A comparison of three rating scales for measuring subjective phenomena in clinical research. II. Use of experimentally controlled visual stimuli

BACKGROUND: In a previous study of three types of global scales we found that verbal rating scales were particularly reliable for rating auditory stimuli. We now wanted to check the performance of the scales for rating experimentally controlled visual stimuli. METHODS: We used a prospective, experimentally controlled, clinimetric study, which was conducted at the Department of Psychiatry of the Autonomous University of Puebla Medical School in the state capital city of Puebla, Mexico. A total of 20 fifth-year medical students participated in the study. Visual stimuli consisted of 15 cards with five different intensities on the gray-to-black scale, administered randomly in three sessions to each subject. With regard to main outcome measurement, validity and consistency indices were determined for visual analog scale (VAS), numerical rating score (NRS), and verbal rating scale (VRS) to rate visual stimuli. RESULTS: For validity, correlation coefficients between scales and reference standard were high, especially in VRS (r=0.902). For consistency, VRS had highest kappa value (k(w)=0.71) for interobserver variability. CONCLUSIONS: Three instruments could be hierarchically ranked for their indices of validity and consistency. Being more consistent than VAS and NRS, VRS merits more frequent usage in clinical research.     

3种不同直径穿刺针甲状腺活检时患者疼痛程度调查

目的探讨不同直径的穿刺针进行甲状腺穿刺活检时患者疼痛程度之间有无差别。方法对2010年10月～2013年3月在成都军区总医院内分泌科进行甲状腺穿刺活检的136例甲状腺结节患者，使用3种不同直径的穿刺活检针进行甲状腺穿刺，采用主诉疼痛分级法（VRT）和数字疼痛分级法（NRS）两种痛觉分级方法让患者对术中和术后当日的疼痛感觉进行评估。采用Z检验的等级相关分析和线性趋势检验，分析受试者疼痛程度与穿刺针型号之间的关系。结果VRT评估3种直径活检针穿刺疼痛程度0—1级，3组患者之间疼痛程度没有差别，不同性别之间也没有差异。NRS评估3种直径活检针穿刺疼痛程度0～3级，3组之间疼痛程度没有差别，疼痛程度与活检针直径没有关系。结论使用不同直径的活检针进行甲状腺穿刺，患者的疼痛程度之间没有差异，应根据患者结节的性质选择适宜的穿刺针。     

皮下神经干扰治疗带状疱疹后遗神经痛的疗效观察

目的比较皮下神经干扰治疗带状疱疹后遗神经痛的临床效果。方法选择经确诊为带状疱疹后遗神经痛的患者60例,随机分为3组,每组20例。A组为皮下神经干扰组,B组为局部神经阻滞组,C组为药物治疗组。通过定期随访,观察并记录患者治疗前（T。）、治疗后当日（T1）、治疗后3d（T2）、7d（T3）,14d（T4）、1个月（T5）各时间点的口述疼痛评分（VAs）、数字疼痛评分（NRS）、睡眠质量评分（QS）及疼痛发生频率（F）,以综合评估患者治疗效果。结果在不同时间点,A组与B组VRS、NRS评分比较差异无统计学意义（P〉O．05）,在T。时间点,A组QS评分明显高于B组,F值明显低于B组,差异有统计学意义（P〈O．05）;在T1、T2时间点,A组VRS、NRS评分及F值明显低于C组,QS评分明显高于C组,差异有统计学意义（P〈O．05）;在T3、T4时间点,A组VRS、NRS评分明显高于C组,差异有统计学意义（P〈0．05）;在T4时间点,A组QS评分明显低于C组,F值明显高于C组,差异有统计学意义（P〈0．05）。结论皮下神经干扰法能有效治疗带状疱疹后遗神经痛,有操作简单,并发症少的优点。     

视觉模拟测量和利克特测量用于评价中风痉挛性瘫痪患者报告结局的比较

目的 比较“视觉模拟测量”和“利克特测量”对中风痉挛性瘫痪患者报告结局的评价,选择相对适合的测量尺度.方法 横断面现场调查的方式,利用先前研制的“基于中风痉挛性瘫痪患者报告结局评价量表”中的19个问题,104例患者分别使用“连续型”和“离散型”视觉模拟测量进行回答,另有110例患者使用5级“典型的”和5级“形式的”利克特测量进行回答.信度分析采用克拉巴赫α系数,相关分析采用Spearman相关系数法,结构效度采用因子分析.结果 除心理领域外,症状和社会领域得分,以及量表总分方面,“连续型”和“离散型”视觉模拟测量量表的克朗巴赫系数均高于5级“典型的”和5级“形式的”利克特测量.“视觉模拟测量”比“利克特测量”在量表的内部一致性信度方面更占优势.每个条目与其所属领域得分间相关系数绝大多数在0.4以上,使用“视觉模拟测量”可以获得更高的相关性.“视觉模拟测量”在量表的探索性因子分析,形成了3个因子,其结果与量表预想的症状、心理、社会三个领域大体一致;“利克特测量”在量表结构效度方面,结果并不理想.结论 测量精度越高,性能评价越好.如果患者不需要他人辅助完成量表,优先选择“视觉模拟测量”.     

基于COSMIN指南对癌症患者支持性照护需求量表的系统评价

背景国内外用于评估癌症患者支持性照护需求的量表较多，但有关此类量表质量的标准化评价研究及不同量表间的横向比较研究较为缺乏，也少有研究者对此类量表的测量特性进行系统的整合与评价。目的评价中文版癌症患者支持性照护需求量表的测量学性能及研究的方法学质量。方法2021年4月检索中国知网、万方数据知识服务平台、维普中文科技期刊全文数据库、中国生物医学文献数据库、PubMed、EmBase、Web of Science、CINAHL Complete数据库，获取有关中文版癌症患者支持性照护需求量表测量学性能评价的研究，检索时限均为建库至2021年3月30日。由两位研究者独立筛选文献、提取资料后，采用健康测量工具遴选标准（COSMIN）系统综述指南，在对量表的测量特性及研究的方法学质量进行评价的基础上，综合评定中文版癌症患者支持性照护需求评估量表各测量特性的证据等级，并形成对于量表的最终推荐意见。采用描述分析法对评价结果进行汇总、分析。结果共纳入15项研究，涉及8个中文版癌症患者支持性照护需求评估量表〔癌症患者支持性照护需求简明问卷中文版（SCNS-SF34）、中文版支持性照护需求筛查工具（SCNS-ST9-C）、癌症患者综合需求评估量表（CNAT）、癌症需求简明问卷（CNQ-SF）、中文版癌症患者未满足需求量表（CaSUN-C）、癌症患者未满足需求简明量表（SF-SUNS）、晚期癌症患者需求评估问卷（ACNQ-41）、晚期癌症患者需求评估表简表（ACNQ-29）〕。就量表的测量特性质量而言，除ACNQ-29的内容效度为"未提及"外，其余7个量表的内容效度均为"不确定"；除CaSUN-C、SF-SUNS的结构效度为"充分"外，其余6个量表的结构效度均为"不确定"；SCNS-SF34、CNQ-SF、CaSUN-C、SF-SUNS的内部一致性为"充分"，ACNQ-41的内部一致性为"不充分"，其余3个量表的内部一致性为"不确定"；CNAT、CNQ-SF、ACNQ-29的假设检验为"未提及"，CaSUN-C、SF-SUNS、ACNQ-41的假设检验为"不确定"，SCNS-SF34、SCNS-ST9-C的假设检验为"充分"；除ACNQ-41的稳定性为"不充分"，SCNS-ST9-C、ACNQ-29的稳定性为"未提及"外，其余5个量表的稳定性均为"充分"；仅SCNS-SF34的跨文化效度为"充分"，其余7个量表的跨文化效度均为"未提及"。8个量表的推荐等级均为B级。结论SCNS-SF34的测量特性得到了最为全面的评价，其具有较好的信效度，且临床应用可行性高，可暂时被推荐使用，但上述结论仍有待更多高质量证据加以支撑。     

Recommendations to guide revision of the Guides to the Evaluation of Permanent Impairment. American Medical Association

The American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition, is the most commonly used tool in the United States for rating permanent impairments for disability systems. The Guides, currently undergoing revision, has been the focus of considerable controversy. Criticisms have focused on 2 areas: internal deficiencies, including the lack of a comprehensive, valid, reliable, unbiased, and evidence-based system for rating impairments; and the way in which workers' compensation systems use the ratings, resulting in inappropriate compensation. We focus on the internal deficiencies and recommend that the Guides remains a tool for evaluation of permanent impairment, not disability. To maintain wide acceptance of the Guides, its authors need to improve the validity, internal consistency, and comprehensiveness of the ratings; document reliability and reproducibility of the results; and make the Guides easily comprehensible and accessible to physicians.     

Fatigue severity of patients with idiopathic chronic fatigue compared to healthy subjects

OBJECTIVE:To analyze the fatigue severity of patients with idiopathic chronic fatigue(ICF) and to compare the severity of this group with that of healthy subjects.METHODS:one hundred and nine ICF patients and 98 healthy subjects were enrolled in this study.Fatigue severity was measured using the Korean-translated Chalder fatigue severity questionnaire.All subjects scored each item on a 10-point scale as a self-rating numeric scale(NRS),and additionally rated their feeling of general fatigue by visual analogue scale(VAS).RESULTS:The total NRS scores of patients with ICF was 53 ± 15 compared with 25 ± 14 of healthy subjects(2.4 folds for physical symptoms vs.1.7 folds for mental symptoms respectively).The VAS scores of patients with ICF were 2.7 times as high as those of healthy subjects.CONCLUSION:This report is the first to compare the severity of fatigue between ICF patients and healthy subjects.This study contains reference data applicable for the management of this disorder in field of complementary and alternative medicine.     

丙泊酚注射痛预测人工流产术后镇痛的可行性

目的探讨依据丙泊酚注射痛选择人工流产术后镇痛方法的可行性。方法拟行人工流产术者1500例,随机分为3组,Ⅰ组为对照组;Ⅱ组静脉注射布托啡诺;Ⅲ组静脉注射布托啡诺并下腹部行物理治疗。每组根据疼痛语言等级评定量表（VRS）分为3亚组：VRS=0为a亚组;VRS=1为b亚组;VRS≥2为c亚组。诱导时当丙泊酚给药量达总量1／4时暂停给药,进行VRS评分,之后静脉注射剩余量丙泊酚完成麻醉诱导。术后30min时采用VAS评分。记录VRS、VAS、术前及术后的MAP、HR。结果术后疼痛发生率Ⅱ、Ⅲ组低于Ⅰ组（P〈0．05）,Ⅰa与Ⅱa、Ⅲa组比较差异无统计学意义（P〉0．05）,Ⅱb组低于Ⅰb组（P〈0．05）,Ⅱb与Ⅲb组比较无统计学差异（P〉0．05）,Ⅱc组低于Ⅱc组（P〈0．05）。结论丙泊酚注射人工流产术时无注射痛者无需给予术后镇痛,轻微注射痛者仅给予布托啡诺镇痛就足够,中、重度注射痛者给予布托啡诺和下腹部物理治疗联合镇痛效果更优。     

Relationships between clinical competence ratings and examination performance.

Relationships between faculty ratings and performance on components of the National Board of Medical Examiners Certifying Examination for Primary Care Physician's Assistants were investigated. A factor analysis of the clinical competence rating form yielded three discrete factors. Results of tests of simple relationships between each rating factor and examination component indicated that four of the six examination components correlated significantly though modestly with at least one of the rating scale factors. The results of multiple regression analyses indicated complex relationships between each of two examination components and the set of rating factors. One implication is that faculty members are able to make discrete judgments about students on more than one dimension.     

Development and Testing of a Scale to Assess Physician Attitudes about Handheld Computers with Decision Support

ObjectiveThe authors developed and evaluated a rating scale, the Attitudes toward Handheld Decision Support Software Scale (H-DSS), to assess physician attitudes about handheld decision support systems.DesignThe authors conducted a prospective assessment of psychometric characteristics of the H-DSS including reliability, validity, and responsiveness. Participants were 82 Internal Medicine residents. A higher score on each of the 14 five-point Likert scale items reflected a more positive attitude about handheld DSS. The H-DSS score is the mean across the fourteen items. Attitudes toward the use of the handheld DSS were assessed prior to and six months after receiving the handheld device.StatisticsCronbach’s Alpha was used to assess internal consistency reliability. Pearson correlations were used to estimate and detect significant associations between scale scores and other measures (validity). Paired sample t-tests were used to test for changes in the mean attitude scale score (responsiveness) and for differences between groups.ResultsInternal consistency reliability for the scale was α = 0.73. In testing validity, moderate correlations were noted between the attitude scale scores and self-reported Personal Digital Assistant (PDA) usage in the hospital (correlation coefficient = 0.55) and clinic (0.48), p < 0.05 for both. The scale was responsive, in that it detected the expected increase in scores between the two administrations (3.99 (s.d. = 0.35) vs. 4.08, (s.d. = 0.34), p < 0.005).ConclusionThe authors’ evaluation showed that the H-DSS scale was reliable, valid, and responsive. The scale can be used to guide future handheld DSS development and implementation.     

慢性病患者生命质量测定量表体系QLICD各量表的测量学特性分析

目的分析慢性病患者生命质量测定量表体系QLICD各量表的测量学特性．方法用QLICD中各疾病对应的量表对患者在住院治疗前后进行测试,从而对量表的信度、效度和反应度进行评价．结果除个别领域外,各量表的内部一致性信度α值均在0．70以上,重测信度均在0．80以上;相关分析与因子分析显示量表有较好的结构效度和效标关联效度（与SF-36为效标）;量表可以测出患者治疗前后各领域的生命质量变化,大部分的标准化反应均数SRM大于0．50．结论QLICD各量表均具有较好的信度、效度、反应度,可作为我国慢性病患者生命质量的测评工具．     

综合医院门诊病人满意度量表研制初探

目的 编制一份综合医院门诊病人满意度量表,用于医院门诊医疗质鼍的评价.方法 以杭州市级4所综合医院内外科门诊病人为调查对象,应用统计学和心理学方法评价量表的信度和效度.结果 量表的条目应答率为98.82%,有效率为96.8%,量表的内部一致性系数为0.76-0.87,量表的构成与管理实际相吻合,因素内相关性强于因素间相关性,支持内容效度;经因子分析,因子负荷和结构与量表结构吻合,支持结构效度.结论 本量表各信效度指标均达到了心理测量学的要求,可以用于门诊病人满意度的评价,为评价医院医疗质量提供依据.     

多模式治疗颈源性头痛的临床分析

目的探讨多模式治疗颈源性头痛的临床疗效及优缺点。方法将46例颈源性头痛的患者,分别采用保守治疗、颈2/3、3/4椎间盘射频热凝治疗和多模式治疗的方法 ,分为保守治疗组（A组）12例、射频热凝治疗组（B组）15例、综合治疗组（C组）19例,并通过颈椎活动度评分（ROM）和疼痛程度数字评分（NRS）对照两种方法的疗效,讨论分析多模式治疗颈源性头痛的优缺点。结果比较3组患者术前与术后的VAS评分,其中,术前A、B、C组分别为（6.9±0.4）、（7.2±0.3）、（7.3±0.4）,术后1个月分别为（2.8±0.4）、（2.9±0.2）、（2.1±0.3）,比较3组术前与术后的ROM评分,其中术前A、B、C组分别为（2.7±0.2）、（3.0±0.4）、（3.2±0.3）,3组患者术前术后及随访的ROM和NRS均获得下降,以多模式治疗组最为显著,差异有统计学意义,46例患者治疗及随访期间均未发现明显不良并发症。结论多模式治疗颈源性头痛是安全高效的临床治疗选择。     

周期序贯针灸疗法对原发性痛经患者疼痛症状及情绪影响的疗效观察

[目的]观察周期序贯针灸疗法对原发性痛经(primary dysmenorrhea,PD)患者疼痛症状及焦虑情绪的影响.[方法]选择2017年1月至2018年6月丹阳市人民医院针灸科门诊就诊的PD患者90例,随机分为药物组、常规针刺组和序贯针灸组,每组各30例.药物组予布洛芬缓释胶囊口服,常规针刺组采用常规针灸方案,序...     

加巴喷丁联合神经阻滞治疗原发性三叉神经痛的临床观察

目的观察加巴喷丁联合神经阻滞治疗原发性三叉神经痛的临床疗效及不良反应。方法将2010年3月至2011年12月南宁市红十字会医院收治的90例原发性三叉神经痛患者按随机数字表法分为单纯加巴喷丁药物治疗组(A组)和加巴喷丁联合神经阻滞治疗组(B组),各45例,A组每天口服加巴喷丁1200 mg,连服4周;B组加巴喷丁用法与A组相同,同时每周给予神经阻滞治疗1次,连续3周。4周后观察两组的疼痛强度(PI)、疼痛缓解度(PAR)、镇痛有效率及不良反应发生情况。结果两组治疗后NRS评分明显低于治疗前(P<0.05),B组在治疗后3、7、14、21、28 d的NRS评分均明显低于A组(P<0.05);B组镇痛效率在治疗后3、7 d与A组无差别,在治疗后14、21、28 d高于A组(P<0.05);两组不良反应发生率比较差异无统计学意义(P>0.05)。结论加巴喷丁联合神经阻滞治疗原发性三叉神经痛临床效果好,不良反应少,是非手术疗法的较好选择。     

Is a line the same as a box? Speech assessment by VAS is not superior to Likert scales in laryngeal cancer patients.

BACKGROUND: The primary purpose was to assess if VAS or Likert was relatively more suitable when assessing self-ratings of voice and speech in patients treated for laryngeal cancer. An additional purpose was to investigate whether the scales differed in measuring change after treatment. MATERIAL/METHODS: Using both VAS and Likert, 71 patients answered three questions at baseline and 12 months after treatment began. For test-retest analyses, additional data were used from 21 subjects. Non-parametric statistical methods suitable for comparing scales with different numbers of response alternatives were applied. RESULTS: Test-retest reliability was strongest for the Likert scale. From baseline to follow-up, both scales detected significant improvements. However, for some Likert scores the associated VAS values varied across a wide range, and this was true for assessments at baseline, at follow-up, and for score changes. At baseline the inter-scale concordance showed a greater number of disordered pairs than at follow-up and on both occasions the older group produced a greater number of disordered pairs. CONCLUSIONS: No support for the superiority of VAS over Likert was found. However, VAS may produce instability in response patterns. When using self-ratings of voice and speech to identify a need of further rehabilitation, Likert scales seem better suited.     

罗西维林缓解膀胱镜检查术中痉挛性疼痛的疗效评估

收集门诊膀胱镜检查术的男性患者125例，试验组的63例在术前1h口服罗西维林片剂20mg，术后继续口服1d，10mg／次，3次／d，对照组62例采用常规方法。对所有患者采用疼痛数字评分法（NRS评分）评价疼痛程度。术中NRS评分分别为试验组（2．1±0．9）分、对照组（3．6±1．8）分（P〈0．01）；对照组患者在术后15min时NRS评分仍然维持在一个相对较高的水平。     

“大学生生活满意度评定量表（CSLSS）”的编制

目的 为了编制适用于中国大学生的个人生话满意度评定量表。方法 根据大学生对各类生话事件评分的权重，归纳出影响其生活的五大类生活问题作为量表项目，选择全国24所高校的近1900名学生作为样本进行测试。结果 样本均数为正态分布，该量表内部一致性较高，4周重测信度在0．69—0．84之间，与SCL-90及消极应对的负相关、与积极应对的正相关，显示了该量表的效标效度和理论效度。结论 该量表可以作为我国大学生个人生活满意度及生活质量的评定工具。     

椎体后凸成形术治疗骨质疏松性椎体压缩性骨折

目的探讨经皮椎体后凸成形术治疗骨质疏松性椎体压缩性骨折的疗效。方法对11例患者在C形臂透视下行椎体后凸成形术,对术前术后的疼痛数字评分法（NRS）、椎体高度的恢复情况进行统计学分析。结果本组手术均成功,所有患者疼痛明显缓解,NRS术前5-8分降为术后48 h 0-1分,术后3个月0-1分,NRS评分与病椎前缘高度术前术后差异统计学意义有（P〈0.05）。结论经皮椎体后凸成形术可迅速缓解患者疼痛,是一种安全有效的方法。     

直升机飞行员工作绩效评定量表的构建

目的:初步构建直升机飞行员工作绩效评定量表.方法:采用定性与定量相结合的方法,根据对15名飞行专家,12名行政及政工干部的开放式问卷调查及访谈结果,编制含有28个条目的问卷初稿;随后对197名直升机飞行员进行调查,得到有效问卷176份;根据分析结果和简约原则对条目进行筛选并对量表进行信度和效度检验.结果:直升机飞行员绩效主要包括3个因子:"飞行质量"、"工作能力"、"工作态度".量表整体及各个分量表的内部一致性系数均大于0.72,并具有良好的区分效度、内容效度和结构效度.结论:本量表全面具体的反映了直升机飞行员的工作绩效,信度和效度符合心理测量学的要求,具有一定的实用价值.