幼年特发性关节炎关节功能及健康评估量表的编制与验证  

Development and validation of the joint function and health assessment scale for juvenile idiopathic arthritis

作　　者：郑琳尹 高莉雅 张宇[1] 罗冲[1] 杨曦[1] 王君君[1] 刘大玮[1] 徐莉[1] 唐雪梅[1] Zheng Linyin;Gao Liya;Zhang Yu;Luo Chong;Yang Xi;Wang Junjun;Liu Dawei;Xu Li;Tang Xuemei(Department of Rheumatology and Immunology,Children′s Hospital of Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Pediatric Infection and Immunity,Chongqing400014,China)

机构地区：[1]重庆医科大学附属儿童医院风湿免疫科、国家儿童健康与疾病临床医学研究中心、儿童发育疾病研究教育部重点实验室、儿童感染与免疫罕见病重庆市重点实验室,重庆400014

出　　处：《中华儿科杂志》2024年第12期1169-1175,共7页Chinese Journal of Pediatrics

基　　金：国家重点研发计划(2021YFC2702003)。

摘　　要：目的构建幼年特发性关节炎关节功能及健康评估量表,并进行验证与初步应用。方法通过文献分析、课题组讨论、半结构化访谈、专家函询形成幼年特发性关节炎关节功能及健康评估量表初稿。采用便利抽样法,前瞻性选取2024年3月至6月在重庆医科大学附属儿童医院风湿免疫科就诊的260例幼年特发性关节炎患儿为研究对象。对患儿或家长进行预调查及正式调查,采用项目分析、信度分析、探索性因子分析、内容效度、效标效度分析等方法检验量表的信效度,并通过估算最小临床重要差异评估量表对临床变化的反应性。结果幼年特发性关节炎关节功能及健康评估量表包括疾病活动评估、日常活动与功能评估、疼痛评估、疲劳评估、疾病转归共5个维度、24个条目,其中功能评估分量表包括4个二级维度、18个条目。功能评估分量表的Cronbach′sα系数为0.88,折半信度为0.86,2~4周后重测信度为0.84;条目水平内容效度指数为0.80~1.00,量表水平内容效度指数为0.93;探索性因子分析共提取4个公因子,累计方差贡献率为70.0%。初步应用提示功能评估分量表与儿童健康评估调查表相关性中等(r=0.70,P<0.05),总量表与儿童关节炎疾病活动度评分27相关性强(r=0.92,P<0.05),与活动性关节计数及活动受限关节计数均中度相关(r=0.77、0.68,均P<0.05)。反应性分析显示量表在41例临床改善患儿及25例疾病活动患儿2次就诊之间的最小临床重要差异分别为0.49(0.44,0.54)、0.51(0.43,0.58)。结论幼年特发性关节炎关节功能及健康评估量表具有良好的信效度,并对临床变化有一定的反应性,简便可操作,可作为临床幼年特发性关节炎患儿关节功能评估的工具。ObjectiveTo develop,validate and initially apply a joint function and health assessment scale for juvenile idiopathic arthritis patients.MethodsThe first draft of the juvenile idiopathic arthritis joint function and health assessment scale was developed through literature analysis,discussion by the research team,semi-structured interviews,Delphi expert correspondence.From March to June 2024,a total of 260 children with juvenile idiopathic arthritis or their parents were prospectively recruited from Department of Rheumatology and Immunology,Children′s Hospital of Chongqing Medical University by convenience sampling method for pre-investigation and formal investigation.The reliability and validity of the scale were tested by item analysis,reliability analysis,exploratory factor analysis,content validity and criterion validity analysis,and the responsiveness of the scale to clinical changes was evaluated by estimating the minimum clinically important difference,and finally the formal scale was formed.ResultsThe juvenile idiopathic arthritis joint function and health assessment scale included disease activity assessment,daily activity and function assessment,pain,fatigue and disease outcome assessment,with a total of 5 dimensions and 24 items,in which the functional assessment subscale included 4 secondary dimensions and 18 items.The Cronbach′sαcoefficient of the function assessment subscale was 0.88,the fold-half reliability was 0.86,and the test-retest reliability after 2-4 weeks was 0.84;the item-level content validity index was 0.80-1.00,and the scale-level content validity index was 0.93.Exploratory factor analysis extracted 4 common factors with a cumulative variance contribution of 70.0%.Preliminary application indicated the functional assessment subscale was moderately correlated with childhood health assessment questionnaire(r=0.70,P<0.05),the total scale was strongly correlated with juvenile arthritis disease activity score-27(r=0.92,P<0.05),and moderately correlated with both active and limited joint

关 键 词：关节炎 关节功能 健康调查 评估 量表 

分 类 号：R725.9[医药卫生—儿科]