患者参与的主观全面评定量表改良及在胃癌患者中的验证

doi:10.3761/j.issn.0254-1769.2021.01.006

摘要/Abstract

摘要：

目的对患者参与的主观全面评定（Patient-generated Subjective Global Assessment,PG-SGA）量表进行改良,检验改良版PG-SGA的信效度及条目质量。方法基于项目反应理论筛选出PG-SGA中质量不佳的条目,修订后形成改良版PG-SGA。2019年9月—2020年2月纳入江苏省某三级甲等医院收治的281例胃癌围手术期患者,利用因子分析法确定改良版PG-SGA的条目权重并赋予相应分值。以主观全面评定（Subjective Global Assessment,SGA）为参照,根据受试者操作特征曲线划分改良版PG-SGA营养评定的截断值。最后评价信效度及条目质量。结果经统计测试,确定了11个条目,总分为0~33分。营养评定的截断值如下:评分≥11分表示营养不良,评分<11分表示营养良好。信效度分析示,改良版PG-SGA用于营养评定的准确性高于PG-SGA,约登指数为0.844;总量表的内容效度指数为0.910;探索性因子分析提取4个公因子,累计方差贡献率为83.494%;Cronbach’s α系数为0.707。项目反应理论分析显示,修订后的条目质量显著改善。结论形成的改良版PG-SGA信效度良好,条目质量佳,临床可用该量表进行营养评定。

关键词: 项目反应理论, 营养评价, 量表改良, 肿瘤护理

Abstract:

Objective To modify the patient-generated subjective global assessment（PG-SGA） scale,and to analyze the reliability,validity and item quality of the modified PG-SGA. Methods Modified items that need to be improved in PG-SGA based on item response analysis were screened out and the revised version of PG-SGA was formed. 281 perioperative gastric cancer patients admitted to a level A tertiary hospital from September 2019 to February 2020 were selected. The weight of each item of the scale was determined by factor analysis;the cut-off values of the modified PG-SGA were divided according to the receiver operator characteristic curve. Finally,reliability and validity were evaluated,and item quality was analyzed again based on item response theory. Results The modified PG-SGA included 11 items,with a total score of 0 to 33. The cutoff value was 11 points. Reliability and validity analysis showed that the accuracy of the modified PG-SGA for nutritional assessment was higher than PG-SGA,and the Youden index was 0.844; the content validity index of the total scale was 0.910; 4 common factors were extracted by exploratory analysis and the cumulative variance contribution rate was 83.494%; the Cronbach’α coefficient of the total scale was 0.707. Analysis results of item response theory showed that the discrimination and difficulty parameters of the modified items were improved. Conclusion The modified PG-SGA is a reliable and valid scale,and the quality of items is improved. This scale can be utilized to conduct clinical nutritional assessment.

Key words: Item Response Theory, Nutrition Assessment, Scale Modification, Oncologic Nursing

花红霞,许勤,陈丽,陆金玲,朱涵菲. 患者参与的主观全面评定量表改良及在胃癌患者中的验证[J]. 中华护理杂志, 2021, 56(1): 39-45.

HUA Hongxia,XU Qin,CHEN Li,LU Jinling,ZHU Hanfei. Modification and evaluation of a patient-generated subjective global assessment among gastric cancer patients[J]. Chinese Journal of Nursing, 2021, 56(1): 39-45.

图/表 6

表1 患者参与的主观全面评定各条目的项目反应理论参数估计结果

Tab.1 Parameter results of PG-SGA items based on item response theory

表2 改良版患者参与的主观全面评定

Modified PG-SGA

图1 改良版PG-SGA、PG-SGA评定营养不良的ROC曲线

Fig 1 ROC curve of modified PG-SGA and PG-SGA in assessing malnutrition

图1 改良版PG-SGA、PG-SGA评定营养不良的ROC曲线

Fig 1 ROC curve of modified PG-SGA and PG-SGA in assessing malnutrition

表3 改良版患者参与的主观全面评定各条目项目反应理论参数估计结果

Parameter results of Modified PG-SGA items based on item response theory

表3 改良版患者参与的主观全面评定各条目项目反应理论参数估计结果

Parameter results of Modified PG-SGA items based on item response theory

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