口腔健康影响程度量表的研究状况和展望

随着医学模式的转变,研究心理因素对疾病的影响已成为现代医学发展的重要内容.口腔健康影响程度最表(OHIP)是反映口腔疾病对病人的身体、心理和社会功能等方而影响程度的综合评估.它的产生,是对现代口腔医学研究的有力补允,也带动了世界范围对口腔健康相关生存质量研究的关注.该文旨在通过介绍该量表的产生、发展、特点等内容,以探讨OHIP在我国的未来发展和应用.     

口腔健康相关生存质量评价的研究与应用

生存质量是指个体特异性的感受,包括对自身健康、疾病状态和(或)其他非医学方面的整体感受。口腔作为机体的一部分,口腔疾病也会影响社交和心理健康。本文就口腔健康相关生存质量评价的相关测评工具和意义作一综述。     

口腔健康影响程度量表的研制和应用

生存质量是指个体特异性的感受,包括对自身健康、疾病状态和(或)其他非医学方面的整体感受.口腔作为机体的一部分,口腔疾病也会影响社交和心理健康.本文就口腔健康影响程度量表的研制和应用以及未来发展作一综述.     

儿童口腔健康相关生存质量量表的验证研究

目的通过对11～14岁儿童口腔健康相关生存质量量表(COHRQoL11-14)中文版的验证研究,探讨其在中国适龄人群中应用的可行性。方法按照国际生存质量评价项目的标准程序,对原版COHRQoL11-14系列问卷11～14岁儿童感知问卷(CPQ11-14)、父母感知问卷(PPQ)和家庭影响问卷(FIS)进行翻译、回译、文化调适和改造,建立COHRQoL11-14中文版。使用该系列量表对11～14岁的儿童及其家长进行儿童口腔健康相关生存质量调查,考评量表的信度和效度。结果 67对儿童及家长接受问卷调查,收回有效问卷CPQ11-1462份,PPQ和FIS各65份,量表的完成率在89%以上。CPQ11-14内部一致性Cronbach′sα系数为0.92,条目-量表相关系数为0.49～0.70,ICCs为0.90,分半信度系数为0.85。PPQ和FIS的Cronbach′sα系数分别为0.91和0.89,分半信度系数分别为0.84和0.83。因子分析显示中文版量表所包含的条目存在预想的逻辑关系。结论 COHRQoL11-14具有可接受的信度和效度,其良好的心理测量学性质为其在中国适龄儿童中的应用提供了理论依据。     

口腔健康影响程度量表在口腔扁平苔藓中应用的研究进展

口腔扁平苔藓是口腔黏膜病中常见的疾病之一,反复发作,常伴有糜烂等症状,严重影响患者的生活质量,随着医学模式的改变,以患者为中心的临床诊疗活动逐渐成为当今主流,全面评估口腔健康相关生活质量显得愈发重要,其中以患者为主导的口腔健康影响程度量表的在口腔领域的应用日益增多,然而口腔健康影响程度量表在口腔扁平苔藓的临床诊治中应用尚少,该文综述了口腔健康影响程度量表及其在口腔扁平苔藓中的验证研究和应用,以期为临床上口腔扁平苔藓的诊治提供一定的参考。     

中文版口腔健康影响程度量表（OHIP-49）的研制

目的：中文版口腔健康影响程度量表（OHIP-49）的翻译及验证研究。方法：按国际标准程序,对英文原版口腔健康影响程度量表（OHIP-49）进行翻译、回译及跨文化适应过程,形成中文版OHIP-49。使用该量表和自评口腔健康状况调查表,对随机抽取的患有不同口腔疾病的患者和社区居民进行口腔健康相关生活质量调查,考评量表的信度和效度。结果：发放问卷360分,回收有效量表333份。OHIP-49各维度及量表总得分的内部一致性Cronbach＇sα系数为0.79～0.96,重测系数为0.83～0.97;量表得分与自评口腔健康呈显著正相关（P〈0.001）;量表各维度及总得分在不同自我评价治疗需要的人群中有显著差异。结论：OHIP-49中文版具有良好的信度、效度,适合在中国人群中应用。     

口腔健康影响程度量表在口腔扁平苔藓诊疗中的初步应用

目的:通过观察口腔扁平苔藓患者治疗前后的口腔健康相关生活质量状况,分析口腔健康影响程度量表(OHIP-14)中文版应用于口腔扁平苔藓临床诊疗的反应度。方法:采用OHIP-14中文版对口腔扁平苔藓患者在治疗前后进行问卷调查,并结合效应大小、标准化反应均数等指标进行反应度分析。结果:治疗后患者的OHIP-14分值较治疗前明显降低(P0.01)。7个维度中除心理不适外,其余维度分值差异均有统计学意义(P0.01),其效应大小在0.24～0.55之间,标准化反应均数在0.33～0.72之间。结论:OHIP-14中文版具有一定的反应度,通过评测口腔扁平苔藓患者的口腔健康相关生活质量可以为疗效评估提供参考。     

成都市社区中老年人口腔健康相关生活质量评价及其影响因素分析

目的　了解成都市社区中老年人的口腔健康相关生活质量状况并分析影响因素。方法　随机抽取成都市600名社区中老年人调查,收集人口社会学特征、全身健康状况、口腔健康行为等信息,使用口腔健康影响程度量表（OHIP-14）评估口腔健康相关生活质量。结果　中老年人的口腔健康相关生活质量得分为（3.91±6.67）分,回归分析显示,收入水平（OR=0.387,P<0.05）、患慢性病（OR=0.665,P<0.05）、患口腔疾病（OR=0.260,P<0.05）、自评心理健康状况（OR=0.338,P<0.05）、每天刷牙2次（OR=1.846,P<0.05）、吸烟（OR=0.566,P<0.05）、主动获取口腔健康知识（OR=2.431,P<0.05）、就医方便程度（OR=0.499,P<0.05）是影响因素。结论　口腔健康相关生活质量受多重因素影响,积极开展社区口腔综合干预措施,提高居民口腔健康行为,改善社区中老年人口腔健康相关生活质量。     

儿童口腔健康相关生存质量量表信度与效度的验证研究

目的 通过对8～15岁儿童口腔健康相关生存质量量表(COHIP)中文版信度与效度的验证研究,探讨其在中国适龄儿童中应用的可行性.方法 按照国际生存质量评价项目的标准程序,对英文原版COHIP系列问卷中的儿童问卷、父母问卷分别进行翻译、回译、文化调适和改造,建立中文版COHIP,形成适应儿童口腔健康和治疗需求的自我评估问卷、内容效度指数(CvI)合格的评估量表.使用该系列量表对8～15岁的儿童及其家长进行儿童口腔健康相关生存质量调查,考评量表的信度和效度.结果 1 189对儿童及家长接受问卷调查,收回有效问卷1 143份,量表完成率为96.1％.COHIP儿童表内部一致性Cronbach's α[系数为0.903,条目-量表相关系数为0.134～0.611,Guttman分半信度系数为0.798,组内相关系数(ICC)为0.926.COHIP家长表内部一致性Cronbach'sα系数为0.796,条目-量表相关系数为0.121～0.614,Guttman分半信度系数为0.796,ICC为0.931.因子分析显示中文版量表所包含的条目存在预想的逻辑关系.结论 中文版COHIP具有良好的信度和效度,其良好的心理测量学性质为其在中国适龄儿童中的应用提供了理论依据.     

学龄前儿童口腔健康影响程度量表中文版的信度和效度评价

目的:评价学龄前儿童口腔健康影响程度量表(The Early Childhood Oral Health Impact Scale,ECOHIS)中文版的信度和效度。方法:对ECOHIS进行初译、回译、质量评价、文化调适和预评估,形成ECOHIS中文版,进而将其应用于成都市两部分人群,一部分为随机选择的成都市2所幼儿园的200名学龄前儿童;另一部分是在四川大学华西口腔医院儿童牙病科就诊的100例3～5岁患儿。通过这些儿童的监护人完成问卷调查,最终对调查结果进行统计学分析,考评量表的信度和效度。结果:①共回收有效问卷292份,有效问卷的回收率为97.3%;②信度—量表总的克朗巴赫α系数为0.899,Guttman分半信度系数为0.799,表格之间相关性r=0.666;③结构效度—经过验证性因子分析,提取3个因子,累积贡献率达63.87%,显示量表存在预想的连带关系和逻辑关系;判别效度—所有条目均能区分幼儿园普通儿童和患儿的生命质量差异(P值均<0.01)。结论:ECOHIS中文版通过严格的性能测试,具有良好的信度和效度,可在我国学龄前儿童中推广应用。     

Comparison of the GOHAI and OHIP-14 as measures of the oral health-related quality of life of the elderly

OBJECTIVES: This paper compares the performance of the GOHAI and the OHIP-14 as measures of the oral health-related quality of life of the compromised elderly. METHODS: Data were obtained from a cross-sectional survey of 225 participants, most of whom lived in a large geriatric care centre. RESULTS: The mean age of subjects was 83 years and the majority had one or more chronic medical conditions and physical disabilities. Their main oral problems were high rates of tooth loss and xerostomia. Additive and simple count methods were used to derive GOHAI and OHIP-14 scores. Using the additive method, 8.4% had a GOHAI score of zero and 30.3% an OHIP-14 score of zero. Using the simple count method the percentage with a score of zero was 15.1% and 45.8%. Both measures discriminated between dentate subjects with and without one or more dentures, with and without a chewing problem and with and without dry mouth. Both also showed significant associations with self-rated oral health and satisfaction with oral health status. Associations tended to be stronger between GOHAI scores and these variables. The measures were equally good at predicting overall psychological well-being and life satisfaction. Although the GOHAI identified more oral functional and psychosocial impacts than the OHIP-14, neither was markedly superior to the other when used as discriminatory measures. However, the high prevalence of subjects with zero scores may compromise the ability of the OHIP-14 to detect within-subject change.     

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口腔健康相关生活质量是近20年来口腔医学研究中备受关注的领域之一,然而相关研究在国内开展较少。本文对常用口腔健康相关生活质量量表、量表的翻译和验证、国内外口腔健康相关生活质量研究情况做一简要介绍。     

Model specification in oral health-related quality of life research

The aim of this study was to analyze conventional wisdom regarding the construction and analysis of oral health-related quality of life (OHRQoL) questionnaires and to outline statistical complications. Most methods used for developing and analyzing questionnaires, such as factor analysis and Cronbach's alpha, presume psychological constructs to be latent, inferring a reflective measurement model with the underlying assumption of local independence. Local independence implies that the latent variable explains why the variables observed are related. Many OHRQoL questionnaires are analyzed as if they were based on a reflective measurement model; local independence is thus assumed. This assumption requires these questionnaires to consist solely of items that reflect, instead of determine, OHRQoL. The tenability of this assumption is the main topic of the present study. It is argued that OHRQoL questionnaires are a mix of both a formative measurement model and a reflective measurement model, thus violating the assumption of local independence. The implications are discussed.     

大学生错畸形与口腔健康相关生存质量的相关性

目的调查错畸形与大学生口腔健康相关生存质量(OHRQoL)的相关性。方法从秦皇岛地区4所高校随机抽取610名无正畸史、缺失牙和颌面部畸形的大学生为研究对象。选用正畸治疗需要指数(IOTN)行牙颌检查,以口腔健康相关生存质量影响程度量表(OHRQoL-UK)对样本进行评估。结果 8.7%受试者自诉在过去1个月中,16个条目中至少有一项受到错畸形的负面影响。在生理、心理和社会三分项中,心理方面的分值最低。OHRQoL-UK表在总分值及三分项上与牙齿健康分值(IOTN-DHC)和牙齿美学分值(IOTN-AC)均呈负相关。结论错畸形客观检查的IOTN牙齿健康部分(IOTN-DHC)和主观自评的IOTN牙齿美学部分(IOTN-AC)均与OHRQoL呈负相关关系。IOTN-DHC与生理方面相关性最大,而IOTN-AC与心理方面相关性最大且无性别差异。     

Developing short-form measures of oral health-related quality of life

OBJECTIVES: Using the item-impact method, we developed an alternative short-form Oral Health Impact Profile (OHIP) that has good psychometric properties and minimal floor effects. METHODS: OHIP data were collected from a sample of older Canadians at two points in time. Data from the first administration were used to develop a 14-item short-form measure; data from the second compare the latter's psychometric properties with those of the original short form developed by Slade (1997), who used a controlled regression procedure. RESULTS: The short form based on the item-impact method had only two items in common with the short form derived from the regression approach and contained more high-prevalence items. The regression short form was subject to marked floor effects, while the impact short form had floor effects comparable to those of the full 49-item OHIP. The former discriminated between dentate and edentulous subjects, while the latter did not. Both discriminated between dentate subjects who did and did not wear dentures, those with and without dry mouth, and those with and without chewing problems. Both were also significantly associated with self-ratings of oral health, satisfaction with oral health, and self-perceived need for dental treatment. The strength of the associations was somewhat stronger with the regression short form, indicating that it performed better as a discriminatory instrument. However, because of its floor effects, it was markedly less sensitive to change than the impact short form. There was an indication that item-impact methods of shortening oral health-related quality of life measures produced more stable results across samples than the statistical approach. CONCLUSIONS: Because the content validity of short-form measures is always compromised, different short forms are required for different purposes and different patient populations. The regression short form developed by Slade (1997) is likely to be better when the aim is to discriminate, while the impact short form developed here may be preferable when the aim is to describe the oral health-related quality of life of populations or to detect change.     

Assessing the responsiveness of measures of oral health-related quality of life

OBJECTIVES: This paper illustrates ways of assessing the responsiveness of measures of oral health-related quality of life (OHRQoL) by examining the sensitivity of the oral health impact profile (OHIP)-14 to change when used to evaluate a dental care program for the elderly. METHODS: One hundred and sixteen elderly patients attending four municipally funded dental clinics completed a copy of the OHIP-14 prior to treatment and 1 month after the completion of treatment. The post-treatment questionnaire also included a global transition judgement that assessed subjects' perceptions of change in their oral health following treatment at the clinics. Change scores were calculated by subtracting post-treatment OHIP-14 scores from pre-treatment scores. The longitudinal construct validity of these change scores were assessed by means of their association with the global transition judgements. Measures of responsiveness included effect sizes for the change scores, the minimal important difference, and Guyatt's responsiveness index. An receiver operating characteristic (ROC) curve was constructed to determine the accuracy of the change scores in predicting whether patients had improved or not as a result of the treatment. RESULTS: Based on the global transition judgements, 60.2% of subjects reported improved oral health, 33.6% reported no change, and only 6.2% reported that it was a little worse. These changes are reflected in mean pre- and post-treatment OHIP-14 scores that declined from 15.8 to 11.5 (P < 0.001). Mean change scores showed a consistent gradient in the expected direction across categories of the global transition judgement, but differences between the groups were not significant. However, paired t-tests showed no significant differences in the pre- and post-treatment scores of stable subjects, but showed significant declines for subjects who reported improvement. Analysis of data from stable subjects indicated that OHIP-14 had excellent test-retest reliability with an intraclass correlation coefficient (ICC) of 0.84. Effect size based on change scores for all subjects and subgroups of subjects were small to moderate. The ROC analysis indicated that OHIP-14 change scores were not good "diagnostic tests" of improvement. The minimal important difference for the OHIP-14 was of 5-scale points, but detecting this difference would require relatively large sample sizes. CONCLUSIONS: OHIP-14 appeared to be responsive to change. However, the magnitude of change that it detected in the context described here was modest, probably because it was designed primarily as a discriminative measure. The psychometric properties of the global transition judgements that often provide the "gold standard" for responsiveness studies need to be established.     

口腔扁平苔藓患者口腔健康相关生活质量的初步研究

目的通过口腔健康影响程度量表（OHIP）-14中文版了解口腔扁平苔藓患者口腔健康相关生活质量情况,探讨其应用于口腔扁平苔藓临床诊疗的可靠性和准确性。方法采用OHIP-14中文版对51例口腔扁平苔藓患者进行问卷调查,同时采用视觉类比标尺（VAS）对疼痛程度进行评分,REU评分系统对病损情况进行评分。通过SPSS 16.0软件对量表的信度和效度进行统计分析。结果OHIP-14的得分为21.67±9.45,量表的内部一致性Cronbach’s α系数为0.901,因子分析提取的5个公因子与量表各领域有密切的逻辑关系,量表得分与REU分值和VAS分值间呈正相关关系（r=0.608,0.807;P<0.000）。结论OHIP-14中文版评测口腔扁平苔藓患者的口腔健康相关生活质量具有较好的信度和效度,可为病情评估提供参考。     

口腔健康相关生活质量调查在正畸学中的应用

口腔健康相关生活质量是反映口腔疾病及其防治对患者的身体功能、心理功能和社会功能等方面影响的综合评估.口腔正畸治疗对患者的生活质量有着显著影响,正畸患者在疗程中感受到功能限制、生理疼痛、心理不适、社会功能障碍和治疗后整体生活质量的改善.本文就口腔健康相关生活质量量表及正畸学相关的口腔健康相关生活质量研究方面作一综述.