精神病患者生活品質問卷應用於思覺失調症患者之最小可偵測變化值

Minimal Detectable Change of the Quality of Life for Mental Disorder Scale in Patients with Schizophrenia

李淑君(Shu-Chun Lee) ； 尤菀薈(Wan-Hui Yu) ； 邱恩琦(En-Chi Chiu) ； 鄧乃瑜(Nai-Yu Deng) ； 謝清麟(Ching-Lin Hsieh)

《職能治療學會雜誌》 33卷2期 (2015/12) Pp. 132-148

https://doi.org/10.6594/JTOTA.2015.33(2).01

摘要

健康相關生活品質 (health-related quality of life, HRQOL) 可代表患者之主觀健康狀態，是思覺失調症患者精神復健的成效指標之一。精神病患者生活品質問卷 (Quality of Life for Mental Disorder Scale, QOLMD) 是國內學者依據本土文化民情發展之HRQOL 問卷。QOLMD 包含8 個層面：生活滿意、自主性、健康維護、家庭支持、社交活動、經濟功能、身體健康及心理健康，且8 個層面分數可再加總為HRQOL 總分。QOLMD 具良好信度及區辨效度；惟QOLMD 之最小可偵測變化值 (minimal detectable change, MDC) 闕如，影響此問卷之應用價值。故本研究之目的為檢驗QOLMD 之再測一致性及計算MDC。MDC 數值可提供臨床及研究人員判斷個別病患之HRQOL 前後測總分變化是否超過隨機測量誤差。共61 位社區之思覺失調症患者參與本研究，其中28 位為男性。研究者以intraclass correlation coefficient (ICC) 檢驗QOLMD 總分及其8 個層面分數之再測一致性，並計算MDC。結果發現QOLMD 總分及自主性、健康維護、家庭支持、社交活動及身體健康等5 個層面呈現好的再測一致性 (ICCs = 0.64-0.74)；生活滿意、經濟功能及心理健康等3 個層面呈中度再測一致性 (ICCs = 0.47-0.54)。QOLMD 問卷總分之MDC 為27.5 分，其8 個層面之MDC 為3.2-9.3 分；QOLMD 總分以及8層面之MDC%大於30%，顯示QOLMD 之隨機測量誤差偏高。此MDC 數據可提供臨床及研究人員判斷思覺失調症患者之HRQOL 是否發生真實變化（超過隨機測量誤差之閾值）。

關鍵字

思覺失調症 ； 健康相關生活品質 ； 最小可偵測變化值

並列摘要

Health-related quality of life (HRQOL) representing one’s subjective health state is acknowledged as an indicator of psychiatric rehabilitation outcomes. The Quality of Life for Mental Disorder Scale (QOLMD) developed by local scholars, it includes 8 dimensions: life satisfaction, autonomy, health maintenance, family support, economic ability, social activity, physical health, and mental health. The sum score of the 8 dimensions presents overall HRQOL. Reliability and discriminant validity of QOLMD have been shown adequate; however, the minimal detectable change (MDC) of QOLMD has not been examined. The purpose of this study was to determine test-retest reliability and MDC of the QOLMD. The values of MDC of the QOLMD allow users to distinguish whether an individual’s HRQOL surpasses random measurement error. Sixty-one individuals with schizophrenia (28 males) participated in the study. Intraclass correlation coefficient (ICC) was used to examine the test-retest reliability and calculate the MDCs of 8 dimensions and total score of QOLMD. We found that 5 dimensions (autonomy, health maintenance, family support, social activity, and physical health) and total score of QOLMD had good test-retest reliability (ICCs = 0.64-0.74). The other 3 dimensions (life satisfaction, economic ability, and mental health) had moderate reliability (ICCs = 0.47-0.54). MDC was 27.5 for total score and 3.2-9.3 for the 8 dimensions of QOLMD. MDC% was more than 30% of the mean of each dimension and total score, which showed substantial amount of random measurement error. These MDCs provide a useful indicator to help users determine whether the change of HRQOL in schizophrenia is real (beyond random measurement error).

並列關鍵字

Schizophrenia ； Health-related quality of life ； Minimal detectable change