腰椎管狭窄症神经性跛行相关结局指标量表的测量学性能评价

Psychometric properties of outcome measurements of walking limitation with neurogenic claudication due to Lumbar Spinal Stenosis

摘要:

目的：评价、比较步行伤残量表的测量学性能。方法：组检索CNKI、万方、Sinomed、PUBMED、EMBASE、web of science等6个数据库,构建腰痛结局测量工具性能研究的文献库,纳入腰痛人群的效度研究,至少评价一项量表测量学性能。2名研究者根据纳入排除标准筛选、提取全文数据,每项研究提取样本大小、年龄、性别、疾病特点,地区和语言等,以及测量学性能的统计学方法及研究结果。采用“量表测量学性能评价标准”评价量表心理测量学性能相关指标的证据强度和性能质量,使用COSMIN标准相应方框中包含的条目对每种测量性能进行评价；根据每个测量性能的所有研究结果是否一致、研究方法学质量等综合评价量表的证据等级。结果：建立包含123篇文献的数据库,全文阅读后纳入量表效度研究10篇,包含11个主观测量工具。根据COSMIN标准,所有的测量学性能研究中,7个测量学性能研究的方法学质量被评为优秀,4个被评为好,6个被评为一般,2个被评为差。综合证据结果显示：内部一致性评价证据为好的量表包括PFS,重测信度评价证据为好的量表包括PFS、PFS walk、ODI walk,结构效度评价证据为好的量表包括HUI3 AMb、OCS-speed、Self-predicted walking distance、ODI walk,效标效度评价证据为好的量表包括HUI3 AMb,反应度受研究方法学质量影响,尚未有证据好的量表。结论：目前尚缺乏高质量的评估NC患者行走伤残结测量工具的测量学性能的研究,或未发现任何一个测量工具可以作为评价NC的金标准。现有证据推荐临床医生和研究人员使用ODI walk作为评价NC的测量工具。未来仍需要设计严谨、方法合理、更大样本量的高质量研究来完善现有证据。

Abstract:

Objective: To evaluate and compare the performance of walking disability scale with neurogenic claudication (NC) due to Lumbar Spinal Stenosis (LSS). Methods: We searched 6 databases and constructed a document database of the study on the performance of the measurement tools for low back pain outcomes, and included the validity study of low back pain population to evaluate the measurement performance of at least one scale. Two researchers selected and extracted full-text data based on inclusion and exclusion criteria, respectively. Sample size, age, sex, disease characteristics, region and language were extracted for each study, as well as statistical methods and study results of measurement performance. The measurement properties evaluation criteria was used to evaluate the quality of the scales, and the items contained in the corresponding boxes of the COSMIN standard were used to evaluate each measurement performance. The evidence level of the scale is evaluated based on the consistency of all the research results of each measurement performance and the quality of the research methodology. Results: A database containing 123 articles was established. After full text reading, 10 validity studies were extracted, including 11 measurements. According to the COSMIN standard, the methodological quality of 7 studies was rated as excellent, 4 as good, 6 as fair, and 2 as poor. The overall evidence showed that: the scale with good internal consistency included PFS, the scale with good test-retest reliability included PFS, PFS walk, ODI walk, the scale with good structure validity included HUI3 AMb, OCS-spd, Self-predicted walking short and ODI walk; the scale with good criterion validity included HUI3 AMb, and the response validity was affected by the quality of research methodology, so there is no good scale. Conclusion: At present, there is a lack of high-quality research on the measurement properties of walking disability for NC patients, or no measurements can be used as the gold standard for NC evaluation. Available evidence recommends that clinicians and researchers use ODI Walk as a measurement tool to evaluate NC. The high-quality studies with rigorous design and large sample size are warranted in future.