的PTSD问题在PROMIS/Neuro-QOL中是如何被低估的。这些定性数据将有助于证实或驳斥每个PROMIS/Neuro-QOL领域/结构的重要性，用部署后与创伤后应激障碍相关的特定感兴趣领域补充现有的概念结构，并充实与这一人群特别相关的HRQOL的详细结构。在第二阶段，现有的高质量生活质量题库和针对与部署有关的创伤后应激障碍的独特性质的新题库都将在退伍军人中进行实地测试。在第三阶段，将根据IRT对实地测试数据进行心理测量学分析，将开发题库的缩写形式，并将为未来开发计算机化自适应测试(CAT)创建算法。

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.