慢性阻塞性肺病病人長新冠症狀嚴重度指數之發展與信效度檢定

Developing and Validating the Long COVID-19 Symptom Severity Index (LCSSI) for Patients With Chronic Obstructive Pulmonary Disease

背景：現有長新冠評估工具多以一般康復者為對象，對如慢性阻塞性肺病等肺部結構脆弱高風險族群，缺乏簡明、易填答且具臨床敏感度的量表。
目的：旨在開發並驗證一項專為呼吸道疾病病人設計之長新冠症狀嚴重度指數的信效度。
方法：研究採二階段設計。第一階段透過文獻回顧與六位胸腔專家小組討論，建構初版題項。第二階段採橫斷式研究設計，於臺灣南部某醫學中心胸腔內科病房與門診進行調查，檢驗量表信效度。
結果：共納入128位慢性阻塞性肺病病人（男性93%），63.3%屬GOLD（global initiative for chronic obstruc¬tive lung disease）Group E。最常見的長新冠症狀為咳嗽／痰（100%）、疲勞／虛弱（90.6%）及呼吸困難（88.3%）。長新冠症狀嚴重度指數具良好內部一致性（Cronbach’sα= .88），與慢性阻塞性肺病評估量表呈顯著正相關（p < .01），與15D健康生活品質量表呈顯著負相關（p < .01），且依GOLD分類，Group E病人在整體症狀嚴重度及咳嗽／痰、呼吸困難與疲勞等核心症狀上皆顯著較高（皆p < .01），皆顯示具良好效度。
結論／實務應用：長新冠症狀嚴重度指數於本樣本顯示可接受之內部一致性與效度證據，支持其作為慢性阻塞性肺病病人長新冠恢復後期症狀評估之參考工具。

Background: Existing tools for assessing Long COVID are primarily designed for the general population. Few instruments adequately capture the needs and vulnerabilities of high-risk groups such as patients with chronic obstructive pulmonary disease (COPD), who have structurally vulnerable lungs.
Purpose: This study was designed to develop and validate the Long COVID Symptom Severity Index (LCSSI), a concise and clinically sensitive instrument designed specifically for use on patients with respiratory diseases.
Methods: The study was conducted in two phases. In Phase I, item generation was based on a literature review and expert panel discussion involving six pulmonologists. In Phase II, a cross-sectional validation study was conducted in the chest medicine wards and outpatient clinics of a medical center in southern Taiwan. The psychometric properties of the LCSSI were examined.
Results: One hundred and twenty-eight patients with COPD (93% male) were enrolled, of whom 63.3% were classified under GOLD (global initiative for chronic obstructive lung disease) Group E. The most prevalent symptoms found were cough/sputum (100%), fatigue/weakness (90.6%), and dyspnea (88.3%). The LCSSI demonstrated excellent internal consistency (Cronbach’sα= .88), and correlated positively with the COPD Assessment Test (p < .01) and negatively with the 15D Health-Related Quality of Life scale (p < .01). Mean LCSSI scores differed significantly across GOLD groups, with Group E showing higher mean total and core symptom scores (all p < .01), supporting construct validity.
Conclusion/ Implications for Practice: Based on this sample, the results indicate the LCSSI has acceptable internal consistency and validity, supporting its use as a reference tool for symptom assessment in patients with COPD during the late recovery phase for Long COVID.