膝部骨性關節炎醫療照護成效量表之發展

Development of Outcome Measurement Instrument for Quantifying the Effectiveness of Medical Care of Knee Osteoarthritis

本研究目的官在發展膝部骨性關節炎醫療照護成效量表與建立量表之信、效度。本量表以健康生活品質為概念，著重於膝部骨性關節炎對病忠生活各功能層面之影響，採取文獻分析與參考國內、外相關七份問卷方式，擬定量表初稿。初稿經專家與病人意見修改後，正式施測於膝部骨性關節炎患者。研究方法採橫斷與縱貫調查法，以採立意取樣方式，於某教學醫院門診，共訪視 111位膝部骨性關節炎忠者。結采顯示，在建構效度的因素分析，經主料分析與直接斜交轉軸後，量表保留 35 題，萃取出五個 因素，分別是「疼痛」、「日常活動與症狀」、「行動功能」、「情緒功能」與「社會參與功能」等，總解釋變其量為52.34% ﹔另外在口服 glucosamine 前後測中，量表中五個次量表皆達顯著改善（ p < .01 ）。在效標關聯效度方面，膝部骨性關節炎醫療照護成效量表之「疼痛」次量表與疼痛視覺類比量表之相關係數為 0.73 ( p < .000 ），膝部骨性關節炎醫療照護成效量表之「日常活動與症狀」次量表與 膝關節嚴重指標之相關係數為 0.80 ( p < .000 ），皆達高度相關，顯示此量表具良好的建構效度與效標關 聯效度。而各次量表之內在一致性信度（ Cronbach’sα 值）介於 0.79一 0.90，顯示此量表具有良好之內 在一致性信度。

The purpose of this study is to develop an outcome measurement instrument for knee osteoarthritis and demonstrate its ability to evaluate different interventions in the medical care of knee osteoarthritis. Developed out of concerns over health-related quality of life, the instrument assesses dimensions of functional status in patients with knee osteoarthritis. A literature review was first performed, followed by seven questionnaires being submitted to knee osteoarthritis, and then review by an expert and lay panel. A cross-sectional and longitudinal survey design was used. A purposive sample was taken from 111 patients with knee osteoarthritis, who were recruited from outpatient services in a medical center. Principal-axis factor analysis with direct oblimin rotation generated a thirty-five item, 5-factor structure, namely pain, activities of daily living and symptoms, mobility function, emotional function and social participation function, accounting for 52.34% of the total variance. Comparison with the group who had taken glucosamine medication revealed longitudinal changes in the instrument total and five subscale scores (p＜.0l). With respect to criterion-related validity, the “pain” subscale of the instrument was significantly correlated with the pain-visual analog scale (r=.73, p＜.000). In addition, the “activities of daily living and symptoms” subscale of the instrument were significantly correlated with the Index of Severity for Osteoarthritis of the Knee (r=.80, p＜.000). The internal consistency reliability established by Cronbachs alpha ranged from 0.79 to 0.90. In conclusion, the study demonstrates that the outcome measurement instrument for the medical care of knee osteoarthritis developed in this paper is reliable and valid.