臺灣博碩士論文加值系統

背景：以不同的生活品質問卷評估慢性阻塞性肺部疾病（COPD）患者的研究愈來愈多，本研究藉由比較一般性生活品質問卷(WHOQOL-BREF)與特定疾病生活品質問卷(SGRQ)兩問卷之心理計量特質，瞭解此兩問卷用於COPD患者時測量特質上的差異。
方法：本研究對象為130名來自門診的男性COPD患者，除測量其肺功能外並以WHOQOL-BREF與SGRQ評估其生活品質。研究方法上首先對問卷內容進行問卷結構與量尺的比較，並以敘述統計量描述各範疇分布，Cronbach’s 值用以探討各範疇之內部一致性，此外並以收斂效度與區辨效度評估問卷的有效性，而問卷間範疇的相關性以皮爾森相關分析進行探討，為瞭解兩問卷與臨床指標之相關亦以ANOVA及ROC曲線分析，最後利用IRT之模式針對WHOQOL-BREF和SGRQ兩份問卷的各項題目心理計量特質進行全面性的描述與分析。
結果：結果顯示相較於SGRQ，WHOQOL-BREF有較少的ceiling effect與floor effect，兩問卷皆有不錯的內部一致性(Cronbach’s 都大於0.7)，WHOQOL-BREF有較佳的收斂效度與區辨效度，成功率分別介於66.7% -100%；92.8% -100%)比上SGRQ分別介於54% -94%；82.1% -91.7%。在兩問卷範疇的相關分析中，WHOQOL-BREF的生理範疇與SGRQ的日常活動（r=0.53）、疾病衝擊（r=0.53）與症狀範疇（r=0.38）有較高且顯著的相關（p<0.001），而此外其它範疇間的相關性皆偏低；ANOVA及ROC曲線分析的結果都顯示SGRQ對於臨床指標的敏感度較佳，但WHOQOL-BREF生理範疇對於臨床指標亦具有不錯的敏感度；以IRT分析各範疇的題目難度結果顯示，WHOQOL-BREF的生理範疇及SGRQ的症狀與日常活動範疇題目之平均難度與患者平均潛在特質較為適中，而WHOQOL-BREF的心理範疇難度亦算適中，其它如社會或環境相關的範疇則難度偏低；IRT模式適合度檢定結果，除了WHOQOL-BREF的生理範疇外，各範疇不符檢定標準的皆低於一題。
結論：兩問卷應用在COPD患者均有不錯的信度與效度心理計量特質，SGRQ較WHOQOL-BREF更具臨床指標的敏感度，但WHOQOL-BREF能提供更廣的層面及以患者主觀意識為中心的生活品質測量。

Background: A number of questionnaires have been used to assess the quality of life (QOL) of patients with chronic obstructive pulmonary disease (COPD). This study compares the performance of the WHOQOL-BREF and the St George’s Respiratory Questionnaire (SGRQ) in patients with COPD. Methods: One hundred and thirty male patients diagnosed with COPD were interviewed in person using both the WHOQOL-BREF and SGRQ. The classic psychometric properties of two questionnaires were compared including internal consistency reliability and validity. The modern psychometric properties based on Item response theory (IRT) was used to calibrate the difficulty of items, and the item fit index was also obtained. Finally, item discrimination and item information were calculated to examine which items were adaptive for COPD patients. Results: The domain scores of the WHOQOL-BREF showed less ceiling and floor effect than the SGRQ. Both questionnaires had acceptable internal consistency (Cronbach’s >0.7). The WHOQOL-BREF had higher convergent and discriminant validity success rates (range, 66.7% to 100% and 92.8% to 100%) than the SGRQ (range, 54% to 94% and 82.1% to 91.7%). The cross-correlations showed that the physical domain of the WHOQOL-BREF correlated strongly with activity, impact, and total domain of the SGRQ (r= 0.53-0.59). The SGRQ are more sensitive in detecting patients’ clinical difference than the WHOQOL-BREF. In IRT analysis, the WHOQOL-BREF physical and SGRQ symptom, activity domain provide the appropriate level of difficulty to capture the patient’s latent trait. All Domains of the two questionnaires have less than one misfit items except the WHOQOL-BREF physical domain. The items related to medical characteristics in both questionnaires showed less item information. Conclusions: In general, both questionnaires showed acceptable reliability and validity psychometric properties. The SGRQ had better validity in assessing symptoms and disease-specific measurements. The WHOQOL-BREF provides more subjective and broader QOL measurements.

中文摘要 i
英文摘要 ii
表目錄 iii
圖目錄 iv
附錄目錄 v
本文
第一章 緒論
第一節 研究背景與動機 ………………………………………………….......1
第二節 研究的重要性 ……………………………………………………….3
第三節 研究目的 ……………………………………………………… …4

第二章 文獻查證
第一節 COPD患者之特性……………………………….…………………… 5
第二節 生活品質之測量…………………………….… …………………… 6
第三節 COPD生活品質之研究…………………….………………………. 8
第四節 不同生活品質測量工具比較之研究……….….………………….. 10
第五節 傳統測量理論之介紹……………………………………………… 11
第六節 項目反應理論之發展與介紹……………………………………… 11
第七節 項目反應理論於臨床之應用 …………………………………….. 16

第三章 研究方法
第一節 研究設計與架構……………………………………………………...18
第二節 研究對象 …………………………………………………………….19
第三節 研究工具 …………………………………………………………… 19
第四節 資料收集過程 ……………………………………………………….20
第五節 資料統計與分析 …………………………………………………….20

第四章 研究結果與討論
第一節 研究對象基本人口學特徵描述 …………………………………... 24
第二節 問卷基本特質描述 ………………………………………………... 24
第三節 問卷傳統心理計量特質 …………………………………………... 26
第四節 問卷現代心理計量特質 …………………………………………....28
第五節 綜合討論 ……………………………………………………………35

第五章 結論與建議
第一節 結論 …………………………………………………………………..41
第二節 研究限制 ……………………………………………………………..45
第三節 應用與建議 …………………………………………………………..46
11. 參考文獻 …………………………………………………….…………………47
12. 表格與圖例 ……..………………………………………….…………………..53
13. 附錄 ……………………………………………………….……………………85

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