Psychometric Properties of Patient-Reported Outcome Measures Assessing Self-Efficacy in Patients with Chronic Obstructive Pulmonary Disease (COPD): A Systematic Review

This systematic review aimed to synthesize the evidence of the psychometric properties of self-efficacy patient-reported outcome measures (PROMs) in patients with chronic obstructive pulmonary disease (COPD). We conducted a systematic search of MEDLINE and other common databases from inception until September 2020. Studies that reported psychometric properties of self-efficacy outcome measures in COPD patients were included. We used the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) 2018 guidelines for data extraction and evidence synthesis. Eighteen studies that assessed nine self-efficacy PROMs were eligible for inclusion. The assessment of structural validity indicated sufficient results rating for the Exercise Self-Regulatory Efficacy Scale and the Self-Care-Self-Efficacy Scale, and insufficient rating for the COPD Self-Efficacy Scale and the Pulmonary Rehabilitation Adaptation Index for Self-Efficacy (PRAISE). Construct validity measures displayed sufficient results rating with correlations ranging from −0.48 to − 0.71 between self-efficacy PROMs and other PROMs such as St. George’s Respiratory Questionnaire, Hospital Anxiety and Depression Scale and Chronic Respiratory Questionnaire. Internal consistency measures indicated sufficient rating for all self-efficacy PROMs with a Cronbach’s alpha range of 0.71 − 0.98. Responsiveness was assessed for the PRAISE with an overall sufficient rating (effect sizes of 0.21 − 0.37). The evidence regarding the psychometric properties of self-efficacy PROMs in COPD is variable. The PRAISE is responsive to changes in self-efficacy in COPD patients attending a pulmonary rehabilitation program. When using self-efficacy PROMs in clinical practice or research, clinicians and researchers should consider the psychometric properties and choose the appropriate outcome measure based on the purpose.

本系统综述旨在综合慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease, COPD）患者自我效能感相关患者报告结局量表（Patient-Reported Outcome Measures, PROMs）的心理测量学属性证据。我们自建库起至2020年9月，对MEDLINE及其他主流医学数据库开展系统性检索，纳入所有报告了COPD患者自我效能感结局量表心理测量学属性的研究，并采用2018版《健康测量工具遴选共识标准》（Consensus-Based Standards for the Selection of Health Measurement Instruments, COSMIN）指南开展数据提取与证据合成。最终有18项针对9种自我效能感PROMs的研究符合纳入标准。结构效度评估结果显示，运动自我调节效能量表（Exercise Self-Regulatory Efficacy Scale）与自我护理自我效能量表（Self-Care-Self-Efficacy Scale）的评分达标，而慢性阻塞性肺疾病自我效能量表（COPD Self-Efficacy Scale）及肺康复适应自我效能量表（Pulmonary Rehabilitation Adaptation Index for Self-Efficacy, PRAISE）的评分未达标。建构效度检验结果显示，自我效能感PROMs与圣乔治呼吸问卷（St. George’s Respiratory Questionnaire）、医院焦虑抑郁量表（Hospital Anxiety and Depression Scale）及慢性呼吸问卷（Chronic Respiratory Questionnaire）等其他量表的相关系数介于-0.48至-0.71之间，评分达标。内部一致性检验结果显示，所有自我效能感PROMs的克朗巴赫α系数（Cronbach’s alpha）介于0.71至0.98之间，评分均达标。针对PRAISE的反应性评估结果显示其总体评分达标，效应量介于0.21至0.37之间。现有关于COPD患者自我效能感PROMs心理测量学属性的证据参差不齐。PRAISE可敏感反映参与肺康复项目的COPD患者自我效能感的变化。临床实践或研究中使用自我效能感PROMs时，临床医师与研究人员应考量其心理测量学属性，并根据应用目的选择合适的结局量表。