中風病人健康生活品質指標

健康相關生活品質已成為醫療重要結果評量，為能有效掌握成人復健最大族群的中風病人其病情或療效變化，極需建立以中風病人健康相關生活品質為結果評量之臨床重要變化指標，尤其當臨床改變量是否為有意義之變化乃是醫療人員、病患、家屬及研究者共同關心的核心議題，但卻無法由傳統研究上常用之統計顯著結果（i.e., P- value）決定。臨床重要變化指標包括「臨床最小重要變化指標 （Minimal clinically important difference, MCID）」與「臨床可察覺之最小變化指標 （Minimally Detectable Change, MDC）」，其估計方法主要可分為兩種：（1）外在指標方法（anchor-based method）；（2）分佈取向方法（distribution-based method）。目前國內外最常被使用之中風病人疾病專屬健康相關生活品質量表為Stroke Impact Scale （SIS）以及Stroke-Specific Quality of Life （SS-QOL）。此二量表皆為具有信度、效度、及反應性驗證之評估工具。然而，不論在國際上或國內，此二量表之臨床重要變化指標皆尚未建立。因此，建議未來可針對SIS 及SS-QOL 兩種中風病人疾病專屬健康相關生活品質評估工具，建立其臨床重要變化指標之估計，將促使研究或醫療人員可同時並用傳統研究上常用之統計顯著結果指標（i.e., P- value）與臨床變化指標。亦將有助於測驗分數之臨床解釋，亦即促使醫護人員、病患、及研究者更能掌握中風病人以健康相關生活品質評量而反應出的病情或療效變化。尤其有助於判斷是否為臨床上有意義之重要變化，並依據此而作出最適切之醫療處置決策，進而提昇臨床醫療效用。

Clinical significance may differ from statistical significance. Statistical significance is defined when the change is resulted from chance or not by the use of P- value; however, it does not provide information regarding whether the change is clinically meaningful or important. Estimations of so called "Minimally clinical important difference, MCID" and "Minimally Detectable Change, MDC" are helpful for data interpretability. The MCID and MDC values greatly enhance clinical decision-makings. To enhance interpretation of the clinical change or therapeutic effectiveness for stroke survivors, it is crucial to estimate MCID and MDC of stroke-specific health-related quality of life (HRQOL) measures. This is particularly true for the Stroke Impact Scale (SIS) and Stroke-Specific Quality of Life (SS-QOL) that are two widely used HRQOL measures with client-centered basis and sound psychometric properties. However, there has been a lack of MCID and MDC data for both the SIS and SS-QOL. Methodologically, there are two approaches to estimate the MCID and MDC: (1) anchor-based method, and (2) distribution-based method. The use of these two methods simultaneously is suggested to estimate the MCID and MDC of the SIS and SS-QOL.