脊柱侧凸支具治疗前依从性评估量表的编制及应用

Development and application of an adherence assessment scale before brace treatment for patients with adolescent idiopathic scoliosis(AIS)

中文关键词:  青少年特发性脊柱侧凸  依从性  量表编制  治疗效果  生活质量

英文关键词:Adolescent idiopathic scoliosis  Adherence  Scale development  Treatment efficacy  Quality of life

中文摘要:

  【摘要】 目的：在探索青少年特发性脊柱侧凸（adolescent idiopathic scoliosis，AIS）患者支具治疗依从性影响因素的基础上，开发支具治疗前依从性评估量表、检验其信效度，并应用量表进一步检验其得分对实际治疗依从性、治疗效果及患者生活质量的预测作用与相关中介机制。方法：2020年9月~2022年12月，纳入239例AIS患者（其中最终接受支具治疗并完成随访的共计71例）。首先基于开放式问卷、参考国际通用量表构建初始量表，随后通过项目分析、探索性因子分析和验证性因子分析等步骤对其进行检验与修订，最终将信效度良好的题项确立为正式版量表。在应用阶段，进一步利用偏相关分析筛选出能显著预测实际依从性的关键题项，形成精简版量表。最后，采用相关分析、中介分析评估精简版量表得分与实际依从性（佩戴时长比）、支具治疗效果（Cobb角变化）及生活质量（中文版BrQ评分）的关系。结果：形成包括8个维度共27题的正式版依从性量表，应用阶段形成9题的精简版量表。精简版量表得分与实际依从性呈显著负相关（r=-0.364，P=0.003），并且该量表总分通过实际依从性的介导对生活质量的间接效应显著（β=-0.09，P=0.049）；而对治疗效果的间接效应则处于临界水平（β=0.063，P=0.064）。结论：精简版量表得分显示出预测患者佩戴支具实际依从性的潜力，并可能通过实际依从性间接影响生活质量。然而，中介分析的探索性结果需要更大样本的研究来进一步检验。

英文摘要:

  【Abstract】 Objectives: To explore the factors influencing brace treatment adherence in adolescent idiopathic scoliosis(AIS) patients, develop a pre-treatment adherence assessment scale, test its reliability and validity, and further apply the scale to examine the predictive effect of its scores on actual treatment adherence, therapeutic outcomes, patient quality of life, and the related mediating mechanisms. Methods: From September 2020 to December 2022, 239 AIS patients were enrolled in this study, 71 of whom ultimately received and completed brace treatment with follow-up. Based on open-ended questionnaires and references to internationally recognized scales, a preliminary scale was initially constructed. It was then tested and revised through steps including item analysis, exploratory factor analysis, and confirmatory factor analysis, resulting in a finalized version with good reliability and validity. In the application stage, partial correlation analysis was further employed to identify key items that significantly predicted actual adherence, forming a concise version of the scale. Finally, correlation analysis and mediation analysis were used to evaluate the relationships between the scores of the concise scale, actual adherence(wear time ratio), therapeutic outcome(change in Cobb angle), and quality of life(Chinese version of the BrQ score). Results: A formal adherence assessment scale consisting of eight dimensions and 27 questions was formed, and a concise version of 9 questions was developed during application. The score of the concise scale showed a significant negative correlation with actual adherence(r= -0.364, P=0.003). Furthermore, the total score of this scale had a significant indirect effect on quality of life mediated by actual adherence(β=-0.09, P=0.049); However, its indirect effect on therapeutic outcome was at a borderline significance level(β=0.063, P=0.064). Conclusions: The findings suggest that the score of the concise scale shows potential for predicting patients′ actual brace-wearing adherence and may indirectly influence quality of life through actual adherence. Nevertheless, given the exploratory scope of the mediation analysis, these results should be interpreted with caution and validated by future research employing adequately large sample sizes.