台灣版腦創傷後生活品質問卷(QOLIBRI)之信效度研究

Validation of the Quality of life after brain injury (QOLIBRI) in Taiwan

林硯農(Yen-Nung Lin)

指導教授 ： 林茂榮

臺北醫學大學/公共衛生暨營養學院/傷害防治學研究所/碩士(2011年)

摘要

摘要
腦創傷後生活品質問卷(Qulity of life after brain injury，QOLIBRI)是一個針對「腦創傷患者生活品質測量」所發展的新工具。本研究的目的在於測試台灣版QOLIBRI的信效度。
本研究為斷代研究，以及以長期追蹤調查所進行的研究。
受試者為國際疾病分類符合腦創傷者，於台北6家教學醫院神經外科門診收案。以面訪及問卷方式取得QOLIBRI及其他腦創傷相關的臨床資訊，以病例調查取得受傷當時的相關資訊。以斷代研究資料分析QOLIBRI的信效度；以追蹤調查資料分析QOLIBRI量表的反應性(Responsiveness)。
289位受試者接受初次面訪，258位完成QOLIBRI量表初測，其中147位於兩年內接受QOLIBRI再測。
主要評估內容：QOLIBRI問卷。
次要評估內容：格拉斯哥昏迷指數(GCS)、細化型格拉斯哥預後量表(GOSE)、醫院焦慮憂鬱量表(HADS)、SF-36健康調查簡表、簡易智能量表(MMSE)、巴氏量表(Barthel Index)等等。
結果：
QOLIBRI量表有非常好的內部一致性(0.83-0.95)及再測信度(0.81-0.89)；「同時效度」顯示「QOLIBRI總分」與GOSE之間、「QOLIBRI日常生活構面」與Barthel Index之間、「QOLIBRI自我感覺構面」與「HADS-anxiety」之間皆達到中度相關(r分別是0.47, 0.42 , -0.50)。SF-36的身體功能、活力狀況、心理健康、社會功能、身體疼痛程度分別與QOLIBRI的日常生活、自我感覺、情緒困擾、社會關係、及身體問題構面有中度以上相關(r分別是0.61, 0.63, 0.53, 0.48, 0.62)。「已知族群效度」顯示「QOLIBRI總分」在有無工作、Barthel Index、日常生活獨立性、「HADS-anxiety」、「HADS-depression」上皆有大的效應值(Cohen’s d均>0.8)。與GOSE間的反應性顯示「QOLIBRI日常生活構面」及「QOLIBRI總分」有小至中等的效應值(Cohen’s d>0.2)。因素分析顯示萃取出的6個因子與QOLIBRI的6個構面吻合。缺點在於情緒困擾構面分數分布明顯偏移，而且與「醫院焦慮憂鬱量表」的同時性相關度不如預期；結構方程式顯示各題項間存有一些共變因子，結構須經調整才能達到可接受的相稱性。
結論：
QOLIBRI的信度良好，「同時效度」測試顯示與GOSE、巴氏量表、SF-36之間有良好相關性；「已知族群效度」以及「對GOSE的反應性」良好，因數分析顯示一個6個構面的結構。對腦傷患者而言，台灣版QOLIBRI是個合宜的健康相關生活品質測量工具。

關鍵字

腦創傷；生活品質

並列摘要

Abstract
Objects:
Quality of life after brain injury (QOLIBRI) questionnaire is a new health-related quality of life (HRQL) instrument specifically designed for traumatic brain injury. This study was conducted to examine psychometric properties of QOLIBRI among persons with traumatic brain injury (TBI) in Taiwan.
Design:
Cross-sectional study and longitudinal follow-up.
Settings:
Eligible participants who had a diagnosis of TBI were identified from outpatients of neurosurgery of 6 teaching hospitals in northern Taiwan. Information on the HRQL and injury-related characteristics were collected at the initial interview with questionnaire. Subjects were followed up to 2 years for updating HRQL information.
Participants:
Two hundred and eighty nine subjects participated in initial interview. Among them, 258 subjects completed QOLIBRI questionnaire and 147 had a follow-up within 2 years after the initial interview.
Main measurement:
QOLIBRI questionnaire.
Second measurements:
Glasgow Coma Scale (GCS)、Glasgow Outcome Scale Extended (GOSE)、Hospital Anxiety and Depression Scale (HADS)、SF-36、Mini-Mental Status Examination (MMSE)、Barthel Index, etc.
Results:
All domains of QOLIBRI had very good internal consistency (0.83-0.95) and test-retest correlation (0.81-0.89). The concurrent analysis showed moderate correlation between “QOLIBRI total” and GOSE, “daily activity” and Barthel Index, and “self perception” and HADS-anxiety (r=0.47, 0.42, -0.50 respectively). The correlation between QOLIBRI and SF-36 met expectation. For the known-group validity, QOLIBRI exhibited large effect size particularly on “QOLIBRI total” with regard to employment, Barthel Index, independence of daily life, HADS-anxiety and HADS-depression (Cohen’s d >0.8). “QOLIBRI total” and “QOLIBRI-daily activity” responded to the change of GOSE well. The factor analysis demonstrated a 6-factor structure compatible with the 6 domains of QOLIBRI. On the other hand, the emotion domain of QOLIBRI was significantly skewed in score distribution and the correlation between emotion domain and HADS was not as high as had been expected. Structure equation modeling revealed that some items might be more influenced by a construct which was not assigned by the QOLIBRI theoretical model.
Conclusion:
The QOLIBRI has very good reliability. Concurrent validity meet expectation with regard to GOSE, Barthel Index, and SF-36. Known-group validity and responsiveness are also good. The QOLIBRI is an appropriate HRQL instrument for persons with TBI in Taiwan.

並列關鍵字

traumatic brain injury ； TBI ； quality of life ； HRQL

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