白內(nèi)障論文：視功能指數(shù)量表的修訂及評價

白內(nèi)障論文：視功能指數(shù)量表(Vf-14)的修訂及評價【中文摘要】引進并修訂國外視功能指數(shù)(VisualFunctionindex-14)量表，形成VF-14中文修訂本并對中文修訂本進行信度、效度及可接受性的評價,為探索國內(nèi)適宜的視功能評價工具提供依據(jù)。方法選取經(jīng)眼科醫(yī)師確診的年齡相關(guān)性白內(nèi)障患者440名、眼科專家12名及健康查體者80名作為研究對象。年齡相關(guān)性白內(nèi)障患者的診斷標準采用國家白內(nèi)障診斷分型標準年齡40-70歲之間，文化程度小學(xué)及以上其中200名參與量表的修訂,240名參與量表的評價;80名健康查體者參與量表的評價眼科專家為從事眼科臨床工作10年以上、職稱為副主任醫(yī)師以上精通英文，其中一名有留美經(jīng)歷,參與量表的翻譯、回譯及修訂。遵循量表的引進原則經(jīng)過眼科專家翻譯、回譯,與原量表比對，形成VF-14中文本一稿，然后向9名眼科專家及200名患者收集修訂意見和建議對VF-14中文本一稿進行文化適應(yīng)性修訂，最終形成VF-14量表中文修訂本。以自行設(shè)計的調(diào)查問卷為工具向240名年齡相關(guān)性白內(nèi)障患者收集VF-14量表中文修訂本評定的資料內(nèi)容包括:調(diào)查對象的一般情況眼科檢查情況VF-14量表中文修訂本的測評■，視功能生存質(zhì)量量表(VF-QoL)的測評,自評視功能狀況及對可接受性信息的評價部分。其中80名患者分別進行2次VF-14中文修訂本測評，時間間隔為一周;80名患者同一天內(nèi)由兩名不同調(diào)查員分別進行VF-14量表中文修訂本的測評;80名患者于術(shù)前一天、術(shù)后一月分別進行視力、VFQOl、自評視功能狀態(tài)及VF-14量表中文修訂本的測評,80名健康查體者進行視力、VFQOl、自評視功能狀態(tài)及VF-14量表中文修訂本的測評。全部調(diào)查問卷收回后進行統(tǒng)一檢查、核對,建立Excel數(shù)據(jù)庫，利用SPSS13.0統(tǒng)計軟件進行資料的處理分析，采用t檢驗、Cronbach’a、ICC值、相關(guān)分析、因子分析等對量表的信度、效度、可接受性進行評價。評價的指標信度評價包括重測信度、內(nèi)部一致性信度、調(diào)查員間信度、分半信度效度評價包括內(nèi)容效度、結(jié)構(gòu)效度、效標關(guān)聯(lián)效度、辨別效度可接受性評價:回答量表的把握度、量表的完成率、每次完成VF-14中文修訂本的時間。結(jié)果1.VF-14量表的翻譯在遵循語義等價性、概念等價性的前提下兩名眼科專家各自將原量表翻譯成中文兩份譯文綜合形成中文初譯本另一名眼科專家進行回譯將其與原量表比對,對與原量表不一致的條目，反復(fù)進行翻譯、回譯，直至達成統(tǒng)一，最終形成VF-14中文本一稿。2.分別向眼科專家和年齡相關(guān)性白內(nèi)障患者收集對VF-14中文本一稿的修訂意見專家認為:在我國目前的經(jīng)濟文化生活背景下,VF-14中文本一稿的絕大部分條目能夠反映被測量的與視功能相關(guān)的生活內(nèi)容各條目意思表達清楚且表達的難易程度對調(diào)查對象適宜。100%的專家認為第9項-娛樂活動（bingo,多米諾骨牌,打牌）和第10項-體育活動（保齡球、手球、網(wǎng)球或高爾夫運動所指內(nèi)容不符和我國國情、民情遵循概念等價原則可改為我國大眾喜聞樂見的項目如娛樂活動改為打麻將，撲克牌，下象棋，體育活動改為羽毛球，乒乓球，籃球，門球。95%的專家認為13、14兩項涉及駕車的條目,與我國國情不符且無等價替代條目;患者認為各條目內(nèi)容通俗易懂，沒有讀不懂的語句表達意思清楚，表達的難易程度適宜1-12項基本符合我國國情、民情,100%的患者認為13、14兩項涉及駕車的條目不符合我國國情、民情。綜合專家和患者的意見和建議最終形成VF-14量表中文修訂本。3.VF-14量表中文修訂本的信度:①重測信度:量表兩次評分的各條目和總分的ICC范圍值在0.814?0.976P<0.05,說明量表重測信度較好;②內(nèi)部一致性信度:量表的Cronbach’a系數(shù)為0.916,說明量表的內(nèi)部一致性較高;③調(diào)查員間的信度:各條目和總分的ICC范圍值在0.854?0.996P<0.05,說明量表的調(diào)查員間的信度較好;④分半信度:VF-14量表中文修訂本的分半信度系數(shù)為0.817P<0.05,說明量表具有較好的分半信度。4.VF-14量表中文修訂本的效度:①內(nèi)容效度:專家一致認為VF-14量表中文修訂本的條目既包括了白內(nèi)障患者基本生存需要的視功能指標又包括白內(nèi)障患者更高生活層次需要的指標內(nèi)容效度良好;②結(jié)構(gòu)效度：采用因子分析得到4個公因子，這4個公因子共能夠解釋總方差的88.70%,各條因子載荷均表現(xiàn)為僅在某一因子上較大。其中第一公因子包括:娛樂活動、體育活動、烹飪等條目，反映患者的立體視功能情況;第二公因子包括:閱讀小字說明、讀書看報、做精細活、填表等條目，反映患者的近視力情況;第三公因子包括:看清樓梯和路緣石、看清各種標識牌、看電視等條目，反映患者的視覺適應(yīng)情況;第四公因子包括:閱讀大體字、認清楚人等條目，反映患者的主觀視覺情況。這與理論構(gòu)想相吻合，表明結(jié)構(gòu)效度較好。③效標關(guān)聯(lián)效度:采用術(shù)前及術(shù)后患者視功能生存質(zhì)量量表(VFQol)與VF-14量表中文修訂本得分做相關(guān)分析,相關(guān)系數(shù)分別為0.55和0.67,P<0.01;采用患者術(shù)前術(shù)后視力與VF-14量表中文修訂本的得分做相關(guān)分析相關(guān)系數(shù)分別為-0.63和-0.72,P<0.01,采用患者主觀視功能改善程度與VF-14量表中文修訂本的得分作相關(guān)分析相關(guān)系數(shù)為0.65和0.76,P<0.01;表明量表的效標關(guān)聯(lián)效度良好。④辨別效度對患者術(shù)前術(shù)后VFQOL、視力、自評功能狀態(tài)的評分進行配對t檢驗，可知患者術(shù)前與術(shù)后視功能狀況的差異有統(tǒng)計學(xué)意義說明患者術(shù)前與術(shù)后的視功能狀況有變化;對患者術(shù)前術(shù)后VF-14量表中文修訂本測評的得分進行配對t檢驗，得t=17.18,P<0.01,說明VF-14量表中文修訂本能辨別患者視功能狀況的變化，對患者術(shù)前及健康查體者的VFQOL、視力、自評功能狀態(tài)的評分進行t檢驗，可知患者術(shù)前與術(shù)后視功能狀況的差異有統(tǒng)計學(xué)意義，說明患者與健康查體者的視功能狀況有變化對患者及健康查體者的VF-14量表中文修訂本測評的得分進行t檢驗，得t=18.674,P<0.01,說明VF-14量表中文修訂本能辨別患者視功能狀況的變化，具有較好的辨別效度。5.量表的可接受性:①在560人次的調(diào)查中,85.4%的患者認為自己做出的評價“比較準確可靠”,而14.6%的患者則認為“絕對準確可靠”；②在560人次的調(diào)查中，量表的完成率達100%;③在全部調(diào)查中,量表的完成時間最短5分鐘，最長10分鐘;表明VF-14量表中文修訂本容易被年齡相關(guān)性白內(nèi)障患者所接受。結(jié)論本次研究經(jīng)過科學(xué)嚴謹?shù)姆椒ㄐ纬闪艘暪δ躒F-14）量表中文修訂本,且經(jīng)過評價可知其信度、效度良好可接受性強，適合目前我國經(jīng)濟文化和生活背景的需要可作為我國眼科患者視功能狀況的評價工具?！居⑽恼縏orevisetheformofVisualFunctionindex-14fromUnitestatesandintroducetoChinainChineserevision,Meanwhileitsreliability,validityandacceptabilitywasevaluatedtoprovideevidencetoexplorethesuitabletoolofvisualfunctionevaluation.Method440patientswhohadbeendiagnosedwithage-relatedcataractand12eyeexpertsand80healthpeoplewereselectedassubjects.Allpatientswerediagnosisbasedonthenationalstandardtodiagnosetheage-relatedcataract.Theagesofthepatientswerebetween40-70yearsoldandthelevelsofallpatients’educationwerefinishingprimaryschoolatleast.Amongthem200patientswereselectedassubjectstoamendofVF-14,and240-patientsand80healthpeopleservedasVF-14evaluation.Theprofessiontitleofeyeexpertswasaboveassociatechiefphysicianandwithclinicalexperiencemorethan10years.TheywereproficientinEnglish,andoneofthemwhohadtheexperienceofstudyinginU.S.A.tookpartintranslationandamendmentofVF.Accordingtotherulesofformintroduction,VF-14inChineseversionwasformedthroughthetranslation,backtranslationandcomparisonbytheophthalmologists.Afterseekingthecommentsandsuggestionsfrom9ophthalmologistsand200patients,thescriptisamendedaccordingtheculturalflexibilityandtherevisedChineseversionofVF-14formisfinallyformulated.Thequestionnairewasappliedtocollectedinformationfrom240age-relatedcataractpatientsforevaluatingChineseversionofVF-14includinggeneralbackgroundofthesubjects;conditionsofeyeexamination,evaluationmaterialtotheChineseamendmentofVF-14Scale,evaluationofVF-QoL,conditionofself-evaluation,andevaluationofinformationacceptability.Amongthem80patientsareevaluatedtwicebytwodifferentinvestigatorswithinonedayandanother80patientsarecheckedwitheyesight,VFQ01,self-evaluationandChineseamendmentofVF-14onedaybeforetheoperationandonemonthafteroperation,80healthpeoplearecheckedwitheyesight,VFQ01,self-evaluationandChineseamendmentofVF-14.AllthequestionnaireswerecollectedtosetanExceldatabaseafterdoubledatacheck.ThedatawereanalyzedbySPSS13.0statisticsoftwareandthecredibility,validity,andacceptabilityoftheformwereevaluatedby"t”test,Cronbach’a,ICCvalue,relativityanalysis,andfactoranalysis.Theindicesoftheevaluationincludedcredibilityevaluation,suchasre-testcredibility,inner-consistencycredibility,inter-investigatorcredibility,anddichotomycredibility;validityevaluationincludedcontentvalidity,structurevalidity,criterion-relatedvalidity,anddiscriminationvalidity.Acceptabilityevaluationincludedthecredibilityofansweringthescale,completenessofthescale,thetimeusedinansweringtheChineseamendmentofVFT4.Result1.ThetranslationoftheformInaccordancewiththeconceptsofsemanticandconceptequivalence,thetranslationoftheformwasdonebytwoophthalmologistsseparately.ThecombinationofthetwotranslationsformedthefirstChineseversionVF-14formandthenthefirstversionwasback-translatedbyanotherophthalmologist.Theback-translatedversionandthefirstChineseeditionwerecomparedandcorrectedbackuntiltheymatcheachother.ThenthefinallytheVF-14formChineseversionisformulated.2.Opinionsseparatelyformophthalmologistsandage-relatedcataractpatientswerecollectedabouttheamendmentofVF-14formChineseedition.TheexpertssuggestedthatunderthebackgroundofcurrentChineseeconomicalandsociallife,VF-14Chineseformreflectslargelythecontentofsightrelatedtestswithclearexpressionandsuitabledifficultytothesubjects.Alltheexpertsthoughtthattheitem8entertainment(bingo,domino,andpoker)anditem10sports(bowling,handball,tennisorgolf)werenotsuitabletoChinesesituationandshouldbereplacedaspopularactivitiesinChinasuchasmah-jong,poker,Chinesechess,badminton,tabletennis,basketball,andgateball.95%ofexpertssuggestedthatitem13and14andtheitemrelatedtodrivingwerenotsuitableinChinesesituation.Allthepatientsbelievethatalltheitemswereeasytounderstandinclearexpression.Items1-12weresuitableinChinawhileitems13and14werenot.Afterconsideringtheopinionsofexpertsandpatients,theVF-14Chineseversionwasfinallyformulated.3.CredibilityofVF-14Chineseversior(Dre-testcredibility:thevaluerangeoftwoscoringofthescaleandthescoreofICCwasbetween0.8140.976(P<0.05),whichindicatesagoodcredibility.?inner-consistencycredibility:thecoefficientoftheformis0.196,whichindicateedahighinner-consistency;③inter-investigatorcredibility:thevaluerangeofalltheitemsandtotalscoreofICCwasbetween0.854?0.996(P<0.05),whichindicatedahighinner-investigatorcredibility.④dichotomycredibility:thecoefficientofdichotomycredibilityinVF-14formChineseversionwas0.817(P<0.05),whichindicatedagooddichotomycredibility.4.ValidityofVF-14forminChineseedition①contentvalidity:expertsagreedunanimouslythattheitemsinVF-14formChineseversionincludedboththesightfunctionofcataractpatientsforbasiclivingneedandthehigherlivingneed;②Structurevalidity:Thefactoranalysisresultsshowedthattherewerefourmainfactorswhichaccountedforthevarianceof88.70%intotal.Factorloadingofeveryitemwasshowedthatonefactorwasmajor.Ofthemthefirstmainfactorincludedentertainment,sportsactivities,cooking,etc,whichreflecttheentriesinthepatientswiththree-dimensionalvisualfunction.Thesecondmainfactorincludedreadingtheinstructionwiththesmallprint,readingnewspaper,doingfinework,fillingouttheforms,etcwhichreflectthepatientsobtainedreflect.Thethirdmainfactorincludedseeingthestairsandkerbstone,andallkindsofidentificationcards,watchingTV,etc,whichreflectthesituationofpatient’visualadaption.Thefourthmainfactorincludedreadinggeneralwords,recognizingTruman,etc,whichreflectthesubjectiveitemswithvisualofpatients.Thisconsistentwiththeconstructedtheoryandindicatedthewellstructurevalidity.③criterion-relatedvalidity:TheformofsurvivalqualitywasappliedbeforeandafteroperationtomakerelevanceanalysiswiththescorefromVF-14formChineseversion.therelevantcoefficientswere0.55and0.67separately(p<0.01).ThesightevaluationscorebeforeandaftertheoperationwasgotandmaderelevanceanalysiswiththescorefromVF-14formChineseamendedversionandtherelevantcoefficientswere-0.63and-0.72repectively(p<0.01).TherelationshipbetweentheimprovementofsightreportedbythepatientsandthescorefromVF-14formChineseamendedversionwasmadeandrelevantcoefficientswere0.65and0.76separately,p<0.01.④discriminantvalidity:therewerethesignificantdifferencebetweenVFQOL,sight,self-evaluationbeforeandafteroperation,whichindicatesthatthescorefromVF-14formChineseamendedversionhadagoodvalidityindistinguishingtheconditionsofpatient’eyesight.therewerethesignificantdifferencebetweenVFQOL,sight,self-evaluationpatientandhealthpeople,whichindicatesthatthescorefromVF-14formChineseamendedversionhadagoodvalidityindistinguishingtheconditionsofpatients’andhealthpeopleeyesight.5.AcceptabilityDThroughtheinvestigationon300patients,85.4%ofpatientsthoughtthatthei