中文版KOOS和OKS在评估膝骨关节炎患者多模式非手术治疗中的对比研究  

Comparison of Chinese KOOS and OKS in multimodal non-surgical treatment of knee osteoarthritis

作　　者：陈墅 曹嘉[1] 蔡筑韵 李章吉 杜杰[3] 顾召华 周琦[1] 钱齐荣[1] CHEN Shu;CAO Jia;CAI Zhuyun;LI Zhangji;DU Jie;GU Zhaohua;Zhou Qi;Qian Qirong(Department of Joint Surgery,Changzheng Hospital,the Second Military Medical University,Shanghai 210003;Xujing Town Community Health Service Center,Qingpu District,Shanghai 201702;Community Health Service Center of Fenglin Street,Xuhui District,Shanghai 200032;Sanlin Community Health Service Center,Pudong New District,Shanghai 200124,China)

机构地区：[1]第二军医大学长征医院关节外科,上海210003 [2]上海青浦区徐泾镇社区卫生服务中心,上海201702 [3]上海市徐汇区枫林街道社区卫生服务中心,200032 [4]上海市浦东新区三林社区卫生服务中心,200124

出　　处：《中华骨与关节外科杂志》2018年第8期600-605,共6页Chinese Journal of Bone and Joint Surgery

基　　金：上海申康医院发展中心临床科技创新项目(SHDC12015320)

摘　　要：背景:目前用于评估膝骨关节炎(osteoarthritis,OA)患者非手术治疗的量表报道较少,膝关节损伤和骨关节炎评分(knee injury and osteoarthritis outcome score,KOOS)与牛津膝关节评分(Oxford knee score,OKS)被报道可用于包括软骨损伤、OA在内的多种膝关节疾患,已被翻译成多种语言版本,但这两种量表针对膝OA患者非手术治疗评估中的心理测量学特征差异尚不明确。目的:比较中文版KOOS和OKS在评估膝OA患者多模式非手术治疗中信度、效度、敏感性的差异,探讨其应用的可行性。方法:经翻译、回译、文化适应性检验和预测试形成中文版KOOS和OKS,对2016年5月至2018年1月在第二军医大学上海长征医院及上海市3个社区门诊接诊的149例拟行非手术治疗的轻中度膝OA患者在首次治疗前完成中文版KOOS和OKS及简明健康调查量表(the short-form 36 health survey scale,SF-36),男58例,女91例;年龄48~72岁,平均(59.3±5.2)岁。为了评估重测信度,40例患者在5~7 d的时间间隔后再次填写中文版KOOS和OKS。所有受试者均予以健康宣教、肌肉训练、口服非甾体消炎药等多模式非手术治疗,治疗后2周、4周、12周分别再次用上述3种量表复评。检验、对比中文版KOOS、OKS量表的内部一致性、内容效度、结构效度、聚合效度和区分效度,分析其天花板效应及地板效应。结果:中文版KOOS和OKS均具有良好的信度(ICC=0.87~0.92和0.90)和较强的内在一致性(Cronbachα=0.76~0.95和0.89),同时两份问卷的内容效度都很好,不产生地板或天花板效应。中文版KOOS和OKS与SF-36的物理成分总分(physical component summary,PCS)高度相关,与精神成分总分(mentalcomponent summary,MCS)的相关性较弱。然而,在4周的物理治疗期间,中文版KOOS中疼痛、日常活动、运动/功能子量表比OKS更敏感。工作特征曲线(receiver operating characteristic curve,ROC)分析揭示了曲线下的面积值(中文版KOOS为0.69~0.7Background： Currently the scale used to evaluate the knee osteoarthritis（OA） patients receiving non-operative treatment is less reported. The Knee Injury and Osteoarthritis Outcome Score（KOOS） and the Oxford Knee Score（OKS）are knee-specific questionnaires that have been widely used and translated into numerous languages. However, the differences in psychometric properties between the two scales remain unclear. Objective： To compare the psychometric properties of Chinese KOOS and OKS used in patients with knee OA after receiving multimodal non-surgical treatment in order to explore the feasibility of their usage. Methods： The original KOOS and OKS were translated into Chinese based on the guidelines of cross-cultural adaptation and translation protocols. One hundred and forty-nine patients（58 males, 91 females;range of age： 48-72 years; mean age： [59.3±5.2] years old） with mild to moderate knee OA were recruited from May 2016 to January 2018 in Shanghai Changzheng Hospital and three community health service centers, and completed both Chinese KOOS and OKS as well as a generic health status questionnaire（Chinese Short Form-36 [SF-36]） before the non-surgical treatment. Forty patients were required to fill in the two measurement scales 5-7 days later again in order to evaluate test-retest reliability. All patients were given health education, muscle training, oral non-steroidal anti-inflammatory drugs, and other non-surgical treatment, and evaluated again by the Chinese version of KOOS, OKS and SF-36 after 2 weeks, 4 weeks and 12 weeks. The reliability, internal consistency, content validity, construct validity, convergent and divergent validity and responsiveness were compared between KOOS and OKS, and the ceiling and floor effects were also assessed. Results： The Chinese KOOS and OKS showed excellent reliability（ICC=0.87-0.92, 0.90） and strong internal consistency（Cronbach alpha=0.76-0.95, 0.89）, and their content validity were all excellent without the ceiling and floor ef

关 键 词：膝 骨关节炎 问卷调查 膝关节损伤和骨关节炎评分 牛津膝关节评分 

分 类 号：R684.3[医药卫生—骨科学]