The Clinic Application Of Chinese Version Of Inflammatory Bowel Disease Questionnaire

BackgroundHealth related quality of life (HRQOL), a subjective quantitative measure of health perception and function, embaces not only the physical but also emotional and social domain. Inflammatory bowel disease (IBD) is a chronic disease of gastrointestinal system which mainly affects young people, including ulcerative colitis (UC) and Crohn's disease (CD). IBD is punctuated by relapses and remissions. With long term of bowel symptoms and systemic symptoms, patients' emotion and social function is also affected. There are a lot of recent researches on HRQOL of IBD patients in abroard. Among them, the design of questionnaires, especially the disease specific questionnaire is an important content. Several disease specific questionnaires exist now, among them, the inflammatory bowel disease questionnaire (IBDQ) authored by Dr Irvine is the most widely used. Also, its reliability and validity evaluation is the most complete. IBDQ have been translated and validated into several languages, and its validated versions also showed good reliability and validity. Only Leong et al validated IBDQ into Hongkong Chinese in 2003 in China. Because of the difference in area, economy and culture, the Hongkong Chinese version is not suitable for mainland people. The incidence of Chinese mainland IBD is increasing rapidly in recent years. There are many IBD patients in China, and their quality of life remains unknow. Validate the mainland Chinese version of IBDQ, evaluate the mainland Chinese IBD patients' HRQOL is really necessary.ObjectivesCooperating with the original author of IBDQ-Dr Irvine, to validate the Chinese version IBDQ, to measure its validity, discriminant ability, reliability and sensitivity to change so as to understand its feasibility in China;to investigate 92 consecutive IBD patients of inpatient department and outpatient department in one of the comprehensive hospitals in Zhejiang Province from April, 2005 to December, 2005 and assess their HRQOL level;to compare the HRQOL of UC patients to CD patients;to compare the result of this study to the norm of SF-36 in Hangzhou and other silimar studies abroad to find whether there is difference;to explore the impact of patients' demographic data, disease data and history of medicine taking on the HRQOL so as to provide scientific basis for improving nursing care and treatment.MethodsTranslated and adapted the Chinese IBDQ according to the standard procedure and regulations provided by Dr Irvine. 92 consecutive Chinese IBD patients (UC 52, CD 40) were chosen from inpatient and outpatient department from April 2005 to December 2005. They were asked to fill out 3 questionnaires: patient general information (including demographic data and disease related data), general HRQOL questionnaire-Chinese version of SF-36 and disease specific HRQOL questionnaire-Chinese version of IBDQ (to investigate patients' HRQOL). Asked patients to evaluate their present disease status as remission, mild, medium, and severe. At the meantime, evaluated the UC and CD patients' disease acitivity index (DAI) using walmsley simple clinical colitis activity index (CAI) and Harvey-Bradshow simple index of Crohn's disease activity (CDAI) respectively. Re-investigated these patients with Chinese IBDQ and re-evaluated their DAI after two weeks to two months of the first investigation. Correlation analysis was made between the two measures of IBDQ, DAI and self evaluation of disease status so as to measure the validity, reliability, discriminant ability and responsiveness. Compared the result of SF-36 of IBD patients to the norm of Hangzhou citizen to find whether there was difference;Compared the results of IBDQ of IBD patients to other countries' similar results to find whether there was difference. Multivariate backward regression analysis was made to explore the influence of demographic data, disease data and history of medicine taking on patients' HRQOL.ResultsAll together there were 92 IBD patients participate the HRQOL investigation and DAI evaluation, and 71 finished a second time.The face validity of Chinese IBDQ was vey good. Factor analysis produced 4 main domains, basically conformed to the theory model. The score of IBDQ correlated with SF-36 score (Pearson: r=0.58-0.84) and DAI (Pearson: r=-0.55-0.75) significantly. Except for bowel domain in CD patients, the correlation of patients' self-evaluation of disease status was also significant with IBDQ score. Except for domains of bodily pain, role emotional and physical funtion of SF-36 correlated less well (<0.50) with emotional and social function domain of IBDQ, other results all conformed to the theory model. In evalation of content validity of Chinese IBDQ, 32 items correlated well with their own domain (>0.40) and these correlations were much better than with other domains. Convergent validity tests and discriminating validity test were 100% and over 80% successful rate respectively. Except for the bowel domain in CD patients, the Chinese IBDQ could discriminate patients with different serious levels according to DAI and self-evaluation. The Chinese IBDQ showed good internal consistency (every Cronbach a of 4 dimensions > 0.70). The Cronbach a of IBDQ in UC and CD was 0.95 and 0.94 respectively. The test-re-test reliability was 0.74-0.87 in UC and 0.53-0.81 in CD (P<0.05). The split half reliability was 0.89 and 0.94 in UC and CD respectively, which showed that the Chinese IBDQ was stable. Except for social domain in UC patients, the Chinese IBDQ was also sensitive to change of DAI (P<0.01), which indicated its good responsiveness.The IBDQ score of 92 IBD patients ranged from 68.0 to 217.0, mean score 177.0 ±29.7. The IBDQ score were 175.6+29.7 and 178.8±29.9 in UC and CD patients respectively, no statistics difference was found between the two (P>0.05). Compared tothe norm of SF-36 of Hangzhou, 5 of 8 domains' score of IBD patients decreased significantly (P<0.05), especially the mental health dimension of CD patients. The multivariate backward regression analysis showed that more than 20 factors could influence the IBDQ score. Among them, DAI, disease duration, history of smoking, history of drinking, history of medicine taking were the important ones, which influenced several domains at different degree. DAI was the most important factor.Conclusions1. The application of Chinese IBDQ in evaluating the Chinese mainland IBD patients was feasible. The reliability, validity and responsiveness were good. The IBDQ can reflect IBD patients HRQOL through the dimensions of bowel symptom, systemic symptom, emotional function and social function.2. The HRQOL of IBD patients were decreased, and the relapse patients decreased more than the remission patients. The HRQOL of UC patients had no statistics difference with CD patients'. Compared with the norm of SF-36 in Hangzhou, 5 of 8 domains' score decreased, especially the mental health dimension of CD patients, and the difference was statistics significant.3. Many factors could influence the HRQOL of IBD patients such as DAI, pre diagnosis smoking history, post diagnosis smoking history, IBD clinic visiting times in the past 6 months, disease duration, history of taking cortisone or traditional Chinese medicine. Each factor influenced the HRQOL differently, and DAI was the most important factor. Pay attention to patient's DAI, promote the remission of disease by all kinds of methods could improve patients' quality of life.4. When taking care of IBD patients, we should not only concern about the physical problem, but also emotional, social and economic problems. Nurses should try their best to find out the influence factors of HRQOL of IBD patients, especially those changeable one, then, take appropriatel actions to improve patients' quality of life.