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基于经典测量理论和项目反应理论对慢性病毒性肝炎患者生命质量量表的评价
DOI: 10.3969/j.issn.1001-5256.2022.11.007
伦理学声明: 本研究方案于2019年2月24日经由昆明医科大学第一附属医院伦理委员会审批，批号：2019-L-10，所纳入患者均签署知情同意书。
利益冲突声明：本研究不存在研究者、伦理委员会成员、受试者监护人以及与公开研究成果有关的利益冲突。
作者贡献声明：刘叶负责概念化、方法论、撰写论文初稿；鲁杰负责资源与数据录入；李顶春负责数据统计学分析；李武进行文章的构思与设计并负责监督和研究管理；陈一晖进行论文的修订和审校。
Evaluation of quality of life instruments for chronic diseases-chronic hepatitis(V2.0)based on classical test theory and item response theory
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摘要:
目的 基于经典测量理论(CTT)与项目反应理论(IRT)对慢性肝炎生命质量量表QLICD-CH(V2.0)的各个条目进行深入分析并评价。 方法 以2019年3月—2020年1月在昆明医科大学第一附属医院感染科住院的226例慢性肝炎患者为研究对象，使用QLICD-CH(V2.0)量表对其进行生命质量测量，采用CTT的变异系数法、因子分析法、克朗巴赫α系数法以及相关系数法，对量表结果进行宏观的统计学分析，并用IRT微观分析各个条目的信息量、区分度系数和难度参数，评价其质量的优劣。 结果 CTT分析结果提示：46个条目的QLICD-CH(V2.0)量表中有36个条目满足4种统计学方法里的3种；IRT分析结果显示：有36个条目的平均信息量＞0.108；区分度在-0.387~3.574之间，有40个条目的区分度＞0.30；各条目的难度系数在-14.805~9.057之间，符合范围在-4~4且从b1到b4呈单调递增趋势的有31个条目。 结论 QLICD-CH(V2.0)量表大部分条目性能较好，但仍有部分条目需要进一步改进优化或删除。 Abstract:Objective Each item of the Chronic Hepatitis Quality of Life Scale (V2.0) was thoroughly analyzed and evaluated according to classical test theory (CTT) and item response theory (IRT). Methods The QLICD-CH (V2.0) scale was used to assess the life quality of 226 patients with chronic hepatitis who were hospitalized in the Department of Infectious Diseases from March 2019 to January 2020. By using CTT's coefficient of variation method, factor analysis method, Cronbach's alpha coefficient method and correlation coefficient method, macroscopic statistical analysis on the scale results was performed. IRT was used to microscopically analyze the information content, discrimination coefficient and difficulty parameters of each item. Results CTT analysis revealed that 36 items of the QLICD-CH (V2.0) scale satisfied three of the four statistical methods. IRT analysis showed that the average information content of 36 items was greater than 0.108, with the degree of discrimination ranging from -0.387 to 3.574; the degree of discrimination of 40 items was greater than 0.30; the difficulty coefficient of each item ranged from -14.805 to 9.057, with 31 items conformed to [-4, 4] and a monotonically increasing trend from b1 to b4. Conclusion The majority of items on the QLICD-CH (V2.0) scale perform well, but there are a few items that could be improved, optimized, or removed. -
表 1 患者的基本情况
Table 1. Basic information of patients
人口学指标 乙型肝炎 丙型肝炎 总例数 性别[例(%)] 男
女94(62.25)
57(37.75)54(72.00)
21(28.00)148(65.49)
78(34.51)婚姻[例(%)]
已婚
未婚
138(91.39)
13(8.61)
71(94.67)
4(5.34)
209(92.48)
17(7.52)民族[例(%)]
汉族
少数民族
135(89.40)
16(10.60)
62(82.67)
13(17.33)
197(87.17)
29(12.83)职业[例(%)]
非职工
职工
112(74.17)
39(25.83)
57(76.00)
18(24.00)
169(74.78)
57(25.22)保险[例(%)]
有医疗保险
现金
119(78.81)
32(21.19)
64(85.33)
11(14.67)
183(80.97)
43(19.03)收入[例(%)]
好
差
142(94.04)
9(5.96)
71(94.67)
4(5.33)
213(94.25)
13(5.75)
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表 2 CTT的量表评价结果
Table 2. Scale evaluation results of CTT
条目及简称 变异度法 因子分析法 克朗巴赫系数法 相关系数法 评价 GPH1胃口 0.929 0.813 0.966 0.2211) √ GPH2睡眠 1.014 0.612 0.966 0.4791) √ GPH3性功能 1.178 0.786 0.964 0.7761) √ GPH4大便 0.929 0.541 0.966 0.4681) √ GPH5疼痛等不舒服 1.329 0.598 0.964 0.7541) √ GPH6生活自理 0.813 0.608 0.966 0.3451) GPH7劳动 0.726 0.666 0.966 0.1552) GPH8独立行走 0.713 0.745 0.966 0.2131) GPH9乏力 1.137 0.608 0.965 0.6921) √ GPS1集中注意力 0.809 0.578 0.967 0.047 GPS2记忆下降 1.296 0.814 0.964 0.7761) √ GPS3生活乐趣 1.085 0.683 0.965 0.5721) √ GPS4烦躁 1.163 0.549 0.965 0.5951) √ GPS5视为家庭负担 1.012 0.491 0.965 0.6271) √ GPS6健康变糟 1.184 0.585 0.965 0.7211) √ GPS7情绪低落忧伤 1.296 0.697 0.964 0.8401) √ GPS8悲观失望 1.307 0.702 0.964 0.8241) √ GPS9恐惧疾病 1.265 0.683 0.964 0.8241) √ GPS10乐观看待疾病 0.931 0.728 0.966 0.3871) √ GPS11脾气性格变差 1.146 0.719 0.964 0.7481) √ GS01因病和别人来往变化 0.862 0.605 0.966 0.4071) GS02和家人关系 0.502 0.897 0.967 0.050 GS03和朋友关系 0.612 0.846 0.967 -0.090 GS04家庭的关心支持 0.353 0.594 0.966 0.152 GS05家庭以外的关心支持 0.836 0.684 0.966 0.3591) GS06因病家庭困难 1.148 0.674 0.965 0.6341) √ GS07工作的地位和作用 1.155 0.539 0.965 0.5911) √ GS08承担家庭角色 0.673 0.510 0.966 0.4131) CH1讨厌油荤 1.240 0.740 0.965 0.6841) √ CH2肝区不适 1.306 0.757 0.965 0.7331) √ CH3饭量减少 1.203 0.778 0.964 0.7861) √ CH4定时复诊不愉快 1.255 0.757 0.964 0.7681) √ CH5别人嫌弃 1.291 0.653 0.964 0.7451) √ CH6眼睛皮肤发黄 1.424 0.726 0.964 0.7831) √ CH7尿色加深 1.161 0.637 0.965 0.7361) √ CH8遗传后代 1.297 0.724 0.965 0.7341) √ CH9恶心呕吐 1.271 0.831 0.964 0.7801) √ CH10餐后上腹不适 1.336 0.715 0.964 0.7901) √ CH11治疗后发热 1.218 0.850 0.964 0.7631) √ CH12严重脱发 1.165 0.777 0.964 0.7621) √ CH13病情复发加重 1.225 0.661 0.964 0.7871) √ CH14用药效果变差 1.313 0.763 0.964 0.8221) √ CH15影响婚恋 1.280 0.793 0.964 0.7991) √ CH16发展肝硬化肝癌 1.228 0.531 0.965 0.6871) √ CH17失去学习机会 1.098 0.602 0.964 0.7451) √ CH18朋友变少 1.218 0.716 0.964 0.7811) √ 注：1) P＜0.01，2)P＜0.05；√表示该条目综合评价好。
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表 3 各条目不同位置点的信息量、平均信息量及评价
Table 3. Information content, average information content and evaluation at different locations of each item
条目 θ值 平均信息量 评价 -2 -1 0 1 2 GPH1 0.036 0.035 0.035 0.035 0.035 0.035 差 GPH2 0.236 0.263 0.269 0.264 0.255 0.257 一般 GPH3 1.853 2.200 1.959 0.988 0.087 1.417 优 GPH4 0.280 0.290 0.286 0.273 0.268 0.279 一般 GPH5 0.953 1.506 1.485 1.356 0.452 1.150 优 GPH6 0.067 0.067 0.065 0.061 0.054 0.063 差 GPH7 0.003 0.003 0.003 0.003 0.003 0.003 差 GPH8 0.020 0.019 0.018 0.016 0.014 0.018 差 GPH9 1.037 1.204 1.043 1.008 0.632 0.985 优 GPS1 0.001 0.001 0.001 0.001 0.001 0.001 差 GPS2 1.727 2.201 1.968 0.459 0.037 1.278 优 GPS3 0.579 0.576 0.543 0.493 0.264 0.491 优 GPS4 0.615 0.648 0.642 0.636 0.489 0.606 优 GPS5 0.643 0.650 0.608 0.555 0.534 0.598 优 GPS6 0.851 0.913 0.888 0.839 0.474 0.793 优 GPS7 1.813 3.121 2.988 0.914 0.042 1.776 优 GPS8 1.525 2.668 2.560 1.068 0.070 1.578 优 GPS9 1.737 2.802 2.576 1.220 0.073 1.682 优 GPS10 0.147 0.150 0.144 0.122 0.088 0.130 一般 GPS11 1.740 1.780 1.753 1.114 0.142 1.306 优 GS01 0.114 0.114 0.104 0.085 0.061 0.096 差 GS02 0.006 0.007 0.008 0.009 0.010 0.008 差 GS03 0.022 0.028 0.033 0.038 0.041 0.032 差 GS04 0.003 0.002 0.002 0.002 0.002 0.002 差 GS05 0.111 0.111 0.102 0.085 0.063 0.094 差 GS06 0.470 0.472 0.467 0.446 0.331 0.437 优 GS07 0.386 0.387 0.368 0.352 0.281 0.355 优 GS08 0.451 0.326 0.147 0.050 0.015 0.198 一般 CH1 0.825 0.869 0.851 0.614 0.199 0.672 优 CH2 1.090 1.265 1.193 0.648 0.126 0.864 优 CH3 1.591 2.326 1.804 1.759 0.231 1.542 优 CH4 1.213 1.367 1.328 0.854 0.162 0.985 优 CH5 0.939 1.142 1.091 0.748 0.182 0.820 优 CH6 1.194 1.861 1.608 0.364 0.036 1.013 优 CH7 1.579 1.832 1.393 1.332 0.232 1.274 优 CH8 1.165 1.764 1.540 1.200 0.201 1.174 优 CH9 1.507 2.336 1.865 1.424 0.148 1.456 优 CH10 1.247 2.061 1.854 1.381 0.186 1.346 优 CH11 2.441 3.903 1.734 0.068 0.002 1.630 优 CH12 2.015 2.608 2.096 1.009 0.067 1.559 优 CH13 1.205 1.298 1.277 0.922 0.202 0.981 优 CH14 1.908 2.669 2.437 0.350 0.019 1.476 优 CH15 1.902 2.207 1.816 0.294 0.022 1.248 优 CH16 0.869 1.104 1.054 1.078 0.581 0.937 优 CH17 1.943 2.052 1.659 1.235 0.137 1.405 优 CH18 2.311 2.600 1.824 0.176 0.010 1.384 优
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表 4 各条目区分度、难度系数及评价结果
Table 4. Discrimination degree, difficulty and evaluation results of each item
条目 区分度 难度系数 区分度评价 难度评价 区分度值 95%置信区间 b1 b2 b3 b4 GPH1 0.3452) 0.043~0.647 -9.603 -4.020 1.331 7.806 √ GPH2 0.9441) 0.606~1.281 -3.621 -1.352 0.398 2.453 √ √ GPH3 2.7371) 2.058~3.417 -1.814 -1.341 -0.607 0.383 √ √ GPH4 0.9921) 0.643~1.341 -5.577 -2.095 -0.227 2.135 √ GPH5 2.2541) 1.728~2.780 -1.502 -0.650 -0.106 1.018 √ √ GPH6 0.4751) 0.167~0.783 — -7.963 -2.981 0.757 √ GPH7 0.103 0.197~0.402 — -10.918 -9.355 2.914 GPH8 0.271 0.052~0.594 — -14.805 -8.565 3.133 GPH9 1.9871) 1.489~2.485 -1.843 -1.170 -0.296 1.301 √ √ GPS1 -0.065 -0.376~0.245 — — 6.625 5.688 GPS2 2.6651) 1.975~3.355 -1.796 -1.223 -0.694 0.026 √ √ GPS3 1.3781) 0.972~1.783 -3.087 -1.865 -0.743 0.829 √ √ GPS4 1.4671) 1.063~1.871 -2.130 -1.008 0.309 1.515 √ √ GPS5 1.4771) 1.066~1.888 -2.747 -1.464 -0.223 1.720 √ √ GPS6 1.7361) 1.292~2.181 -2.047 -1.121 -0.083 1.179 √ √ GPS7 3.2621) 2.465~4.059 -1.603 -1.067 -0.381 0.308 √ √ GPS8 2.9991) 2.272~3.726 -1.564 -1.068 -0.336 0.387 √ √ GPS9 3.1171) 2.358~3.877 -1.610 -1.159 -0.403 0.436 √ √ GPS10 0.7051) 0.382~1.028 -6.524 -4.914 -1.690 0.247 √ GPS11 2.5171) 1.902~3.133 -1.962 -1.367 -0.431 0.509 √ √ GS01 0.6191) 0.286~0.951 — -6.232 -2.199 4.731 √ GS02 -0.205 -0.566~0.155 — — 9.057 5.254 GS03 -0.3872) -0.731~-0.043 — 8.328 7.529 1.932 GS04 0.140 0.344~0.624 — — -10.363 -9.113 GS05 0.6101) 0.285~0.934 — -6.815 -2.397 4.841 √ GS06 1.2441) 0.866~1.622 -2.706 -1.501 -0.163 1.316 √ √ GS07 1.1171) 0.756~1.477 -2.905 -1.651 -0.522 1.354 √ √ GS08 1.2331) 0.613~1.853 -4.624 -4.048 -2.339 3.290 √ CH1 1.6761) 1.228~2.123 -2.179 -1.328 -0.423 0.515 √ √ CH2 2.0101) 1.500~2.520 -1.902 -1.188 -0.564 0.306 √ √ CH3 2.7891) 2.121~3.457 -1.655 -1.147 -0.440 0.761 √ √ CH4 2.1361) 1.595~2.677 -1.867 -1.346 -0.456 0.473 √ √ CH5 1.9271) 1.429~2.426 -1.757 -1.348 -0.503 0.490 √ √ CH6 2.4351) 1.801~3.069 -1.589 -1.097 -0.530 4.910 √ CH7 2.4491) 1.847~3.052 -1.889 -1.240 -0.614 0.705 √ √ CH8 2.3941) 1.804~2.984 -1.589 -1.141 -0.451 0.631 √ √ CH9 2.7751) 2.099~3.451 -1.620 -1.158 -0.511 0.591 √ √ CH10 2.5991) 1.986~3.211 -1.556 -0.904 -0.336 0.640 √ √ CH11 3.5741) 2.522~4.627 -1.693 -1.325 -0.841 3.538 √ √ CH12 2.9781) 2.213~3.742 -1.751 -1.390 -0.747 0.364 √ √ CH13 2.0921) 1.562~2.621 -1.943 -1.329 -0.375 0.578 √ √ CH14 2.9991) 2.218~3.781 -1.705 -1.222 -0.554 4.945 √ CH15 2.6781) 1.965~3.391 -1.918 -1.271 -0.687 3.840 √ √ CH16 1.9211) 1.443~2.398 -1.674 -0.833 0.362 1.258 √ √ CH17 2.6641) 1.988~3.339 -1.947 -1.449 -0.670 0.532 √ √ CH18 2.9441) 2.140~3.748 -1.929 -1.369 -0.728 3.691 √ √ 注：1) P＜0.01, 2)P＜0.05；—表示计算无意义；√表示该条目评价好。
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