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首页> 外文期刊>JAMA otolaryngology-- head & neck surgery >Response shift in quality of life after endoscopic sinus surgery for chronic rhinosinusitis
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Response shift in quality of life after endoscopic sinus surgery for chronic rhinosinusitis

机译：内窥镜鼻窦手术治疗慢性鼻-鼻窦炎后生活质量的反应改变

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IMPORTANCE: Patient-reported measures are designed to detect a true change in outcome, but they are also subject to change from biases inherent to self-reporting: changing internal standards, changing priorities, and changing interpretations of a given instrument. These biases are collectively known as "response shifts" and can obscure true change after medical interventions. OBJECTIVE: To determine the presence of response shifts in patients with chronic rhinosinusitis (CRS) after endoscopic sinus surgery. DESIGN, SETTING, AND PARTICIPANTS: Multisite, prospective, observational cohort study conducted at academic tertiary care centers between February 2011 and May 2013. Study participants comprised a population-based sample of 514 adults (age ≥18 years) with CRS, who elected surgical intervention for continuing medically refractory symptoms. INTERVENTION: Endoscopic sinus surgery. MAIN OUTCOMES AND MEASURES: Preoperative and postoperative data from the 22-item Sinonasal Outcome Test (SNOT-22) survey instrument was characterized using exploratory factor analysis. Subsequent longitudinal structural equation models were estimated to test structure, potential response shifts, and true change in the SNOT-22 scores. RESULTS: A total of 339 participants (66.0%) provided survey evaluations at baseline and 6-month follow-up. Factor analysis of the SNOT-22 revealed 5 correlated, yet distinguishable, underlying factors. Endoscopic sinus surgery had a differential impact across these factors, with the largest effect size in rhinologic symptoms (mean [SD] SNOT-22 scores before and after surgery, 13.18 [5.11] and 7.37 [5.48], respectively; d = -1.13 [P < .001]) and extranasal rhinologic symptoms (8.31 [3.46] and 4.83 [3.68], respectively; d = -1.00 [P < .05]) (d is an effect size measure defined as the difference in means divided by the presurgery SD). Endoscopic sinus surgery had a smaller, yet significant, effect size on the remaining 3 factors: ear/facial symptoms (7.32 [4.6]) and 3.90 [4.07], respectively; d = -0.74[P < .001]), psychological dysfunction (11.90 [7.21] and 6.50 [6.69], respectively; d = -0.75 [P < .05]), and sleep dysfunction (10.12 [5.59] and 5.88 [5.37], respectively; d = -0.76[P < .001]). Participants were found to undergo recalibration, reprioritization, and reconceptualization of symptoms after intervention; however, the magnitude of these response shifts was small and not clinically significant. CONCLUSIONS AND RELEVANCE: The SNOT-22 measures 5 distinct factors, not a single construct. Reporting of individual subscale scores may improve sensitivity of this instrument in future studies. Participants undergoing endoscopic sinus surgery experience only clinically insignificant response shifts, validating assessment of change through use of presurgery and postsurgery SNOT-22 responses. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01332136
机译：重要信息：患者报告的措施旨在检测结果的真实变化，但也可能会因自我报告的固有偏见而发生变化：更改内部标准，更改优先级以及更改给定仪器的解释。这些偏见统称为“反应转移”，在医疗干预后可能掩盖真实的变化。目的：确定内窥镜鼻窦手术后慢性鼻鼻窦炎（CRS）患者是否存在反应转移。设计，地点和参与者：2011年2月至2013年5月间，在学术三级护理中心进行了多地点，前瞻性，观察性队列研究。研究参与者包括514名CRS成年人（年龄≥18岁），他们选择了手术方法进行人群研究。持续的难治性症状的干预。干预：内窥镜鼻窦手术。主要结果和措施：使用探索性因素分析来表征22项鼻鼻窦结果测试（SNOT-22）调查仪器的术前和术后数据。估计随后的纵向结构方程模型，以测试结构，潜在的响应位移以及SNOT-22分数的真实变化。结果：共有339名参与者（66.0％）在基线和6个月的随访期间提供了调查评估。 SNOT-22的因素分析显示了5个相关但可区分的潜在因素。内窥镜鼻窦手术对所有这些因素都有不同的影响，鼻病学症状的影响大小最大（手术前后平均[SD] SNOT-22评分分别为13.18 [5.11]和7.37 [5.48]; d = -1.13 [ P <.001]）和鼻外鼻部症状（分别为8.31 [3.46]和4.83 [3.68]; d = -1.00 [P <.05]）（d是一种效果大小量度，定义为均值之差除以术前SD）。内窥镜鼻窦手术对其余3个因素的影响较小，但意义重大：耳/面部症状分别为（7.32 [4.6]）和3.90 [4.07]。 d = -0.74 [P <.001]），心理障碍（分别为11.90 [7.21]和6.50 [6.69]; d = -0.75 [P <.05]）和睡眠障碍（10.12 [5.59]和5.88 [d] 5.37]; d = -0.76 [P <.001]）。参与者被发现在干预后要进行症状的重新校准，重新排序和重新概念化。然而，这些反应变化的幅度很小，在临床上并不重要。结论和相关性：SNOT-22测量5个不同的因素，而不是一个单一的结构。报告单个分量表分数可能会提高该仪器在未来研究中的敏感性。接受内窥镜鼻窦手术的参与者仅经历了临床上微不足道的反应转变，通过使用术前和术后SNOT-22反应验证了变化的评估。试验注册：clinicaltrials.gov标识符：NCT01332136

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