BACKGROUND: Patients often have cough after lung surgery, and there is a lack of tools to specifically assess postoperative coughs. LCQ-MC (Leicester Cough Questionnaire in Mandarin-Chinese) was revised and validated to explore its value on clinical application. METHODS: A total of 250 patients undergone the lung operation of single medical team, from September 2015 to December 2016 in the Department ofThoracic Surgery, West China Hospital, Sichuan University, were investigated. Among them, 121 patients completed LCQ-MC and 129 patients completed simplified LCQ-MC, we verified the reliability and validity. RESULTS: The new questionnaire was not changed in terms of content layout and the scoring method of LCQ-MC, consisting of 12 items and three domains (physical, psychological and social). There was good content validity (S-CVI/UA=0.83). Concurrent validity was high when the simplified LCQ-MC was compared with daytime cough symptom score (r=-0.578, P<0.001). There was a moderate relationship with response to night-time cough symptom score (r=-0.358, P=-0.004) and SF36 total score (r=0.346, P=0.030), and weak relationship with the Hospital Anxiety and Depression Scale total score (r=-0.241, P=0.046). Cronbach's alpha coefficients of simplified LCQ-CM total and three domains varied between 0.79 and 0.89. One week apart test-retest reliability (n=30) was high (r=0.88-0.96). CONCLUSIONS: Simplified LCQ-MC has good reliability and validity that can be used for clinical applications.
BACKGROUND:Patients often have cough after lung surgery, and there is a lack of tools to specifically assess postoperative coughs. LCQ-MC (Leicester Cough Questionnaire in Mandarin-Chinese) was revised and validated to explore its value on clinical application. METHODS: A total of 250 patients undergone the lung operation of single medical team, from September 2015 to December 2016 in the Department ofThoracic Surgery, West China Hospital, Sichuan University, were investigated. Among them, 121 patients completed LCQ-MC and 129 patients completed simplified LCQ-MC, we verified the reliability and validity. RESULTS: The new questionnaire was not changed in terms of content layout and the scoring method of LCQ-MC, consisting of 12 items and three domains (physical, psychological and social). There was good content validity (S-CVI/UA=0.83). Concurrent validity was high when the simplified LCQ-MC was compared with daytime cough symptom score (r=-0.578, P<0.001). There was a moderate relationship with response to night-time cough symptom score (r=-0.358, P=-0.004) and SF36 total score (r=0.346, P=0.030), and weak relationship with the Hospital Anxiety and Depression Scale total score (r=-0.241, P=0.046). Cronbach's alpha coefficients of simplified LCQ-CM total and three domains varied between 0.79 and 0.89. One week apart test-retest reliability (n=30) was high (r=0.88-0.96). CONCLUSIONS: Simplified LCQ-MC has good reliability and validity that can be used for clinical applications.
本研究共通过2个阶段构建改良LCQ-MC，阶段1：2015年9月-2016年4月共121例患者完成LCQ-MC，通过数据分析与咨询专家意见，进行以下修改：①合并意思相近条目；②删除容易造成混淆条目；③使条目语言更通俗易懂，最终形成14个条目3个维度的LCQ-MC1（Leicester Cough Questionnaire in Mandarin-Chinese version 1），具体详见附件1。阶段2：将LCQ-MC1以问卷的形式亲自送达给专家，请专家就每一个条目与胸外科肺部疾病患者术后咳嗽情况的关联性予以评分，评分标准为“1分=不相关，2分=弱相关，3分=较强相关，4分=非常相关”，并提出修改建议。共送达6份问卷，回收6份。根据专家打分情况及建议修改，最终形成12个条目3个维度的LCQ-MC2（Leicester Cough Questionnaire in Mandarin-Chinese version 2），具体详见附件2。2016年6月-2016年12月共129例患者完成LCQ-MC2。阶段3：患者出院1周后重复调查一次LCQ-MC2，要求1周内仍有咳嗽症状且未使用相关控制咳嗽的药物，完成重复调查30份并计算重测信度。
LCQ-MC2: Leister Cough Questionnaire in Mandarin-Chinese version 2; HADS: Chinese version of the Hospital Anxiety and Depression Scale; SF-36: Chinese version of the Medical Outcome Study 36-item Short-Form Healthy Survey.
Daytime cough symptom score
-0.597
-0.508
-0.390
-0.578
Nighttime cough symptom score
-0.372
-0.284
-0.216
-0.358
HADS total score
-0.126
-0.208
-0.257
-0.241
SF-36 total score
0.123
0.560
0.321
0.346
LCQ-MC2的标准关联效度Criterion-related validity of LCQ-MC2
Test-retest reliability of LCQ-MC2 (one week apart)
Birring et al.*
Gao et al. +
LCQ-MC2
*Patients with chronic cough; +Patients with non-cystic fibrosis bronchiectasis.
Physical
0.93
0.84
0.95
Psychological
0.90
0.82
0.81
Social
0.88
0.89
0.85
Total
0.96
0.89
0.88
1周后LCQ-MC2重测信度Test-retest reliability of LCQ-MC2 (one week apart)
讨论
外科手术后，患者常常出现不同程度的咳嗽，这可能与手术创伤、麻醉或者气管插管有关[。胸外科手术由于其手术与疾病的特殊性，术后出现的咳嗽几率较高且持续时间较长，有些甚至会演变成顽固性咳嗽，严重影响患者的术后康复与生活质量[。然而，胸外科缺乏能客观有效评估咳嗽的工具，不利于术后咳嗽的临床研究以及加速患者术后康复[。因此，研制一种适用于胸外科术后咳嗽的评估工具有重要临床意义。本研究所采用LCQ-MC，最早由Birring等于2003年创建，2009年由Wei等首次翻译为中文，2014年由Gao等正式翻译成普通话版使其更加符合中国人使用习惯；该量表由19个条目，社会、心理和社会3个维度组成，7个等级正项计分[。但是，国内关于LCQ-MC应用于胸外科的报道较少，本研究首次将LCQ-MC引入用于胸外科评估肺疾病患者术后咳嗽情况[。在本研究开始阶段，直接引用LCQ-MC用于调查肺部疾病患者术后咳嗽情况，通过临床实践中的问题与专家的建议将LCQ-MC初步修减为14个条目。在随后的验证阶段中，逐步将量表缩减为12个条目，得到最终版本的问卷。新问卷保留了LCQ-MC的结构与评分方式，并对语言进行了进一步优化，比如将原条目中的“2周内”，统一修改为“手术后”，使其更加适合外科使用。经过统计学验证后的新量表具有良好的信度与效度。效度分析主要通过内容效度与标准关联效度验证：内容效度指量表各条目是否测定其希望的内容，一般通过专家评议打分，新问卷的所有条目内容效度（I-CVI）均大于0.83，内容效度（S-CVI/UA）达到0.83，说明了其新量表的内容能较好地反映出肺部疾病患者术后的咳嗽情况[。标准关联效度选用了目前较为公认的三个评价工具加以比较，其中使用日间夜间症状咳嗽积分为中国2009年版咳嗽指南提供的简化版，但仅为专家共识，尚未经过严格验证；中文版HADS主要应用于综合医院患者中焦虑和抑郁的筛查，是目前临床上最常见的症状自评工具；中文版SF-36是全球应用最广的生命质量测试工具[。新量表总分与日间咳嗽症状积分强相关、夜间咳嗽症状积分中等相关，与SF-36总分中等相关；与HADS弱相关，说明新量表能较好地体现患者在生理和社会维度方面的健康变化情况，但是对于心理方面的变化较差，可能是由于心理维度由原来7个条目缩减为3个条目导致。信度分析主要通过内部一致性与重测信度验证：采用克朗巴赫α系数，计算出的值越高说明内部一致性越好，一般认为大于0.7就能说明有较好的信度，新问卷的总分和各维度克朗巴赫α系数介于0.71-0.84[。30例患者在出院后一周完成了重复调查，重测信度介于0.81-0.95，说明量表的重复性高[。本研究尚存在许多不足之处，不利简化中文版莱斯特咳嗽问卷在胸外科的推广。首先，简化中文版莱斯特咳嗽问卷调查对象为胸外科肺部疾病患者，未详细区分肺癌患者与非肺癌患者，在今后的研究中应将肺癌患者与非肺癌患者分开研究[。其次，由于样本量过少，未能计算最小临床差异值（minimal clinically important difference, MCID），亟需进一步的研究[。最后，对于是否继续沿用LCQ-MC的评分方式和三个维度还有待进一步讨论。综上所述，简化中文版莱斯特咳嗽问卷在胸外科的应用中取得了良好的效果，但是也存在一些不足之处，相信在未来的不断应用与改进中，新问卷能成为一种简洁、有效的咳嗽评估工具。
Authors: Christopher P Fagundes; Qiuling Shi; Ara A Vaporciyan; David C Rice; Keyuri U Popat; Charles S Cleeland; Xin Shelley Wang Journal: J Thorac Cardiovasc Surg Date: 2015-05-28 Impact factor: 5.209