原標(biāo)題：兒童RAPP問(wèn)卷—評(píng)估哮喘和鼻炎患者生活質(zhì)量的新工具
背景：RhinAsthma Patient Perspective（RAPP）是經(jīng)過(guò)驗(yàn)證的簡(jiǎn)短問(wèn)卷，用于評(píng)估合并性哮喘和鼻炎的成年患者的健康相關(guān)生活質(zhì)量（HRQoL），但尚無(wú)兒科版本。 
方法：兒童RAPP問(wèn)卷是通過(guò)將兒童鼻炎量表分為五個(gè)獨(dú)特的項(xiàng)目得出的。在基線（T0）和30天（T1）之后，對(duì)150例合并性哮喘（主要是間歇性或輕度持續(xù)性）和鼻炎的兒童（6-11歲）進(jìn)行了以下研究：兒童RAPP問(wèn)卷，兒童合并性哮喘和鼻炎問(wèn)卷，兒童哮喘生活質(zhì)量問(wèn)卷（PAQLQ，年齡>6歲），兒童鼻—結(jié)膜炎生活質(zhì)量問(wèn)卷（PRQLQ），兒童哮喘控制測(cè)試（CACT）、KiddyKindl®（6歲）或KidKindl®（年齡>6歲）和鼻癥狀視覺(jué)模擬量表（VAS）。最后一次就診時(shí)，實(shí)施全球變化評(píng)級(jí)（GRC）量表。研究已在中央注冊(cè)系統(tǒng)ClinicalTrials.gov（ID：NCT03276416）上注冊(cè)。  
結(jié)果：兒童RAPP調(diào)查問(wèn)卷能很好地再現(xiàn)哮喘兒童評(píng)分（相關(guān)系數(shù)在0.91～0.95之間）。兒童RAPP調(diào)查問(wèn)卷在臨床穩(wěn)定（GRC=0）的情況下表現(xiàn)出充分的收斂有效性（與PAQLQ、PRQLQ、CACT、KiddyKindl/KidKindl和VAS的絕對(duì)斯皮爾曼秩相關(guān)系數(shù)＞0.5）、內(nèi)部一致性（克朗巴哈系數(shù)＞0.70）、）、重復(fù)性（組內(nèi)相關(guān)系數(shù)在0.61和0.8之間）、判別效度（對(duì)哮喘控制狀態(tài)和鼻炎嚴(yán)重程度的敏感性）和對(duì)癥狀改善的敏感性（GRC>1）。最小重要差異（MID）為-20。地板效應(yīng)和天花板效應(yīng)的影響很小。兒童RAPP調(diào)查問(wèn)卷在較年幼的兒童（6-8歲）中也表現(xiàn)出良好的可用性。
結(jié)論：兒童RAPP調(diào)查問(wèn)卷是一份有效的五項(xiàng)問(wèn)卷，用于評(píng)估6-11歲伴有哮喘和鼻炎的兒童的生活質(zhì)量。雖然中重度哮喘患者需要進(jìn)一步的研究，但該工具在臨床試驗(yàn)和常規(guī)醫(yī)療實(shí)踐中對(duì)改善兒童呼吸道過(guò)敏的管理是有用的。


延伸閱讀
Clinical & Experimental Allergy
RAPP-children: a new tool for assessing quality of life in patients with asthma and rhinitis
DOI: 10.1111/CEA.13599 
Abstract:
Background: RhinAsthma Patient Perspective (RAPP) is a short, validated questionnaire for assessing health-related quality of life (HRQoL) in adult patients with comorbid asthma and rhinitis, while a paediatric version is still not available.
Methods: RAPP-children was derived by combining RhinAsthma-children subscales into five unique items. At baseline (T0) and after 30 days (T1), 150 children (6-11 years) with comorbid asthma (predominantly intermittent or mild persistent) and rhinitis were given the following: RAPP-children, RhinAsthma-children, Paediatric Asthma Quality of Life Questionnaire (PAQLQ, age >6 years), Paediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ), Childhood Asthma Control Test (CACT), KiddyKindl® (age 6 years) or KidKindl® (age >6 years), and a Visual Analogue Scale for nasal symptoms (VAS). At the final visit, a Global Rating of Change (GRC) scale was administered. The approved study was registered on the central registration system ClinicalTrials.gov (ID: NCT03276416).
Results: RAPP-children fairly reproduced RhinAsthma-children scores (concordance correlation coefficients between 0.91 and 0.95). RAPP-children showed adequate convergent validity (absolute Spearman’s rho larger than 0.5 with PAQLQ, PRQLQ, CACT, KiddyKindl/KidKindl, and VAS), internal consistency (Cronbach’s alpha >0.70), repeatability (intra-cluster correlation coefficient between 0.61 and 0.8) in the presence of clinical stability (GRC=0), discriminant validity (sensitivity to asthma control status and rhinitis severity), and sensitivity to symptom improvements (GRC>1). The minimal important difference (MID) was -20. Floor and ceiling effects were minimal. RAPP-children showed fair usability also in younger children (6-8 years).
Conclusion: RAPP-children is a valid, five-item questionnaire for assessing HRQoL in children aged 6 to 11 years with concomitant asthma and rhinitis. Although further investigation is required in moderate and severe asthmatics, this tool can be useful in clinical trials and in routine medical practice for improving the management of respiratory allergy in children.
First Author:
Salvatore Fasola
Correspondence:
Salvatore Fasola, Institute for Biomedical Research and Innovation, National Research Council, Palermo, Italy, Via Ugo La Malfa 153, 90146 Palermo, Italy.
All Authors:
Salvatore Fasolaa, Laura Montalbanoa, Giuliana Ferranteb, Giovanna Cilluffoa, Velia Maliziaa, Ilaria Baiardinic, Fulvio Braidod, Giovanni Viegia, Stefania La Gruttaa.
　　創(chuàng)建過(guò)敏性疾病的科研、科普知識(shí)交流平臺(tái)，為過(guò)敏患者提供專業(yè)診斷、治療、預(yù)防的共享平臺(tái)。