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標題: | 中文化兒童排尿障礙問卷量表之信度及效度統計分析 Statistical Analysis of Reliability and Validity of a Chinese Version of Dysfunctional Voiding Symptom Score (DVSS) Questionnaire |
作者: | Shang-Jen Chang 張尚仁 |
指導教授: | 陳秀熙(Tony Hsiu-Hsi Chen) |
關鍵字: | 兒童排尿障礙,問卷量表,信度,效度,因素分析,貝氏定理, pediatric dysfunctional voiding,questionnaire scale,reliability,validity,factor analysis,Bayesian theorem, |
出版年 : | 2011 |
學位: | 碩士 |
摘要: | 兒童排尿障礙為一個多重病因的疾病,其臨床的症狀表現:包含了日間尿失禁,急尿,急尿屈膝,排尿困難及便秘等症狀。從西元2000年起,至少有四種兒童排尿障礙問卷量表被提出來測量兒童排尿障礙。但至今仍沒有中文化的量表被提出,因此我們便著手翻譯中文問卷量表,並以適當統計方法分析信度及效度。本研究設計為年齡及性別配對之個案對照研究。個案組為從西元2008九月開始,在門診收集60位(38位女生,22位男生)經由臨床評估及尿路動力學診斷為排尿障礙的兒童,予其父母或主要照顧者填寫排尿障礙問卷,並於一週內填寫第二次量表。我們收集了基本資料,包含了身高,體重,尿液分析,尿路動力學檢查結果。另外於幼稚園及小學收集年齡及性別相同的健康兒童作為對照組,同樣予其父母或主要照顧者填寫排尿障礙問卷,共235位(90位男生及145位女生)作為對照組。
原版兒童排尿障礙問卷量表(DVSS)為英文,由Farhat等人提出,包含了十個問題,每題權重相同為0到3分。其中七個問題與排尿症狀相關,2個與便秘相關,一個與壓力事件相關。中文化問卷由楊緒棣翻譯,並再翻譯成英文。中文版問卷並由台灣泌尿科醫學會五位小兒泌尿委員會委員審視內容效度。 信度分析方面共有2項:1.內部一致性以Cronbach’s alpha檢驗,2.重測信度以組內相關係數(intraclass correlation)檢驗。我們採用羅吉斯迴歸及ROC曲線分析來作預測效度分析。此外,並以因素分析,將十個問題分類,得到不同的建構面向。我們並採用貝氏定理來分析在不同盛行率地區作篩檢時,同樣量表的分數可能患有排尿障礙的機率及風險比。 本研究個案平均總分為9.65±3.87分,而對照組為 4.13±2.60分。個案量表的量表內部項目相關係數(Cronbach’s alpha)為 0.448,顯示此量表所測量的疾病症狀為異質化的組成。以組內相關係數評估重測信度為0.89。經由ROC曲線分析決定量表總分切點為6.66,其AUC為0.89,敏感性為81.67%,而特異性為82.63%。因數分析發現所有的症狀可以分類為三種建構:1. 尿失禁及急尿症狀,2. 排泄困難症狀,3. 疼痛及壓力症狀。依貝氏方法調整以DVSS於不同盛行率地區,或於小兒泌尿門診篩檢時的預測機率,同樣的DVSS總分,在不同地區為個案的機率不同,比如同樣的DVSS總分8分,在社區(盛行率2%)可能為個案的機率只有8%,風險比為 0.09,而在門診(盛行率30%)則機率增加至63%,風險比為 1.74。 根據本研究結果,中文化兒童排尿障礙問卷量表具有良好的重測信度,並且可以用來預測個案的效度,由貝氏方法發現中文化兒童排尿障礙問卷應用於社區及門診篩檢時,同樣的分數會有不同的風險比。 Dysfunctional voiding in children is a multifactorial disease presenting with a variety of symptoms including daytime incontinence, urgency, curtsying, difficult voiding and constipation. In spite of four different scales have been validated to measure pediatric dysfunctional voiding since 2000, there is still lacking of psychometrically-sound scales in Chinese to measure pediatric dysfunctional voiding, we performed an age- gender-matched case-control study to evaluate the reliability and validity of Dysfunctional Voiding Symptom Score (DVSS) in Chinese version. From Sep 2008 to Feb 2011, we enrolled 60 children (38 girls and 22 boys, case) with diagnosis of dysfunctional voiding by clinical evaluation and urodynamic studies in clinics of pediatric urology. Baseline characteristics were recorded including age, gender, body height, weight, urine analysis and parameters associated with urodynamic studies. The DVSS was completed at clinics by the parents who mainly take care of the child in the presence of the child. After one week, the DVSS was administered at home and returned to clinics for evaluation of test-retest reliability. For the control group, we enrolled 235 age- and gender- matched healthy children from kindergartens and elementary schools. The DVSS consisted of 10 items with the score of each item scores ranging from 0 to 3. Among these items, seven were related to voiding, two were related to defecation and one was related to stressful events. The DVSS was translated into Chinese and did back translation into English. The DVSS in Chinese version was reviewed by five members in the committee of pediatric urology of Taiwan Urological Association with respect to content validity. The reliability of DVSS questionnaires completed by cases was assessed with Cronbach’s alpha test (internal consistency) and intraclass correlation (ICC, test-retest reliability). The predictive validity was first analyzed with logistic regression and was further assessed by Receiver Operating Characteristic curve analysis. Factor analysis was used to classify the ten symptoms into latent factors and estimate factor score of individual latent variables. Finally, we applied Bayesian method to evaluating the posterior probability and odds of dysfunctional voiding in children screened with DVSS from areas of different prevalence rates. Mean total scores of DVSS in case and control group were 9.65(±3.87) and 4.13(±2.60), respectively. The Cronbach’s alpha coefficient was 0.448 for the ten items among DVSS indicating a heterogeneous composition of symptoms in dysfunctional voiding. Intraclass correlation coefficient for test-retest reliability was 0.89. The cut-off for total DVSS score was 6.66, yielding 81.67% of sensitivity and 82.63% of specificity. Factor analysis revealed three latent variables (overactive bladder symptoms, difficult elimination symptoms, stress and dysuria symptoms). Using Bayesian method, the applications of DVSS in areas of different prevalence figures give an indication of significantly different probabilities of dysfunctional voiding, 8% and 63% in a community with 2 % prevalence and pediatric urology clinics with 30 % prevalence, respectively give a total score equal to 8. Conclusions: DVSS in Chinese version is reliable and valid to predict children with dysfunctional voiding. Through Bayesian method, we found significantly different probabilities and odds of having dysfunction voiding in children with the same total DVSS scores from areas of different prevalence figures. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/9591 |
全文授權: | 同意授權(全球公開) |
顯示於系所單位: | 流行病學與預防醫學研究所 |
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