個案自陳成效測量資訊系統(PROMIS)生活品質相關量表之發展

台灣科技部補助研究計畫成果

個案自陳成效測量資訊系統(PROMIS)生活品質相關量表之發展

(MOST 103-2314-B-002-179-MY3)

主持人: 台灣大學醫學院職能治療學系 潘璦琬 副教授

中 文 摘 要

        慢性疾病患者的生活品質低於健康人。而精神障礙者的生活品質除了低於健康人之外，甚至比其他慢性疾病患者來的差。雖然精神醫療的發展已經使得個案功能改善，進一步得以在社區上過正常的生活。但是生活品質的研究結果顯示，精神障礙者仍需要適當的服務以改善生活品質與滿意度。本計畫透過國際合作方式，與美國大型計畫-個案自陳成效測量資訊系統(patient reported outcome measurement information system, PROMIS)的核心實驗室的研究者合作，共同發展生活品質測量的繁體中文版，並進行測試，建立台灣個案生活品質相關量表的完整版。

        本研究第一年翻譯了PROMIS中的情緒困擾-焦慮(29題)，情緒困擾- 憂鬱(28題)，情緒困擾-憤怒(22題)，睡眠困擾(27題)以及睡眠相關的障礙(16題)。透過嚴謹的翻譯、反翻譯、反覆修訂、專家檢測以及認知檢測等流程，完成繁體中文版之建置。第二年與第三年，進行了正常個案的收集，以及精神疾病個案的收集。共收集311位正常個案，其中33%為男性，平均年齡為28歲 (SD=9.46)。以及409位精神疾病患者。其中男性占46.7%，平均年齡為45歲(SD=11.89)。總共收集了720位個案資料。男性共佔40.7%，平均年齡為38歲(SD=14)。收集資料用了較久的時間，特別是精神障礙者。

        本研究資料透過羅序模式分析，支持PROMIS的5份量表具有良好的內在一致性，以及可接受的建構效度。進一步比較台灣正常個案與精神障礙者在PROMIS五份量表的分數差異，在調整年齡、教育程度以及婚姻狀態後，兩組沒有顯著差異。若與美國常模相比，結果發現，台灣正常個案的憂鬱，焦慮以及精神障礙個案的憂鬱、焦慮及睡眠障礙分數，均顯著高於美國常模(代表較為嚴重)。此結果可作為未來介入的參考。所翻譯以及驗證的PROMIS五份量表的繁體中文版，可望用於未來臨床與研究中。

        本研究結束後，PROMIS也成立台灣PROMIS國家中心，由我擔任中心負責人，促進未來持續的研究交流。

中文關鍵詞： 個案自陳量表，憂鬱，焦慮，生氣，睡眠障礙個案自陳量表，憂鬱，焦慮，生氣，睡眠障礙

Abstract

      Persons with chronic disease have poorer quality of life than normal people. Among the client groups, researchers in mental health area have been faced a problem to find proper quality of life scale and related measures which are reliable and valid, and can be relied upon to provide adequate information regarding clients’ quality of life.

      Although the progress of the modern psychiatry promotes the functional recovery of the persons with mental illness, the quality of life for those persons are still in need of attention. The purpose of the study is to collaborate with researchers from one of the renowned project- PROMIS (Patient-Reported Outcome Measurement Information System), and develop the traditional Chinese version of the quality of life related measures. We chose to translate five scales among PROMIS based on the suggestions made by American Psychiatric Association to measure the functions of the clients. They are emotional distress-anxiety (29 items), emotional distress-depression (28 items), emotional distress-anger (22 items), sleep disturbance (27 items) and sleep-related impairment (16 items).

      For the first year, we adapted a standard procedure of translation developed by PROMIS core center. We used translation, back translation, expert review and cognitive debriefing to develop the traditional Chinese version.

      From the second year, we recruited 311 normal subjects and 409 persons with mental illness to participate in the study. The normal group had average age of 27.9 (SD=9.46) and there were 33% of the male. For the persons with mental illness group, their average age is 45.5 (SD=11.89) and 46.7% were male. A total of 720 subjects filled out 5 scales.

      We applied Rasch measurement model to analyze the dataset. The results showed that the internal consistency for all 5 scales were high. After removing a few items on 5 scales, the final scales fit the Rasch model to form a unidimensional scale for each scale. We compared the scores of 5 scales between normal group and client group and found that, after adjusting for the differences on age, educational status and marital status, there was no significant difference on scores for all 5 scales. We compared the scores on 5 scales between Taiwanese subjects and norm of USA. We found that there were significant differences on scores of depression and anxiety between Taiwanese normal group and US norm. We also found that there were significant differences on the scores of depression, anxiety and sleep disturbance between client group and US norm. The implication of the results can be an evidence for future clinical intervention. The translated version of 5 scales can be applied in clinical practice and research in the future.

      After the end of the project, a national center of PROMIS was established which Dr. Pan serves as the representative of the center. It is expected that there will be continuous exchange of research activities related to PROMIS in the future.

英文關鍵詞： self-reported outcome; depression; anxiety; anger; sleep disturbance

表 1、情緒困擾-焦慮 例題

	題目	從不	很少	有時	經常	總是
1	我感到害怕。	□1	□2	□3	□4	□5
2	我感到驚嚇。	□1	□2	□3	□4	□5
3	當我感到緊張， 這反應令我驚嚇。	□1	□2	□3	□4	□5

 

表 2、睡眠困擾 例題

	題目	完全不會	稍微	普通	相當多	非常多
1	我的睡眠是安穩的。	□5	□4	□3	□2	□1
2	我的睡眠很淺。	□1	□2	□3	□4	□5
3	我的睡眠很沉。	□5	□4	□3	□2	□1

 

表 3、睡眠相關障礙 例題

	題目	從不	很少	有時	經常	總是
1	因為我睏了，所以難以完成事情。	□1	□2	□3	□4	□5
2	因為我睏了，所以難以專注。	□1	□2	□3	□4	□5
3	當我醒來時，我感到清醒。	□5	□4	□3	□2	□1

 

表 4、生氣 例題

	題目	從不	很少	有時	經常	總是
1	當我挫折時，我會表現出來。	□1	□2	□3	□4	□5
2	我比別人所知的更易被激怒。	□1	□2	□3	□4	□5
3	我對他人感到嫉妒。	□1	□2	□3	□4	□5

 

表 5、憂鬱 例題

	題目	從不	很少	有時	經常	總是
1	我覺得自己沒有用。	□1	□2	□3	□4	□5
2	我覺得我沒有什麼好期待的。	□1	□2	□3	□4	□5
3	我感到無助。	□1	□2	□3	□4	□5