Chinesization of the 10-item Identity-Consequence Fatigue Scale and Its Application in Patients after Gastrointestinal Tumor Surgery

doi:10.12114/j.issn.1007-9572.2018.00.250

Abstract

Abstract: Background　Postoperative fatigue（POF）has a high incidence and a serious impact on prognosis and quality of life for patients after gastrointestinal tumor surgery.At present，there is no simple and targeted tool for gastrointestinal tumor patients to assess POF.In addition，the existing assessment scales have some limitations.Objective　To translate the 10-item Identity-Consequence Fatigue Scale（ICFS-10）into Chinese and test its reliability and validity and determine the optimal cut-off point in patients after gastrointestinal tumor surgery.Methods　We developed the Chinese version of ICFS-10 based on the translation，back translation，revision based upon expert consultations and cultural adaptation guideline recommended by American Academy of Orthopaedic Surgeons Evidence Based Medicine Committee.Then，using it and the Chinese version of PFS-R，and Chinese version of HADS，we conducted a survey among a convenience sample of 80 patients who underwent gastrointestinal tumor surgery in Jiangsu Province Hospital from November 2017 to January 2018.The reliability and validity of the Chinese version of ICFS-10 were analyzed，and its optimal cut-off point was defined by ROC analysis and threshold effect analysis.Results　According to the scale score of the Chinese version of ICFS-10，these patients were divided into high-score group（n=20）and low-score group（n=20）by the critical ratio.High-score group scored higher in each item of the Chinese version of ICFS-10 compared with the low-score group（P<0.05）．Item score increased with the scale score of the Chinese version of ICFS-10（P<0.05）．The Chinese version of ICFS-10 demonstrated scale-level content validity index（CVI）of 0.96，item-level CVI of 0.86 to 1.00.KMO value of Chinese version of ICFS-10 was 0.868，Bartlett's test of χ2 was 780.99，P<0.001，indicating that it was suitable for exploratory factor analysis.Exploratory factor analysis indicated that Chinese version of ICFS-10 consisted of 2 factors with igenvalues of 6.191，1.543（extracted on the basis of the extraction decision rule of eigenvalue ≥1.000）which explained 77.34% of the total variance，and factor loading of all 10 items ranged 0.588 to 0.918.The scale score of the Chinese version of ICFS-10 showed a positive correlation with that of the Chinese version of PFS-R（P<0.05）．The values of Cronbach's α for the scale and two common factors of the Chinese version of ICFS-10 were 0.928，0.907，0.877，respectively.For the diagnosis of POF，the AUC of the Chinese version of ICFS-10 was 0.833〔95%CI（0.729，0.910）〕，yielding a maximal Youden index of 0.595 with a sensitivity of 80.6%，specificity of 79.0%，and a cut-off point of 22.Threshold effect analysis revealed a change point（K）of 24〔95%CI（12，27）〕with a logarithmic likelihood ratio of 0.074.Therefore，the optimal cut-off point of the Chinese version of ICFS-10 was determined as 24 for the diagnosis of POF，and the evaluation of the physiology and psychology of such patients by this scale showed，49 cases（66.2% of the total）scored more than 24.Conclusion　The Chinese version of ICFS-10 has good reliability and validity and can be used to assess the POF.Its optimal cut-off point of 24 can be used as a warning sign of the adverse effects of POF on physiological and psychological health.

Key words: Gastrointestinal neoplasms, Fatigue, Reliability, Validity, Postoperative period

摘要： 背景　术后疲劳（POF）在消化道肿瘤人群中具有较高的发生率且对患者预后和生活质量产生了严重影响。目前尚无针对消化道肿瘤术后患者POF的简便评估工具，且现有评估量表均具有一定的局限性。目的　汉化10条目简明围术期疲劳评测量表（ICFS-10），对其进行信效度检验，并确定其诊断消化道肿瘤术后患者POF的截断值。方法　采用方便抽样法选取2017年11月—2018年1月在江苏省人民医院行手术治疗的消化道肿瘤患者80例为调查对象。遵循美国矫形外科医师学会循证医学委员会推荐的跨文化调适指南，通过前译、回译、专家咨询，形成中文版ICFS-10。采用一般情况调查表、中文版ICFS-10、中文版Piper癌因性疲乏修订量表（PFS-R）、中文版医院焦虑抑郁量表（HADS）对调查对象进行调查。分析中文版ICFS-10信效度；通过受试者工作特征（ROC）曲线和阈值效应分析确定中文版ICFS-10诊断消化道肿瘤术后患者POF的截断值。结果　采用临界比值法将患者分为高分组（20例）和低分组（20例），高分组中文版ICFS-10各条目得分均高于低分组（P<0.05）。中文版ICFS-10各条目得分与其总分均呈正相关（P<0.05）。中文版ICFS-10各条目的内容效度指数（CVI）为0.86~1.00，中文版ICFS-10的CVI为0.96。中文版ICFS-10的KMO值为0.868，Bartlett's球形检验χ2=780.99，P<0.001，表明适合做探索性因子分析。在探索性因子分析中，按特征值≥1.000的标准可提取2个公因子，其特征值分别为6.191、1.543，累积方差贡献率为77.34%，各条目的载荷值为0.588~0.918。中文版ICFS-10总分与中文版PFS-R总分呈正相关（P<0.05）。中文版ICFS-10的Cronbach's α系数为0.928，提取的2个公因子的Cronbach's α系数分别为0.907和0.877。中文版ICFS-10诊断消化道肿瘤术后患者POF的ROC曲线下面积为0.833〔95%CI（0.729，0.910）〕，Youden指数最大值为0.595，此时灵敏度为80.6%，特异度为79.0%，对应的截断值为22分；阈值效应分析结果显示，折点K值为24〔95%CI（12，27）〕，对数似然比为0.074；结合两个截断值可得，中文版ICFS-10诊断消化道肿瘤术后患者POF的截断值为24分。以中文版ICFS-10总分>24分为POF明显且影响患者生理、心理水平对患者进行评估，结果显示，49例（66.2%）患者得分>24分。结论　中文版ICFS-10信效度良好，可有效评估POF。中文版ICFS-10诊断消化道肿瘤术后患者POF的截断值为24分，可作为POF对患者生理、心理均产生不利影响的警示值。

关键词: 胃肠肿瘤, 疲劳, 信度, 效度, 手术后期间

XU Xinyi,XU Qin. Chinesization of the 10-item Identity-Consequence Fatigue Scale and Its Application in Patients after Gastrointestinal Tumor Surgery　[J]. Chinese General Practice, 2019, 22(2): 210-214. DOI: 10.12114/j.issn.1007-9572.2018.00.250.
徐欣怡,许勤. 简明围术期疲劳评测量表的汉化及其在消化道肿瘤术后患者中的应用价值研究[J]. 中国全科医学, 2019, 22(2): 210-214. DOI: 10.12114/j.issn.1007-9572.2018.00.250.

References

［1］ROSE E A，KING T C.Understanding postoperative fatigue［J］．Surg Gynecol Obstet，1978，147（1）：97-102.
［2］梁文杰.外科术后疲劳相关因素初探［D］．广州：广州中医药大学，2010.
［3］OLIVEIRA M，OLIVEIRA G，SOUZA-TALARICO J，et al．Surgical oncology：evolution of postoperative fatigue and factors related to its severity［J］．Clin J Oncol Nurs，2016，20（1）：E3-8．DOI：10.1188/16.CJON.E3-E8.
［4］PADDISON J S，SAMMOUR T，KAHOKEHR A，et al．Development and validation of the Surgical Recovery Scale（SRS）
［J］．J Surg Res，2011，167（2）：e85-91．
［5］PADDISON J S，BOOTH R J，HILL A G，et al．Comprehensive assessment of peri-operative fatigue：development of the Identity-Consequence Fatigue Scale［J］．J Psychosom Res，2006，60（6）：615-622．DOI：10.1016/j.jpsychores.2005.08.008.
［6］N?STDAHL T，BERNKLEV T，RAEDER J，et al．Postoperative fatigue; translation and validation of a revised 10-item short form of the Identity-Consequence Fatigue Scale（ICFS）［J］．J Psychosom Res，2016，84：1-7．DOI：10.1016/j.jpsychores.2016.03.002.
［7］TORRE L A，BRAY F，SIEGEL R L，et al．Global cancer statistics，2012［J］．CA Cancer J Clin，2015，65（2）：87-108．DOI：10.3322/caac.21262.
［8］CHEN W，ZHENG R，BAADE P D，et al．Cancer statistics in China，2015［J］．CA Cancer J Clin，2016，66（2）：115-132．DOI：10.3322/caac.21338.
［9］郭金玉，李峥.量表引进的过程及评价标准［J］．中华护理杂志，2012，47（3）：283-285.
GUO J Y，LI Z.Scale introduction process and evaluation criteria［J］.Chinese Journal of Nursing，2012，47（3）：283-285.
［10］BEATON D E，BOMBARDIER C，GUILLEMIN F，et al．Guidelines for the process of cross-cultural adaptation of self-report measures［J］．Spine（Phila Pa 1976），2000，25（24）：3186-3191.
［11］PIPER B F，DIBBLE S L，DODD M J，et al．The revised Piper Fatigue Scale：psychometric evaluation in women with breast cancer［J］．Oncol Nurs Forum，1998，25（4）：677-684.
［12］SO W K，DODGSON J，TAI J W.Fatigue and quality of life among Chinese patients with hematologic malignancy after bone marrow transplantation［J］．Cancer Nurs，2003，26（3）：211-219.
［13］ZIGMOND A S，SNAITH R P.The Hospital Anxiety and Depression Scale［J］．Acta Psychiatr Scand，1983，67（6）：361-370.
［14］叶维菲，徐俊冕.“综合性医院焦虑抑郁量表”在综合性医院病人中的应用与评价［J］．中华行为医学与脑科学杂志，1993，2（3）：17-19.
［15］林崇德.心理学大辞典［M］．上海：上海教育出版社，2003.
［16］焦丽.食管癌患者术后疲劳综合征影响因素分析［D］．济南：山东大学，2013.
［17］陆守曾，陈峰.医学统计学［M］．2版.北京：中国统计出版社，2007.
［18］杨丽峰，杨洋，张春梅，等．老年人衰弱评估量表的编制及信效度检验［J］．中华护理杂志，2017，52（1）：49-53．DOI：10.3761/j.issn.0254-1769.2017.01.010.
YANG L F，YANG Y，ZHANG C M，et al．Development and reliability and validity tests of Elderly Frailty Assessment Scale［J］．Chinese Journal of Nursing，2017，52（1）：49-53．DOI：10.3761/j.issn.0254-1769.2017.01.010.
［19］OBAMIRO K O，CHALMERS L，BEREZNICKI L R.Development and validation of an oral Anticoagulation Knowledge Tool（AKT）［J］．PLoS One，2016，11（6）：e0158071.
［20］朱燕波.生命质量（QOL）测量与评价［M］．北京：人民军医出版社，2010.

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