中国版视功能指数量表的修订及其在白内障患者生活质量评估中的应用

摘要

背景 白内障是目前全球主要的致盲眼病,患者视功能状态的全面评价要结合临床检查结果和患者主观评价.视功能指数量表(VF-14)是针对发达国家白内障患者研发的评估工具. 目的 研制中国版视功能指数量表并评估其在白内障患者生活质量(QoL)测量中的应用价值,探讨白内障患者QoL的影响因素.方法 采用前瞻性横断面调查研究方法,对原版VF-14量表进行翻译、回译和文化调试,形成中国版VF-12量表(VF-12-CN).于2013年2-10月在温州医科大学附属眼视光医院对拟行白内障手术的年龄相关性白内障或糖尿病性白内障患者215例中发放VF-12-CN进行QoL问卷调查,分析量表的条目区分度、信效度以及白内障患者得分的影响因素.任意选取完成问卷的48例白内障患者,由2名经过统一培训的调查员独立进行评分,由专家小组成员采用4级评分法对量表各条目内容是否能反映所测患者的心理特质、是否达到测量的目的进行评价. 结果 从受试者中共收回有效调查答卷200份,应答率为93.02％.根据中国的文化和经济背景及生活习惯对原版VF-14量表中涉及填表、体育和娱乐活动的3个条目进行了修改,对于应答率过低的关于驾车的2个条目进行删除.形成的VF-12-CN量表的条目区分度好,Cronbach's α系数为0.863,Guttmann Split-Half系数为0.874,调查员间信度为0.958.VF-12-CN量表中所有内容效度指数均为1.0;经因子分析共提取2个公因子,累计方差贡献率为59.3％.量表总分与年龄、较好眼裸眼远视力、较差眼裸眼远视力均呈正相关(r=0.277、0.534、0.367,均P＜0.01);文盲与非文盲组的量表得分分别为12.5±8.6和15.7±7.4,差异有统计学意义(t=2.798,P＜0.01);此外,不同年龄、较好眼裸眼远视力、较差眼裸眼远视力和白内障眼数间量表得分的差异均有统计学意义(均P＜0.05).不同性别间及是否有眼部伴发病或全身伴发病组间患者总评分的比较,差异均无统计学意义(t=-0.426、0.304、-1.019,均P＞0.05).较好眼裸眼远视力、患者年龄及文化程度为白内障患者QoL的主要影响因素,回归方程为量表总分=25.045-10.927×较好眼裸眼远视力-3.342×文化程度+3.201×年龄(R=0.586,R2=0.334,F=34.247,P=0.000). 结论 VF-12-CN量表具有良好的测量特性,可用于中国人白内障患者QoL的评估.较好眼裸眼远视力是影响白内障患者QoL的主要因素.%Background Cataract is the main cause of blindness in the world.The comprehensive evaluation of the visual function of the patients with cataract should be combined with clinical examination results and subjective evaluation.Visual function index-14 (VF-14) is an assessment tool for the cataract patients in developed countries.Objective This study was to develop a Chinese version visual function index-14 (VF-12-CN) and assess its application value in the evaluation of cataract patients,quality of life (QoL) and the affecting factors.Methods A prospective cross-sectional investigation was carried out.The VF-14 was revised and developed into a VF-12-CN by translating,back-translating and cultural adaptating.The QoL questionnaires of VF-12-CN were given to 215 patients with age-related cataract or daibetic cataract who were going to receive cataract surgery in Eye Hospital of Wenzhou Medical University from February to October,2013.Psychometric properties of the VF-12-CN,including item difficulty and discrimination,Cronbach's α coefficient,Split-Half reliability,intra-investigators reliability,content validity,and construct validity were tested,and the influence factors of the final questionnaire were analysised.Forty-eight patients who finished questionnaires were scored by 2 invistigators separately.Level 4 score method was used to assess whether VF-12-CN could reflect the psychometric properties of cataract.The Ethics Committee of the Eye Hospital of Wenzhou Medical University approved the study.Results Total 200 questionnaires were taken back with the response rate of 93.02％.Three items which involved filling of form,physical training and recreational activities were revised based on Chinese culture and life style,and 2 items that related with driving were deleted from VF-14 due to a lower response rate.The VF-12-CN showed an excellent item discrimination,with the Cronbach's αt coefficient of 0.863,Split-Half reliability of 0.874,intra-investigators reliability of 0.958 and I-CVI,S-CVI/UA,and S-CVI/Ave of 1.0.Two common factors were extracted by the factor analysis,with a cumulative variance contribution rate of 59.3％.The scale scores were positively correlated with age,uncorrected distant visual acuity (UCDVA) of better eyes and UCDVA of worse eyes(r=0.277,0.534,0.367,all at P＜0.01).The scores were 12.5±8.6 in the illiteracy group and 15.7±7.4 in the non illiteracy group,showing an evidently difference between them (t =2.798,P ＜ 0.01),and significant differences also were found between different ages,UCDVA of better eyes,UCDVA of worse eyes or the number of cataract eyes (all at P＜0.05).No significant differences were seen between gender,with and without ocular or systematic concomitant disease (t =-0.426,0.304,-1.019,all at P＞0.05).The main factors affecting the QoL of cataract patients included UCDVA of better eyes,educational degree and age,with the regression equation:scores =25.045-10.927 × UCDVA of better eyes-3.342 × education + 3.201 × age (R =0.586,R2 =0.334,F =34.247,P =0.000).Conclusions VF-12-CN is a reliable and valid tool for assessing the visual functions of Chinese cataract patients.The UCDVA of better eyes is the main factor affecting QoL in cataract patients.