世衛組織生活品質問卷(WHOQOL-BREF)與聖喬治呼吸問卷(SGRQ)之實証比較：以COPD患者為例; An empirical comparison of the WHOQOL-BREF and St George’s Respiratory Questionnaire in patients with COPD

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Title:	世衛組織生活品質問卷(WHOQOL-BREF)與聖喬治呼吸問卷(SGRQ)之實証比較：以COPD患者為例;An empirical comparison of the WHOQOL-BREF and St George’s Respiratory Questionnaire in patients with COPD
Authors:	陳宏偉;Hung-Wei Chen
Contributors:	中國醫藥大學環境醫學研究所
Keywords:	慢性阻塞性肺部疾病;WHOQOL-BREF;SGRQ;項目反應理論;chronic obstructive pulmonary disease;WHOQOL-BREF;SGRQ;Item response theory
Date:	2004
Issue Date:	2010-01-20 16:00:50 (UTC+8)
Abstract:	背景：以不同的生活品質問卷評估慢性阻塞性肺部疾病（COPD）患者的研究愈來愈多，本研究藉由比較一般性生活品質問卷(WHOQOL-BREF)與特定疾病生活品質問卷(SGRQ)兩問卷之心理計量特質，瞭解此兩問卷用於COPD患者時測量特質上的差異。方法：本研究對象為130名來自門診的男性COPD患者，除測量其肺功能外並以WHOQOL-BREF與SGRQ評估其生活品質。研究方法上首先對問卷內容進行問卷結構與量尺的比較，並以敘述統計量描述各範疇分布，Cronbach’s 值用以探討各範疇之內部一致性，此外並以收斂效度與區辨效度評估問卷的有效性，而問卷間範疇的相關性以皮爾森相關分析進行探討，為瞭解兩問卷與臨床指標之相關亦以ANOVA及ROC曲線分析，最後利用IRT之模式針對WHOQOL-BREF和SGRQ兩份問卷的各項題目心理計量特質進行全面性的描述與分析。結果：結果顯示相較於SGRQ，WHOQOL-BREF有較少的ceiling effect與floor effect，兩問卷皆有不錯的內部一致性(Cronbach’s 都大於0.7)，WHOQOL-BREF有較佳的收斂效度與區辨效度，成功率分別介於66.7% -100%；92.8% -100%)比上SGRQ分別介於54% -94%；82.1% -91.7%。在兩問卷範疇的相關分析中，WHOQOL-BREF的生理範疇與SGRQ的日常活動（r=0.53）、疾病衝擊（r=0.53）與症狀範疇（r=0.38）有較高且顯著的相關（p<0.001），而此外其它範疇間的相關性皆偏低；ANOVA及ROC曲線分析的結果都顯示SGRQ對於臨床指標的敏感度較佳，但WHOQOL-BREF生理範疇對於臨床指標亦具有不錯的敏感度；以IRT分析各範疇的題目難度結果顯示，WHOQOL-BREF的生理範疇及SGRQ的症狀與日常活動範疇題目之平均難度與患者平均潛在特質較為適中，而WHOQOL-BREF的心理範疇難度亦算適中，其它如社會或環境相關的範疇則難度偏低；IRT模式適合度檢定結果，除了WHOQOL-BREF的生理範疇外，各範疇不符檢定標準的皆低於一題。結論：兩問卷應用在COPD患者均有不錯的信度與效度心理計量特質，SGRQ較WHOQOL-BREF更具臨床指標的敏感度，但WHOQOL-BREF能提供更廣的層面及以患者主觀意識為中心的生活品質測量。; Background: A number of questionnaires have been used to assess the quality of life (QOL) of patients with chronic obstructive pulmonary disease (COPD). This study compares the performance of the WHOQOL-BREF and the St George’s Respiratory Questionnaire (SGRQ) in patients with COPD. Methods: One hundred and thirty male patients diagnosed with COPD were interviewed in person using both the WHOQOL-BREF and SGRQ. The classic psychometric properties of two questionnaires were compared including internal consistency reliability and validity. The modern psychometric properties based on Item response theory (IRT) was used to calibrate the difficulty of items, and the item fit index was also obtained. Finally, item discrimination and item information were calculated to examine which items were adaptive for COPD patients. Results: The domain scores of the WHOQOL-BREF showed less ceiling and floor effect than the SGRQ. Both questionnaires had acceptable internal consistency (Cronbach’s >0.7). The WHOQOL-BREF had higher convergent and discriminant validity success rates (range, 66.7% to 100% and 92.8% to 100%) than the SGRQ (range, 54% to 94% and 82.1% to 91.7%). The cross-correlations showed that the physical domain of the WHOQOL-BREF correlated strongly with activity, impact, and total domain of the SGRQ (r= 0.53-0.59). The SGRQ are more sensitive in detecting patients’ clinical difference than the WHOQOL-BREF. In IRT analysis, the WHOQOL-BREF physical and SGRQ symptom, activity domain provide the appropriate level of difficulty to capture the patient’s latent trait. All Domains of the two questionnaires have less than one misfit items except the WHOQOL-BREF physical domain. The items related to medical characteristics in both questionnaires showed less item information. Conclusions: In general, both questionnaires showed acceptable reliability and validity psychometric properties. The SGRQ had better validity in assessing symptoms and disease-specific measurements. The WHOQOL-BREF provides more subjective and broader QOL measurements.
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