SF-36量表用于国人脊髓型颈椎病的信度分析及其与神经功能的相关性研究

目的:评估SF-36量表用于国人脊髓型颈椎病(cervical spondylotic myelopathy,CSM)患者健康相关生活质量(quality of life,QOL)的信度,并验证术后疗效评价中,生活质量评价与神经功能评估的一致性。方法:本研究前瞻性收集了接受手术治疗的脊髓型颈椎病患者142例,男84例,女58例,年龄60.0±10.9岁。所有患者均接受手术治疗。分别于术前、术后3个月、术后1年和术后2年以上末次随访时分别使用改良日本骨科协会评分法(modified Japanese Orthopaedic Association,mJOA)评分和健康状况调查简表(SF-36量表)进行神经功能和生活质量评估,并与正常人群的常模进行对比。使用克隆巴赫系数(Cronbachα)分析SF-36量表八个维度的信度,并进一步分析在术后不同随访时间节点SF-36各维度与神经功能评价的相关性。根据患者各项评分的变化趋势,分析患者的康复峰值时间。结果:术前CSM患者SF-36量表8个维度中,除“精神健康”维度外,其余7各维度较健康成年人常模均存在显著功能缺陷。SF-36量表各维度的Cronbachα介于0.73~0.85之间(Cronbachα:生理功能=0.85、生理职能=0.83、躯体疼痛=0.80、整体健康=0.81、活力=0.81、社会功能=0.79、情感职能=0.73、精神健康=0.75)。术后3个月时,mJOA评分的改善仅与患者SF-36量表中生理功能和躯体疼痛两个维度得分有显著相关性(相关系数R:生理功能=0.32,躯体疼痛=0.20;P<0.05);术后1年时,mJOA评分的改善与SF-36量表中生理功能、整体健康、社会功能和情感职能四个维度有显著相关性(相关系数R:生理功能=0.39,整体健康=0.24,社会功能=0.22,情感职能=0.19;P<0.05);在术后2年以上末次随访时,mJOA评分的改善与SF-36量表中生理功能、活力和情感职能三个维度显著相关(相关系数R:生理功能=0.38,活力=0.20,情感职能=0.20;P<0.05)。SF-36量表的生理总评分和心理总评分分别在17.7个月和18.9个月达到峰值。结论:SF-36量表各维度的信度较高,是一项可靠的评估CSM患者健康相关生活质量的方法。在术后不同随访期的疗效评估中,SF-36量表各维度与神经功能改善评估的一致性不尽相同:在术后恢复早期,mJOA评分的改善与SF-36量表中的生理相关维度显著相关;随着术后恢复期延长,mJOA评分的改善则与生理、心理相关维度均显著相关。

The reliability of quality of life evaluation using SF-36 and its correlation with neurological function assessment in Chinese patients with cervical spondylotic myelopathy

Objectives:To calculate the reliability of SF-36 and to verify its consistency with neurological function assessment after surgery for Chinese cervical spondylotic myelopathy(CSM)patients.Methods:The data of 142 CSM patients(male=84,female=58,average age was 60.0 years old,SD=10.9)who underwent surgical treatment were prospectively collected.Both neurological measurement(modified Japanese Orthopaedic Association,mJOA score)and quality of life(QOL)measurement(SF-36)were used to evaluate patients in this study preoperatively and at the follow-up of 3-month,1-year and over 2-year postoperatively.The re sults of SF-36 evaluation in CSM patients were compared with that of healthy adults.Cronbachαwas used to assess the reliability of 8 domains of SF-36.We also analyzed the consistency of domains of SF-36 with mJOA score at different follow-up time points.Based on the changing trends of each scale,we calculated the peak recovery time of CSM patients during the follow-up period.Results:The scores for all SF-36 domains except for mental health domain indicated that patients with CSM were significantly impaired compared with healthy adults.Cronbachαranged from 0.73(for role-emotional)to 0.85(for physical functioning).(Cronbachα:physical functioning=0.85,role-physical=0.83,bodily pain=0.80,general health=0.81,vitality=0.81,social functioning=0.79,role-emotional=0.73,mental health=0.75).At the 3-month follow-up,improvements in mJOA scores were only significantly correlated with the patient′s scores of physical functioning and bodily pain.Correlation coefficient(CC)(R):physical functioning=0.32,bodily pain=0.20;P<0.05].At 1 year after surgery,improvements in mJOA scores were significantly correlated with physical functioning,general health,social functioning and role-emotionalCC(R):physical functioning=0.39,general health=0.24,social functioning=0.22,role-emotional=0.19;P<0.05].While at final follow-up,improvements in mJOA scores were significantly correlated with physical functioning,vitality and role-emotionalCC(R):physical functioning=0.38,vitality=0.20,role-emotional=0.20;P<0.05].The physical component score(PCS)peaked at 17.7 months and the mental component score(MCS)at 18.9 months,respectively.Conclusions:SF-36 is a reliable method to evaluate patients with CSM.The evaluation of quality of life was inconsistent with the neurological function improvement in different stages of the postoperative follow-up.At the early stage of recovery,the improvements in mJOA scores essentially correlated with domains from the physical components of the SF-36,while at later stages the improvements were associated with domains from both physical and mental components.