中医整体观下中医卒中后失语患者报告结局量表研制

doi:10.3969/j.issn.1006-9771.2021.00.004

《中国康复理论与实践》 ›› 2021, Vol. 27 ›› Issue (11): 1356-1364.doi: 10.3969/j.issn.1006-9771.2021.00.004

• 标准与规范 • 上一篇

中医整体观下中医卒中后失语患者报告结局量表研制

舒鑫¹,董兴鲁¹,郝晓晖¹,卫冬洁²,黄幸¹,李晓琳¹,徐敏杰¹,李昌明¹,孔乔¹,黄佳钦¹,刘孟宇³,常静玲¹()

1.北京中医药大学东直门医院神经内科,北京市 100700
2.中国康复研究中心北京博爱医院听力语言科,北京市 100068
3.中国中医科学院中医临床基础医学研究所,北京市 100700

收稿日期:2020-06-12 修回日期:2021-05-17 出版日期:2021-11-25 发布日期:2021-12-03
通讯作者: 常静玲 E-mail:ear6979@163.com
作者简介:舒鑫(1993-),女,汉族,河南信阳市人,硕士研究生,主要研究方向：中医药防治脑血管病。
基金资助:
1.国家自然科学基金面上项目(81973790);2.国家公益性中医药行业科研专项(201407001-9);3.北京市自然科学基金重点项目(7181005)

Development of A Patient-reported Outcomes Scale for Post-stroke Aphasia Based on Traditional Chinese Medicine Holism

SHU Xin¹,DONG Xing-lu¹,HAO Xiao-hui¹,WEI Dong-jie²,HUANG Xing¹,LI Xiao-lin¹,XU Min-jie¹,LI Chang-ming¹,KONG Qiao¹,HUANG Jia-qin¹,LIU Meng-yu³,CHANG Jing-ling¹()

1. Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing 100700, China
2. Department of Speech and Hearing Therapy, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing 100068, China
3. Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing 100700, China

Received:2020-06-12 Revised:2021-05-17 Published:2021-11-25 Online:2021-12-03
Contact: CHANG Jing-ling E-mail:ear6979@163.com
Supported by:
National Natural Science Foundation of China(General)(81973790);National Public Welfare Scientific Research of Traditional Chinese Medicine Special Project(201407001-9);Beijing Natural Science Foundation(7181005)

摘要/Abstract

摘要：

目的研制中医整体观指导下的卒中后失语患者报告结局(PRO)量表。方法根据PRO量表研制规范,参考中医整体观,构建理论模型;通过病例回顾法、患者访谈法、专家问卷调查法、共识会议法,建立并优化条目池,编制量表。结果围绕生理、心理、社会领域,构建基于中医整体观的条目池。通过对条目池整理,形成专家评议表。结合专家调查和会议讨论结果,最终筛选出40项条目,形成中医卒中后失语患者报告结局量表(第一版)。结论构建了基于中医整体观的中医卒中后失语患者报告结局量表,可供进一步临床验证。

关键词: 脑卒中, 卒中后失语, 中医, 整体观, 患者报告结局, 量表开发

Abstract:

Objective To develop a patient-reported outcomes (PRO) scale for post-stroke aphasia based on the Traditional Chinese Medicine (TCM) holism.Methods Referring to the TCM holism, the theoretical model was established following the standard process for the development of the PRO scale. An item pool was established and optimized with case review, patient interview, expert questionnaire survey and consensus conference. The PRO scale was established finally.Results A pool of post-stroke aphasia items based on the holistic view of TCM was constructed in the physical, psychological and social model. The Expert Comment Form for the PRO Scale for Aphasia after Stroke was formed after sorting out the item pool. After expert surveys and meeting discussion, 40 items were finally selected to form the first version of Patient-reported Outcomes Scale for Post-stroke Aphasia-TCM.Conclusion The first version of Patient-reported Outcomes Scale for Post-stroke Aphasia-TCM has been developed based on the TCM holism and the concept of PRO, which can be evaluated clinically.

Key words: stroke, post-stroke aphasia, Traditional Chinese Medicine, holism, patient-reported outcomes, scale development

舒鑫,董兴鲁,郝晓晖,卫冬洁,黄幸,李晓琳,徐敏杰,李昌明,孔乔,黄佳钦,刘孟宇,常静玲. 中医整体观下中医卒中后失语患者报告结局量表研制[J]. 《中国康复理论与实践》, 2021, 27(11): 1356-1364.

SHU Xin,DONG Xing-lu,HAO Xiao-hui,WEI Dong-jie,HUANG Xing,LI Xiao-lin,XU Min-jie,LI Chang-ming,KONG Qiao,HUANG Jia-qin,LIU Meng-yu,CHANG Jing-ling. Development of A Patient-reported Outcomes Scale for Post-stroke Aphasia Based on Traditional Chinese Medicine Holism[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(11): 1356-1364.

图/表 2

表1

表2

卒中后失语条目池"

领域	条目
生理领域
语言认知	1. 您是否感到说话不流利? 2. 您感觉说话量较前增多还是减少? 3. 您感觉语速较前有何改变? 4. 您是否感觉自己说话声音减弱? 5. 您是否感觉说话含糊不清? 6. 您有语言重复的现象吗? 7. 您有找词困难的情况吗? 8. 您有经常说错词的情况吗? 9. 您是否感觉别人理解不了或错误理解自己说的话? 10. 您是否感到理解不了或理解错别人说的话? 11. 您是否感觉复述有些困难? 12. 您是否感觉自己阅读时,理解不了文章的意思? 13. 您是否有看不懂图画意思的情况? 14. 您是否感觉之前可以写的字句,现在写不出来? 15. 您感觉计算力有下降吗? 16. 您是否感觉自己记忆力有所下降? 17. 您是否有分不清自己在哪里的情况? 18. 您是否记有分不清时间的情况(例如分不清现在是哪季节)?
躯体症状	19. 您最近感觉自己面色如何? 20. 您是否感觉到困倦乏力? 21. 您白天经常汗出吗? 22. 您是否感到肢体麻木不适? 23. 您有便秘吗? 24. 您有口干吗? 25. 您小便色深黄吗? 26. 您夜里睡觉时出汗吗? 27. 您吃饭有食欲吗? 28. 您饮食有减少吗? 29. 您有入睡困难吗? 30. 您睡眠容易醒吗? 31. 您多梦吗? 32. 您是否感觉睡眠较浅? 33. 您大便黏滞不爽(大便解不尽感、粘连便池难冲)吗?
心理领域	34. 您脾气急躁易怒吗? 35. 您有低落抑郁的情绪吗? 36. 您感觉生活充实、美好吗? 37. 您情绪是否容易波动(时而愤怒、时而悲伤)? 38. 您会因病情而焦虑不安吗?
社会领域	39. 个人生活是否可完全自理? 40. 您是否能完成日常工作? 41. 失语有影响您和朋友、邻居的关系吗? 42. 失语影响您的娱乐活动(如逛商场、爬山、骑行等)吗? 43. 您能够得到社会医疗体系的支持(如医保报销、社区医疗服务、下乡义诊)吗? 44. 您的生活是否能得到社会上他人的帮助?

表2

参考文献 33

[1]	STEFANIAK J D, HALAI A D, LAMBON RALPHA M A. The neural and neurocomputational bases of recovery from post-stroke aphasia[J]. Nat Rev Neurol, 2020, 16(1):43-55. doi: 10.1038/s41582-019-0282-1
[2]	CONROY P, SOTIROPOULOU D C, HUMPHREYS G F, et al. Time for a quick word? The striking benefits of training speed and accuracy of word retrieval in post-stroke aphasia[J]. Brain, 2018, 141(6):1815-1827. doi: 10.1093/brain/awy087
[3]	GUINA J, GUINA C. Wants talk psychotherapy but cannot talk: EMDR for post-stroke depression with expressive aphasia[J]. Innov Clin Neurosci, 2018, 15(1-2):45-48.
[4]	WILSON S M, ERIKSSON D K, SCHNECK S M, et al. A quick aphasia battery for efficient, reliable, and multidimensional assessment of language function[J]. PLoS One, 2018, 13(2):e0192773. doi: 10.1371/journal.pone.0192773
[5]	BARROWS P D, THOMAS S A. Assessment of mood in aphasia following stroke: validation of the Dynamic Visual Analogue Mood Scales (D-VAMS)[J]. Clin Rehabil, 2018, 32(1):94-102. doi: 10.1177/0269215517714590
[6]	田凤霞. 中文版脑卒中后失语症生活质量量表的信度和效度研究[J]. 护理实践与研究, 2020, 17(4):10-12.
	TIAN F X. Study on reliability and validity of scale of Chinese version aphasia quality of life after stroke[J]. Nurs Prac Res, 2020, 17(4):10-12.
[7]	KRISTINSSON S, HALLDORSDOTTIR T H. Translation, adaptation and psychometric properties of the Icelandic Stroke and Aphasia Quality of Life Scale-39g[J]. Scand J Caring Sci, 2021, 35(1):244-251. doi: 10.1111/scs.v35.1
[8]	LAWTON M, CONROY P, SAGE K, et al. Aphasia and Stroke Therapeutic Alliance Measure (A-STAM): development and preliminary psychometric evaluation[J]. Int J Speech Lang Pathol, 2019, 21(5):459-469. doi: 10.1080/17549507.2019.1648551
[9]	VALSANGKAR N, FERNANDEZ F, KHULLAR O. Patient reported outcomes: integration into clinical practices[J]. J Thorac Dis, 2020, 12(11):6940-6946. doi: 10.21037/jtd
[10]	PHILLIPS L, CARSEN S, VASIREDDI A, et al. Use of patient-reported outcome measures in pediatric orthopaedic literature[J]. J Pediatr Orthop, 2018, 38(8):393-397. doi: 10.1097/BPO.0000000000000847
[11]	张珺, 沈毅, 卞卫和, 等. 乳腺癌中医PRO调查问卷的研究[J]. 南京中医药大学学报, 2011, 27(3):295-297.
	ZHANG J, SHEN Y, BIAN W H, et al. Research on the design of Primary TCM PRO Questionnaire for Breast Cancer[J]. J Nanjing Med Univ, 2011, 27(3):295-297.
[12]	于长禾, 张英, 万颖, 等. 基于结局指标重要性和中医药代表性构建中医临床疗效评价指标体系[J]. 中华中医药杂志, 2021, 36(3):1238-1243.
	YU C H, ZHANG Y, WAN Y, et al. Construction of evaluation index system of TCM clinical efficacy based on importance of outcome assessment and representativeness of TCM treatment[J]. Chin J Tradit Chin Med Pharm, 2021, 36(3):1238-1243.
[13]	张艳宏, 刘保延, 何丽云, 等. "基于中风痉挛性瘫痪患者报告的临床结局评价量表"性能评价的初步研究[J]. 中国中医药信息杂志, 2011, 18(2):18-21.
	ZHANG Y H, LIU B Y, HE L Y, et al. Preliminary study on performance evaluation of "Self-Evaluating Instrument Based on Patient Reported Outcome for Apoplexy Spastic-Paralysis Patients"[J]. Chin J Inform Tradit Chin Med, 2011, 18(2):18-21.
[14]	王雪飞, 刘强, 钟海珍, 等. 基于中风病患者报告的结局评价量表(初稿)的研制过程[J]. 中华中医药杂志, 2012, 27(2):292-295.
	WANG X F, LIU Q, ZHONG H Z, et al. Development process of patient-reported outcome draft scale of stroke[J]. Chin J Tradit Chin Med Pharm, 2012, 27(2):292-295.
[15]	World Health Organization. International Classification of Functioning, Disability and Health: ICF[M]. Geneva: World Health Organization, 2001.
[16]	HELMS E, WETZEL E, WEIERSTALL R. Development and validation of the Subclinical Stress Symptom Questionnaire SSQ-25[J]. Nervenarzt, 2017, 88(9):1050-1057. doi: 10.1007/s00115-016-0181-2
[17]	王海舻, 马淑然, 黄晓楠, 等. 季节性情感障碍研究进展综述[J]. 环球中医药, 2019, 12(2):307-314.
	WANG H L, MA S R, HUANG X N. Review of seasonal affective disorder[J]. Global Tradit Chin Med, 2019, 12(2):307-314.
[18]	吴寒斌, 高虹. 现代化国际化背景下中医思维特色刍议[J]. 中华中医药杂志, 2018, 33(1):30-32.
	WU H B, GAO H. Discussion on special thinking mode of TCM under the background of modernization and internationalization[J]. Chin J Tradit Chin Med Pharm, 2018, 33(1):30-32.
[19]	柳金英, 王爱琴, 常静玲. 脑卒中后失语诊疗中的形神思维构建与探索[J]. 环球中医药, 2016, 9(7):837-839.
	LIU J Y, WANG A Q, CHANG J L. Construction and exploration of form-spirit thinking in diagnosis and treatment of aphasia after stroke[J]. Global Tradit Chin Med, 2016, 9(7):837-839.
[20]	王琦. 形神一体的形神观[J]. 中华中医药杂志, 2012, 27(3):652-654.
	WANG Q. View of body-spirit syncretism[J]. Chin J Tradit Chin Med Pharm, 2012, 27(3):652-654.
[21]	张晟, 陈月. 中医患者报告结局量表的研究现状[J]. 中华中医药杂志, 2018, 33(3):1026-1029.
	ZHANG S, CHEN Y. Research status of patient reported outcome scale of Traditional Chinese Medicine[J]. Chin J Tradit Chin Med Pharm, 2018, 33(3):1026-1029.
[22]	车艳娇, 庞立健, 吕晓东, 等. 中医生活质量量表方法学科学研究思路[J]. 中华中医药杂志, 2020, 35(3):1051-1056.
	CHE Y J, PANG L J, LÜ X D, et al. Scientific research thinking of quality of life scale methodology in Traditional Chinese Medicine[J]. Chin J Tradit Chin Med Pharm, 2020, 35(3):1051-1056.
[23]	刘健, 汪元. 基于中医整体观思想的痹病学科科技创新模式探讨[J]. 中医药管理杂志, 2013, 21(1):27-30.
	LIU J, WANG Y. Discussion on scientific and technological innovation mode of arthralgia: disease subject based on holistic view of Traditional Chinese Medicine[J]. J Tradit Chin Med Manage, 2013, 21(1):27-30.
[24]	吕小红, 赵新华, 谭虹虹, 等. 肿瘤患者护理病历质量分析与管理对策[J]. 现代医药卫生, 2019, 35(8):1232-1235.
	LÜ X H, ZHAO X H, TAN H H, et al. Quality analysis and management strategy of nursing records for cancer patients[J]. J Mod Med Health, 2019, 35(8):1232-1235.
[25]	王爱琴, 常静玲. 脑卒中后失语的语言功能中西医评价方法探讨[J]. 中华中医药杂志, 2014, 29(9):2899-2902.
	WANG A Q, CHANG J L. Discussion on the function of post-stroke aphasia language evaluation in TCM and western medicine[J]. Chin J Tradit Chin Med Pharm, 2014, 29(9):2899-2902.
[26]	汪凯, 董强, 郁金泰, 等. 卒中后认知障碍管理专家共识2021[J]. 中国卒中杂志, 2021, 16(4):376-389.
	WANG K, DONG Q, YU J T, et al. Experts Consensus on Post-stroke Cognitive Impairment Management 2021[J]. Chin J Stroke, 2021, 16(4):376-389.
[27]	EI HACHIOUI H, VISCH-BRINK E G, LINGSMAH F, et al. Nonlinguistic cognitive impairment in poststroke aphasia: a prospective study[J]. Neurorehabil Neural Repair, 2014, 28(3):273-281. doi: 10.1177/1545968313508467
[28]	刘鑫鑫, 马艳玲, 刘艳君, 等. 卒中后失语患者非语言认知功能损害特点的临床研究[J]. 中国卒中杂志, 2019, 14(2):116-120.
	LIU X X, MA Y L, LIU Y J, et al. Clinical study of non-linguistic cognitive impairment in patients with post-stroke aphasia[J]. Chin J Stroke, 2019, 14(2):116-120.
[29]	FORKEL S J, CATANI M. Lesion mapping in acute stroke aphasia and its implications for recovery[J]. Neuroquantology, 2018, 115:88-100.
[30]	黄娇, 胡镜清, 江丽杰, 等. 基于中风病证相关患者报告结局测量量表的编制及初步考评[J]. 世界科学技术-中医药现代化, 2016, 18(5):813-820.
	HUANG J, HU J Q, JIANG L J, et al. Development and evaluation of the syndrome related instrument for patient reported outcome with the stroke[J]. Mod Tradit Chin Med Mater Med-World Sci Tech, 2016, 18(5):813-820.
[31]	ICD-11. Lancet, 2019, 393(10188):2275. doi: S0140-6736(19)31205-X pmid: 31180012
[32]	宋昭赫. 卒中后失语患者抑郁情绪特征比较[J]. 临床医药文献电子杂志, 2017, 4(57):11170-11172.
	SONG Z H. Comparison of depression emotion characteristics in patients with aphasia after stroke[J]. Electron J Clin Med Liter, 2017, 4(57):11170-11172.
[33]	杨亚男, 倪青, 张美珍. 患者报告结局纳入中医疗效评价体系的可行性及国内现状探析[J]. 环球中医药, 2019, 12(3):361-365.
	YANG Y N, NI Q, ZHANG M Z. Patient reported outcomes: feasibility of being subsumed the TCM efficacy evaluation system and domestic status[J]. Global Tradit Chin Med, 2019, 12(3):361-365.

维度	条目
核心症状	语言不利、语速减慢、语言不能、语言不清、语言重复、找词困难、错语、语声降低、命名困难、复述不行、书写不能、计算力下降、记忆力下降、理解力下降、定向力下降
全身症状	面色少华、麻木、纳差、乏力、口干、自汗、盗汗、寐差、便秘、大便黏滞
心理症状	烦躁、悲伤、易哭、焦虑、情绪不稳
社会症状	不愿与人交往、寡言少语

中医整体观下中医卒中后失语患者报告结局量表研制

Development of A Patient-reported Outcomes Scale for Post-stroke Aphasia Based on Traditional Chinese Medicine Holism

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 2

参考文献 33

相关文章 15

Metrics

本文评价

推荐阅读 0

[1]	林娜, 高菡璐, 卢惠苹, 陈燕清, 郑军凡, 陈述荣. 虚拟现实技术对脑卒中上肢功能影响的弥散张量成像研究[J]. 《中国康复理论与实践》, 2024, 30(1): 61-67.
[2]	王昊懿, 史亚伟, 鲁俊, 许光旭. 主观垂直感知障碍对脑卒中患者功能影响的回顾性研究[J]. 《中国康复理论与实践》, 2024, 30(1): 68-73.
[3]	陈珺雯, 陈谦, 陈程, 李淑月, 刘玲玲, 吴存书, 龚翔, 鲁俊, 许光旭. 改良八段锦身体活动对脑卒中患者心肺功能、运动功能和日常生活活动能力的效果[J]. 《中国康复理论与实践》, 2024, 30(1): 74-80.
[4]	胡永林, 马颖, 窦超, 陆安民, 江小鸽, 宋新建, 肖玉华. 肩部控制训练联合神经松动术对脑卒中偏瘫患者肩痛及上肢功能的效果[J]. 《中国康复理论与实践》, 2024, 30(1): 81-86.
[5]	王贺, 韩靓, 阚梦凡, 于少泓. 电刺激治疗脑卒中后肩手综合征有效性的系统评价与Meta分析[J]. 《中国康复理论与实践》, 2023, 29(9): 1048-1056.
[6]	孙藤方, 任梦婷, 杨琳, 王耀霆, 王红雨, 闫兴洲. 高压氧治疗联合重复外周磁刺激干预脑卒中患者踝运动功能和平衡能力的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 875-881.
[7]	王亚楠, 刘西花. 脑卒中偏瘫患者主观和客观平衡功能测量的相关性及预测效能[J]. 《中国康复理论与实践》, 2023, 29(8): 890-895.
[8]	王海云, 王寅, 周信杰, 何爱群. 基于“中枢-外周-中枢”理论的经颅直流电刺激结合针刺干预脑卒中患者中枢及上肢功能的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 919-925.
[9]	陈怡婷, 王倩, 崔慎红, 李映彩, 张思鈺, 魏衍旭, 任慧, 冷军, 陈斌. 双侧序贯重复经颅磁刺激干预脑卒中患者上肢运动功能的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 926-932.
[10]	李振亚, 孙洁, 郭鹏飞, 王光明. 脑卒中患者口期和咽期吞咽功能改变与误吸的相关性：基于电视透视吞咽检查[J]. 《中国康复理论与实践》, 2023, 29(8): 933-939.
[11]	华玲, 张一楠, 郑玉, 孙俏仪, 房辉, 宋达. 手控节律音乐治疗对脑卒中后单侧空间忽略的效果[J]. 《中国康复理论与实践》, 2023, 29(7): 833-838.
[12]	蒋孝翠, 刘臻, 苏清伦, 赵秦, 夏晓昧, 陆飞. 间歇性Theta节律经颅磁刺激对脑卒中后非流利性失语的影响[J]. 《中国康复理论与实践》, 2023, 29(7): 839-843.
[13]	唐强, 郑爽, 王蕾, 王艳, 李保龙, 刘贵军, 朱路文. 基于世界卫生组织康复胜任力架构的中医康复学专业课程开发研究[J]. 《中国康复理论与实践》, 2023, 29(7): 862-868.
[14]	许苗苗, 李楠, 应颖, 杨凯翔, 杨婧瑞, 李杰, 邱彦群. 重复外周磁刺激对左右颈7神经交叉移位术后脑卒中患者上肢运动功能的效果[J]. 《中国康复理论与实践》, 2023, 29(6): 686-690.
[15]	郑莉, 鲍治诚, 张琪, 任绪艳, 苏敏. 经皮耳迷走神经电刺激结合康复机器人训练对脑卒中患者上肢功能的效果[J]. 《中国康复理论与实践》, 2023, 29(6): 691-696.