手部烧伤结局评估工具的汉化和跨文化调试及信效度检验

张娟; 柴雪珺; 关立锋; 马月兰; 张晓雯; 姚苗

doi:10.3760/cma.j.cn501120-20210201-00042

手部烧伤结局评估工具的汉化和跨文化调试及信效度检验

doi: 10.3760/cma.j.cn501120-20210201-00042

宁夏医科大学总医院烧伤整形美容科，银川　　750004

基金项目:

宁夏回族自治区自然科学基金 NZ17152

详细信息

通讯作者:
柴雪珺，Email：1374280614@qq.com

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出版历程
- 收稿日期: 2021-02-01

Sinicization, cross-cultural adjustment and reliability and validity test of the Burnt Hand Outcome Tool

Burns and Plastic Surgery Department, General Hospital of Ningxia Medical University, Yinchuan 750004, China

Funds:

Natural Science Foundation of Ningxia Hui Autonomous Region of China NZ17152

More Information

Corresponding author: Chai Xuejun, Email: 1374280614@qq.com

摘要

摘要: 目的将手部烧伤结局评估工具（BHOT）引入中国，对其进行汉化、跨文化调试和信效度检验，为手部烧伤患者治疗效果的评估和医疗决策的制订提供参考依据。方法采用横断面调查研究方法。征得原作者授权后采用Brislin翻译模式对BHOT进行直译、合成、回译和专家审核，形成中文版BHOT（C-BHOT）2。采用目的抽样法邀请10名从事烧伤救治工作的专家进行跨文化调试，形成C-BHOT 3。采用偶然抽样法，选择2020年1—3月在宁夏医科大学总医院治疗的21例符合入选标准的手部烧伤患者行预测试，完善后形成最终版C-BHOT 4。采用偶然抽样多地点跨区调查法于2020年5月—2021年3月，选择宁夏医科大学总医院、空军军医大学第一附属医院、陆军军医大学（第三军医大学）第一附属医院和南昌大学第一附属医院的符合入选标准的住院患者。采用一般资料调查表和C-BHOT 4进行调查，采用临界比法和相关系数法进行项目分析，采用克龙巴赫α系数检验内部一致性，采用重测信度判断稳定性，采用内容效度指数分析内容效度，采用探索性因子分析进行结构效度检验。对数据行独立样本t检验、Pearson相关分析。结果经汉化、跨文化调试、预测试后形成共20个条目的C-BHOT 4，所有条目调整为正向计分，在原工具的基础上修改7处。正式调查共发放问卷353份，回收有效问卷344份，有效回收率97.45%。344例患者中男性（297例）明显多于女性（47例），年龄为23~57岁。项目分析中各条目的临界比为5.48~12.59（P<0.05），高分组和低分组每个条目得分比较差异明显（t=-10.72~-2.84，P<0.05或P<0.01），各条目得分间、各条目得分与工具总分间均呈明显正相关（r=0.68~0.71、0.47~0.63，P<0.05或P<0.01）。信度检验中，整个工具的克龙巴赫α系数为0.837，重测信度为0.702~0.793。效度检验中，整个工具的内容效度指数为0.923，探索性因子分析共提取出3个公因子，累计方差贡献率为76.162%，验证性因子分析中的比较拟合指数为0.924。结论引进的BHOT经汉化、跨文化调试、预测试和信效度检验后，验证出C-BHOT 4在中国手部烧伤患者结局评估中具有良好的信效度，可作为一种有效的测评工具进行应用。
- 手 /
- 烧伤 /
- 患者报告结局 /
- 量表汉化 /
- 信度 /
- 效度
Abstract: Objective To introduce the Burnt Hand Outcome Tool (BHOT) into China to conduct sinicization, cross-cultural debugging, and test the reliability and validity, thus provide a reference for the evaluation of treatment effect and making of medical decisions of hand burn patients. Methods The cross-sectional research was conducted. After obtaining the authorization of the original author, the Brislin translation mode was used to literally translate, synthesize, back-translate, and be checked by experts to form the Chinese version of BHOT (C-BHOT) 2. Ten experts in the field of burn rescue and treatment were invited by purpose sampling method to conduct cross-cultural debugging to form C-BHOT 3. A total of 21 hand burn patients who were treated in General Hospital of Ningxia Medical University from January to March 2020 and conformed to the inclusion criteria were selected by accidental sampling method for pre-testing. Then the final version of C-BHOT 4 was formed. Hospitalized patients who met the selection criteria were recruited using accidental sampling, multi-site and cross-regional survey method from May 2020 to March 2021 in General Hospital of Ningxia Medical University, the First Affiliated Hospital of Air Force Medical University, the First Affiliated Hospital of Army Medical University (the Third Military Medical University), and the First Affiliated Hospital of Nanchang University. The survey was performed with the general information questionnaire and C-BHOT 4. Critical ratio method and correlation coefficient method were used for item analysis, Cronbach's α coefficient test tool was used to test internal consistency, test-retest reliability was used to judge the stability of the tool, content validity index analysis tool was used to analyze the content validity, and exploratory factor analysis was used to test the validity of the structure. Data were statistically analyzed with independent sample t test or Pearson correlation analysis. Results After the sinicization, cross-cultural debugging, and pre-testing, C-BHOT 4 was formed with a total of 20 items. All items were adjusted to positive scoring, and 7 modifications were made on the basis of the original tool. A total of 353 questionnaires were issued in the formal survey, and 344 valid questionnaires were returned, with an effective response rate of 97.45%. In the 344 patients, there were more male patients (297 patients) than female patients (47 patients), with ages of 23 to 57 years. The critical ratios of each item in the item analysis ranged from 5.48 to 12.59 (P<0.05). There were statistically significant differences in the scores between patients in high-score group and low-score group (t=-10.72--2.84, P<0.05 or P<0.01). There was significant positive relationship among the scores of each two items and between scores of each item and the overall tool score (r=0.68-0.71, 0.47-0.63, P<0.05 or P<0.01). In reliability test, the Cronbach's α coefficient of the whole tool was 0.837, and the test-retest reliability was 0.702-0.793. In validity test, the content validity index of whole tool was 0.923. The exploratory factor analysis extracted 3 common factors, and the cumulative variance contribution rate was 76.162%. The comparative fit index in the confirmatory factor analysis was 0.924. Conclusions After the BHOT tool being sinicized, cross-culturally debugged, pre-tested, and tested for reliability and validity, it was verified that C-BHOT 4 has good reliability and validity in assessing the outcome of Chinese hand burn patients, and therefore can be used as an effective tool for the evaluation.
- Hand /
- Burns /
- Patient-reported outcome /
- Scale sinicization /
- Reliability /
- Validity
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表1 344例手部烧伤患者的一般资料

项目与分类	例数	构成比（%）
性别
男	297	86.34
女	47	13.66
年龄（岁）
18~45	185	53.78
46~60	159	46.22
婚姻状况
已婚	238	69.19
未婚	35	10.17
离异	49	14.24
丧偶	22	6.40
文化程度
初中	129	37.50
高中	150	43.60
大专	48	13.95
本科及以上	17	4.94
烧伤严重程度
轻度	95	27.62
中度	121	35.17
重度	67	19.48
特重度	61	17.73
烧伤深度
深Ⅱ度	158	45.93
Ⅲ度	186	54.07
烧伤原因
火焰	54	15.70
热液	103	29.94
热固体	77	22.38
化学	62	18.02
电击	48	13.95
并发症
有	176	51.16
无	168	48.84
植皮
是	188	54.65
否	156	45.35

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表2 2组手部烧伤患者采用中文版手部烧伤结局评估工具评估后各条目得分比较（分，x¯±s）

组别	例数	条目1	条目2	条目3	条目4	条目5	条目6	条目7	条目8	条目9	条目10
高分组	92	5.3±1.5	5.9±1.3	5.1±0.6	5.3±1.3	4.4±1.8	6.4±1.7	5.2+1.4	5.8±1.6	5.9±1.1	6.3±1.6
低分组	92	2.4±1.5	2.2±0.9	2.6±0.5	2.6±0.5	3.4±1.3	3.0±1.0	2.8±1.3	2.8±0.8	3.0±1.4	2.8±1.6
临界比		8.45	6.48	5.73	8.94	7.37	12.30	8.48	9.36	5.48	12.59
t值		-2.85	-3.62	-2.84	-10.72	-6.26	-5.37	-4.82	-5.26	-4.92	-6.05
P值		<0.05	<0.05	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<0.01	<0.05
注：条目1、2、3、4、5、6、7、8、9、10、11、12、13、14、15、16、17、18、19、20分别为完成较简单的活动（如玩扑克牌或玩橡皮泥）；完成需要一些力量的活动（如使用锤子或拍手鼓）；患手力量如何；患手完成精细动作（如捡豆子或套杯子）时的情况如何；患手进行一般活动（如吃饭、穿衣、洗漱）时的情况如何；拧开盖紧的杯子盖；拿购物袋或箱子；系衣服上的扣子；使用筷子吃饭；用笔写字；我对手的外观不满意；手部瘢痕处皮肤与正常皮肤相比，颜色如何；手部瘢痕处组织与正常组织相比，僵硬度如何；手部疼痛程度如何；手部瘙痒程度如何；手部烧伤对您的正常生活有怎样的影响；手部烧伤对您与家人和朋友之间的社交活动有怎样的影响；手部烧伤使我不自信；由于手部烧伤我感觉自己很没用；一想到手部烧伤我就很沮丧

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表3 344例手部烧伤患者采用中文版手部烧伤结局评估工具评估的内容及各因子载荷量值矩阵

维度	条目	因子1的载荷量值	因子2的载荷量值	因子3的载荷量值
手部一般活动	1.完成较简单的活动（如玩扑克牌或橡皮泥）	0.795	0.153	0.051
	2.完成需要一些力量的活动（如使用锤子或拍手鼓）	0.824	0.164	0.048
	3.患手力量如何	0.879	0.037	0.135
	4.患手完成精细动作（如捡豆子或套杯子）时的情况如何	0.820	0.233	0.072
	5.患手进行一般活动（如吃饭、穿衣、洗漱）时的情况如何	0.754	0.059	0.029
手部特殊活动	6.拧开盖紧的杯子盖	0.838	0.138	0.078
	7.拿购物袋或箱子	0.836	0.036	0.092
	8.系衣服上的扣子	0.783	0.083	0.135
	9.使用筷子吃饭	0.821	0.021	0.151
	10.用笔写字	0.782	0.082	0.048
手部外观、瘢痕、疼痛和感觉	11.我对手的外观不满意	0.203	0.831	0.115
	12.手部瘢痕处皮肤与正常皮肤相比，颜色如何	0.257	0.775	0.191
	13.手部瘢痕处组织与正常组织相比，僵硬度如何	0.137	0.636	0.092
	14.手部疼痛程度如何	0.053	0.882	0.081
	15.手部瘙痒程度如何	0.330	0.794	0.129
手部烧伤对生活、社交和情绪的影响	16.手部烧伤对您的正常生活有怎样的影响	0.105	0.036	0.763
	17.手部烧伤对您与家人和朋友之间的社交活动有怎样的影响	0.177	0.055	0.826
	18.手部烧伤使我不自信	0.028	0.105	0.787
	19.由于手部烧伤我感觉自己很没用	0.163	0.037	0.921
	20.一想到手部烧伤我就很沮丧	0.164	0.028	0.863
特征值		11.301	9.595	6.837
累计方差贡献率（%）		41.324	18.605	16.233
注：条目1、2填表说明为：请您根据过去1周的活动情况回答，条目3~5填表说明为下列问题与患手相关，若双手均烧伤，依据严重的一侧回答：条目6~10填表说明为请您根据过去1周的活动情况回答：条目11~15填表说明为：请根据患手情况回答问题，若双手均烧伤，依据严重的一侧回答，条目16、17填表说明为：请您根据过去4周的活动情况回答，条目18~20填表说明为：请您根据过去1周的活动情况回答；因子1、2、3分别为手部活动、手部感受、手部影响

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