間歇性外斜視兒童生活品質與測量：系統性文獻回顧和統合分析

Quality of Life and Measures in Children with Intermittent Exotropia: A Systematic Review and Meta-Analysis

背景：近年來的研究已聚焦於間歇性外斜視兒童的生活品質，然而以往的大多數研究的小樣本限制了臨床照顧有意義證據的提供。目的：本系統性文獻回顧和統合分析的研究目的在針對間歇性外斜視兒童生活品質及測量工具進行文獻回顧，並進而瞭解及詮釋相關測量工具的選擇及相關研究結果。同時，本研究也比較了亞洲與西方國家間歇性外斜視兒童的生活品質差異。方法：本研究檢索了2018年6月前發表於Ovid MEDLINE, CINAHL, PsycINFO, PubMed, Academic Search, Complete, ProQuest Medical Library和the Cochrane library等資料庫的文章。同時針對測量工具使用群體、工具性質、工具類型、心理計量等特性和生活品質狀況進行審查。由兩名獨立的審查者使用標準化的文獻評讀工具進行文章品質的審查。總共有六篇文章符合審查並納入此研究。結果：納入的六篇文章皆為橫斷性研究，只有一篇研究以兒童年齡層作為探討變項。本研究發現，儘管生活品質測量工具較以前開發的工具更能滿足心理計量標準，然而目前被使用來測量間歇性外斜視兒童生活品質的工具僅有兩個，且其中一個常用的測量工具只有單一面向測量。統合分析顯示，間歇性外斜視兒童的生活品質為中等至高等程度（Mean＝75.36）（95％ CI：66.47－84.25），此數值低於健康兒童生活品質。同時，亞洲國家間歇性外斜視兒童生活品質亦低於西方國家兒童（Mean＝64.89：80.59）.結論：此研究證實了間歇性外斜視兒童的較低生活品質，尤其是亞洲間歇性外斜視兒童其生活品質更是低於西方國家，目前測量工具的研究不足。建議未來應進行特定兒童年齡，跨文化和縱向軌跡研究，以全面了解間歇性外斜視兒童，尤其是亞洲兒童的生活品質狀況。

Background: Recent research has focused on the quality of life of children with intermittent exotropia. Small sample size in most previous studies in intermittent exotropia children limited providing meaningful evidences for clinical care. Aims: The purpose of this systematic review and meta-analysis was to provide an overview of quality of life and measures for children with intermittent exotropia, supporting the selection of measures and the interpretation of results from studies and measures. Also, the quality of life in Asian countries was compared to its in Western countries. Methods: Studies published before June 2018 were retrieved from Ovid MEDLINE, CINAHL, PsycINFO, PubMed, Academic Search Complete, ProQuest Medical Library, and the Cochrane library. Quality of life status were reviewed. Also, the instruments with respect to target group, nature, type and psychometric properties were reviewed. Two independent reviewers assessed the methodological quality using standardized critical-appraisal instruments. Six studies were included in the review. Results: All studies were cross-sectional and only one study investigated age-specific variables. Although instruments developed meet psychometric criteria more adequately than that developed previously, it is concluded that only two evaluative assessment measures and single dimension is existed in one frequently used measures. The meta-analysis revealed quality of life for children with intermittent exotropia was moderate to high (Mean = 75.36) (95% CI: 66.47 - 84.25) which was lower than healthy children; Also, this was lower in Asian countries than for Western countries children (Mean = 64.89: 80.59). Conclusion: The study confirmed the lower quality of life in children with intermittent exotropia, especially for Asian children and limited measurement tool. Age-specific, cross-cultural, and longitudinal trajectory studies are suggested to comprehensively gain a whole understanding of quality of life for children with intermittent exotropia especially for Asian children.