两种疲劳量表在类风湿关节炎患者中应用的信效度检验

背景　疲劳是评价类风湿关节炎（RA）患者疾病状况的重要指标，慢性病治疗功能评估-疲劳量表（FACIT-F）及Bristol类风湿关节炎患者疲劳多维度问卷（BRAF-MDQ）是目前国外用于评估RA患者疲劳水平比较全面的量表，因此，了解我国RA患者疲劳状况并探寻有效的评估工具对于全面治疗RA，改善患者临床症状具有重要意义。目的　检验中文版FACIT-F及中文版BRAF-MDQ在评估RA患者疲劳时的信效度。方法　采用便利抽样方法，于2017年7月—2018年3月选取在广东省惠州市第一人民医院接受住院及门诊治疗的281例RA患者为研究对象。采用一般资料调查表、中文版FACIT-F、中文版BRAF-MDQ、健康调查简表-生理机能领域（SF-36 PF）、疼痛-视觉模拟评分量表（VAS）、疲劳-VAS进行问卷调查。采用项目分析、探索性因素分析、效标关联效度、信度分析评价中文版FACIT-F和中文版BRAF-MDQ的信效度。结果　项目分析显示高分组中文版FACIT-F与中文版BRAF-MDQ总分高于低分组（P<0.05）。探索性因子分析显示中文版FACIT-F共提取1个公因子，各条目因子负荷范围为0.563~0.941，累积方差贡献率为71.40%；BRAF-MDQ同提取2个公因子，各条目因子负荷范围为0.565~0.804，累积方差贡献率为73.53%。FACIT-F总分与SF-36 PF得分呈正相关，与疼痛-VAS得分、疲劳-VAS得分呈负相关（P<0.05）；BRAF-MDQ总分、躯体生活得分、认知情感得分与SF-36 PF得分呈负相关，与疼痛-VAS得分、疲劳-VAS得分呈正相关（P<0.05）。中文版FACIT-F量表内部一致性Cronbach's α系数为0.965，组内相关系数（ICC）为0.967；中文版BRAF-MDQ量表内部一致性Cronbach's α系数为0.956，躯体生活、认知情感维度Cronbach's α系数分别为0.929、0.948，ICC为0.962，躯体生活、认知情感维度ICC为0.968、0.954。结论　中文版FACIT-F及中文版BRAF-MDQ均具有良好的信度和效度，医务人员可根据临床需要选择合适的量表来评估RA患者疲劳程度。

Validity and Reliability of the Chinese Version of FACIT-F and BRAF-MDQ in Rheumatoid Arthritis Patients

Background　Fatigue is an important indicator of disease status in patients with rheumatoid arthritis （RA）.The Functional Assessment of Chronic Illness Therapy-Fatigue （FACIT-F）and the Bristol Rheumatoid Arthritis Fatigue Multi-Dimensional Questionnaire （BRAF-MDQ） are currently used abroad to assess the fatigue of RA patients.Therefore，understanding the fatigue status of RA patients in China and exploring effective assessment tools are of great significance for the comprehensive treatment of RA and the improvement of clinical symptoms.Objective　To assess the validity and reliability of the Chinese version of FACIT-F and Chinese version of BRAF-MDQ in patients with RA.Methods　A total of 281 outpatients and inpatients with RA who were treated in the First People's Hospital of Huizhou，Guangdong Province from July 2017 to March 2018 were enrolled using convenience sampling.A set of questionnaires comprised of Socio-demographic Questionnaire，Chinese version of FACIT-F，Chinese version of BRAF-MDQ，Chinese version of SF-36 Physical Functioning subscale （SF-36 PF） and fatigue-VAS （fatigue-VAS），and pain-VAS （pain-VAS） were used to collect data.The reliability and validity of both Chinese version of FACIT-F and Chinese version of BRAF-MDQ were evaluated by item analysis，exploratory factor analysis，correlation analysis，criterion-related validity and reliability analysis.Results　Item analysis showed that the mean total scores of both Chinese version of FACIT-F and Chinese version of BRAF-MDQ were much higher in the top 27% （high score group） compared with the bottom 27% （low score group） （P<0.05）.One common factor was extracted from the Chinese version of FACIT-F，which explained 71.40% of the total variance，achieving factor loadings of 0.563-0.941，while two common factors were extracted from the Chinese version of BRAF-MDQ，which explained 73.53% of the total variance and the factor loadings obtained were 0.565-0.804.The total score of Chinese version of FACIT-F was positively correlated with the total score of SF-36 PF，but negatively correlated with the total score of pain-VAS and fatigue-VAS （P<0.05）.The total score of the Chinese version of BRAF-MDQ and scores of its two domains of physical fatigue，cognitive-emotional fatigue were negatively correlated with the score of SF-36 PF，whereas positively correlated with that of pain-VAS and fatigue-VAS （P<0.05）.The Cronbach's α （measuring the internal consistency），and intraclass correlation coefficient （ICC） of the Chinese version of FACIT-F were 0.965，0.967，respectively.The Cronbach's α and ICC were 0.956，0.962，respectively for the Chinese version of BRAF-MDQ，0.929，0.968，respectively for the physical fatigue domain，and 0.948，0.954 respectively for the cognitive-emotional fatigue domain. Conclusion　Both the Chinese version of FACIT-F and BRAF-MDQ have statistically acceptable levels of reliability and validity for assessing fatigue in patients with RA.Healthcare providers can choose the appropriate scale to assess the fatigue level of RA patients according to the clinical needs.