| BACKGROUND:Health is a common goal pursued by people all over the world.The requirements and pursuits of health in human society are increasingly enthusiastic.Health evaluation,early identification of health and early intervention have always been the focus of discussion and research.Chinese medicine has obvious advantages in understanding health and giving timely intervention.Chinese medicine emphasizes that human health has different objective laws and characteristics at different stages of life,which fits the modern medical pursuit of the health in whole process of life.Many TCM scholars have made outstanding contributions to the study of health,such as the establishment of nine types of constitution criteria and the presentation of health status.The study review and summarize current state of research and current research result related to medical health status and health evaluation.Comparing those health evaluation scales and questionnaires widely used at home and abroad.Useliterature research to analyze the application of health assessmentscales on non-disease population health status evaluation in traditional Chinesemedicine.Provide reference for further health-related research with TCM characteristics.METHODS:1.Theoretical research:Review and organize a large number of literatures,tease out the origin and the development of the concept of health in health medicine area and categorize health-related research and achievement.2.Literature research:2.1 Scales comparative analysis:(1)Looked through and reviewed related literatures of health status evaluation,and reviewed the main reference scale in the literatures.At the same time,reviewed widely used health assessment scales of domestic and overseas.Selected 10 widely used scales.Simplify and standardize the items according to the relevant academic materials.(2)Re-classified all items into three dimensions as same as the definition of WHO:physical,psychological and socialdimension,and also add one dimension:overall self-evaluation.(3)Use the Microsoft Office Excel software 2010 to create scale items database and perform data entry.Use SPSS20.0 to analysis the distribution rule of all items.2.2 Scales application comparative analysis:(1)To search the related literatures from the database CNKI,WanFang Data,VIP and CBM by compute.Using the search strategy as below:Keyword= "scale" OR "questionnaire" AND "health evaluation" AND "TCM".Search all Chinese-language literature in the time range of Jan.1997 to Dec.2017.(2)Filter literatures according to established literature exclusion and inclusion criteria.(3)Import literatures into Note Express 2.0 Software for Document Management and use Microsoft Office Excel to conduct data extraction.(4)Process data and conduct information statistical analysis.RESULTS:1.Theoretical research:The meaning and content of health are constantly changing with the development of human society.People's understanding of health changed from survival,disease elimination to physical,mental,and social adaptation.The theory of traditonal Chinese medicine and many Chinese cultural traditions have included the comprehensive contents of the current Western medical understanding of health from the very beginning.The study of health-related concepts in TCM includes the exploration of concepts such as health,sub-health,and health status.Current assessments of health include studies of constitution,multiple dimensions of health,and studies of special populations.The means of checking the level of health has evolved from the initial traditional medical physical examination to the current genetic testing.Tools and methods for assessing health status have been extended from previous human tissue or trauma detection to many non-invasive measurement methods,such as health assessment scale.Data of health evaluation are integrated at the national level for more comprehensive application,such as establishing a national health index system to guide health work.2.Literature research:2.1 Scales comparative analysis:10 scales have been chosen:NHP(Nottingham Health Profile),CMI(Comell Medical Index),EQ-5D(European Quality of Life-5 Dimensions),SF-36(36-item Short Form Health Survey),WHOQOL-100(WHOQuality of Life 100),Wu-tai PersonalityQuestionnaire(hereafter called WTPQ),Sub-health StatusQuestionnaire(hereafter called SHSQ),TCM Constitution Scale(hereafter called TCMCS),Syndrome Element Health Information Questionnaire(hereafter called SEHIQ),SRHMS(Self-rated Health Measurement Scale).(1)Different scale items are distributed differently.?The scale with the largest items number is CMI,and the scale with the lowest total items number is EQ-5D with an average of 75.2 items of all 10 scales.?In every dimension,CMI has the largest itemsnumberin body dimension with 150 items.The smallest dimension items number is zero:the social dimension of CMI,the social dimension of SEHIQ,the social dimensions of SF-36,the social dimensions of ED-5D,the total evaluation dimensions of NHP,the body dimensions,social dimensions,and overall self-evaluation dimensions of WTPQ.?The proportion of the overall self-evaluation dimension,social dimension and body dimension items of foreign scales is higher than that of domestic scales;the proportion of mental dimension items of domestic scales is higher than that of foreign scales.(2)Physical dimensions:All scales evaluate physical conditions in several ways.Foreign scales often evaluate physical conditions through multiple aspects of indirect information,such as "self-care ability" and"physical activity ability".Domestic scalesare more accustomed to evaluate the physical status directly,such as "sleep status","excretory functions" are directly asking for specific physical conditions.After screening,233 physical items were filtered including 33 pain-related times.Except pain items,in all physical items,there are?2 physical items with frequency of occurrence above 3%:feel cold,sleep self-evaluation.?4 items with frequency between 2%?3%:palpitation,pharyngeal foreign body sensation,short of breath,dizziness?32 items with frequency between 1%?2%:insomnia,chest tightness,dry stool,poor quality of sleep,night sweats,stuffy nose,forgetfulness,etc.? 94 items with frequency below 1%:poor hearing,dry eyes,etc.(3)158 psychologicalitems were filtered,there are?2 items with frequency above 10%:depression,anxiety ? 4 items with frequencybetween5%?10/%:cognition,self-esteem confidence,nervousness,anger?19 items with frequencybetween 1%?5%:sensitiveness,stubbornness,happiness and happiness,pessimism,wide interest,vitality,etc.? 13 items with frequency below 1%:indifferent,subjective,dependent,etc.(4)71 social dimension items were filtered,there are?1 item with frequency above 10%:social support ? 11 items with frequencybetween 5%?10%:economic conditions,living environment,housing conditions,traffic conditions,access to medical services and social security,etc.?4items with frequency below 5%:family life,ability to handle,natural environment,role evaluation(5)The scoring method is based on quantitative grading score.?5 scales take 2-level grade system:SF-36,NHP,CMI,WTPQ,SEHIQ?5scales take 5-level grade system:SF-36,ED-5D,WHOQOL,SHSQ?2 scale use VAS:ED-5D and SRHMS(6)The language descriptions of foreign scales are more concrete,clear and easy to understand withwestern cultural characteristics.The language descriptions of domestic scales are insufficient colloquialization and unclear expression.2.2Scales application comparative analysis:A total of 849 articles were retrieved from CNKI,Wanfang,VIP,and CBM databases according to the predetermined search strategy.There were 227 articles coming from CNKI,65 articles from Wanfang,43 articles fromVIP,and 514 articles from CBM.Read every title of the literature and eliminate 125 documents that obviously do not fit the research content.724 articles were remained.77 literatures review and thinking literatures were excluded afterreading literature abstracts.Delete 115 duplicate documents.Finally,532 articles were obtained.Read the full text of 532 articles.According to exclusion criteria,delete incomplete or inaccurate documents,delete documents that do not clearly indicate the source of the scale and the name of the scale,delete documents with disease-specific scales or focus on certain aspects of healthscales in the literature.Then we have 225 articles.According to the content of the study,excluded the literature with the research population are patient.Finally 82 articles that met the criteria were included,including a total of 27 scales.(1)27 health evaluation scales were involved in 82 articles,including 66 journal articles,15 dissertations,and 1 conference paper.Fifteen articles were about the scale/questionnaire preparation,and 11 papers discussed the scale/questionnaire evaluation.Other 56 papers were related with scales application.(2)The number of publishing is showing an increasing trend,which has increased from 2005 to 2009.The amount of documents issued in 2010 was less than in 2009,but increase significantly in 2011.The number of published articles ranked the most in 2013 and 2014.After 2015,it has stabilized.The number of article publishing began increasing again in 2017.(3)The R&D institutions of the scale are mainly Chinese medicine institutions.The Chinese medicine institutions with 2 scales are:Southern Medical University(4/27),Guangzhou Medical University(3/27),China Academy of Chinese Medical Sciences(2/27),Shanghai University of Chinese Medicine(2/27)Beijing University of Chinese Medicine(2/27),Nanjing University of Chinese Medicine(2/27).(4)Top 5 scales with the reference frequency:TCMCS40.38%(42/104),SF-36 14.42%(15/104),SSS 7.69%(8/104),SHMS V1.0 3.85%(4/104),SHSQ2.88%(3/104),SHSQ-25 2.88%(3/104),HSTCM 2.88%(3/104),WHOQOL-BREF2.88%(3/104).(5)In the cross-sectional study(62/82),one of them used both methods:cross-sectional and non-randomized controlled studies.There are also randomized controlled trial(13/82)and self-controlled trial(6/82).The sample size of the study population ranged from 24 to 8,448.Among these articles,48articles' sample size are between 100 to 1000,and 22 articles with more than 1,000 sample sizes.12 articles were small sample studies which less than 100.(6)First authors came from 43 organizations and mainly are Chinese medicine universities.Seven organizations issued more than 3 articles:11 articles in Southern Medical University(13.41%),10 articles in Guangzhou University of Chinese Medicine(12.20%),9 articles in Beijing University of Chinese Medicine(10.98%),4 articles in Shanghai University of Traditional Chinese Medicine(4.88%),and 3 articles in China Academy of Chinese Medical Sciences(3.66%),3 articles(3.66%)from Nanjing University of Traditional Chinese Medicine and 3 articles(3.66%)from Tianjin University of Traditional Chinese Medicine.All these 7 organizations issued more than 50%of all these 82 articles(52.44%).(7)?Of the 42 articles in the TCMCS(including the English and Korean editions),4 articles are about the compilation and evaluation of the TCMCS(1 for the compilation of the English version,and 1 for the Korean version.All of them are dissertations)and 38 articles are research literatures which use TCMCS as a research tool.The vast majority of articles use scales to conduct cross-sectional surveys(26/38 articles),and one is a cross-sectional survey combine with randomized study,8 articles are randomized controlled trials,and 3 articles arepre-and post-control observation.?Among the 15 articles using SF-36,1 article used SF-36 as a validity standard to evaluate other scales.Randomized controlled studies were used in 4 articles.Five articles used pre-and post-control studies,and 5 were cross-sectional surveys to understand the basic health status of the population.The research population is broader,including the elderly,outpatient and physical examination center populations,community residents and college students,as well as police and military personnel.?Eight articles related to SSS.Among these,there 6 journal papers and 2 papers for dissertations with one dissertation involved the scale preparation process.Six cross-sectional epidemiological surveys were conducted.The study population consisted mainly are undergraduates.There are 2 randomized controlled trials with study population are hospital workers and university students.?SHMS V1.0 were applied in 4 articles(3 journal papers,1 dissertation).Two epidemiological cross-sectional survey methods were used and two randomized controlled trials were used.The research population comes from workers,teachers,students,civil servants,community residents,and physical examinations.?SHSQ appeared in three articles.The study population was community residents and employees of the unit.The research methods were cross-sectional surveys.SHSQ-25 involves 3 literatures with 1 cross-sectional study to study the health status of college students and 2 randomized controlled trials.The study population is a physical examination population.WHOQOL-BREF was mainly used as a measurement standard in 2 articles,and another one was used in randomized controlled trials.?The 4 scales were used twice in articles,and 15 scales were only applied once in these 82 articles.CONCLUSIONS:Through the statistics of domestic and international scales,it is found that the dimensions and items are distributed differently.The characteristics of foreign scales are the large numbers of items,and the proportion of social dimension items in the total number of items is relatively high.At the same time,the proportion ofpsychological dimension items inforeign scales accounts for a small differencewhich indicating that foreign scales pay same attention to the social environment and mentality.The health effects of the condition.The scoring methods adopted by foreign scales include two-level scores,five-level scores,and VAS.The combination of two scoring methods are commonly used.The language description of foreign language scales is more simple,clear,and colloquial.In the domestic scale items,there are more body dimension items and fewer social dimension items which indicating that the internal scale does not pay enough attention to the social dimensions.In terms of quantitative scores,the domestic scale used the same scoring method as foreign scales,but each domestic scale used only one scoring method.The language of domestic scales are often lack of clarity of expression and lack of colloquialization. |
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