康复护理日常生活活动评定量表的信度和效度研究

背景在康复医学中有许多种日常生活活动(ADL)能力评定量表,但符合康复护理程序的评定量表甚少.为此,浙江省康复中心从2000年开始研究设计了康复护理ADL(rehabilitative nursing ADL,RNADL)评定量表,并制定了评定内容和评定标准.目的探讨康复护理ADL评定量表在患者日常生活活动功能评测中的重测信度、内部一致性及量表的有效信度.设计重复测量设计.单位浙江省望江山疗养院,浙江省康复中心.对象2001-04/2003-04浙江省望江山疗养院康复医学科进行康复治疗的ADL功能障碍的40例患者.方法对40例住院康复患者用RNADL量表进行评测者内部、评测者之间的信度分析;内部一致性用Cronbach α计算;并分别用RNADL和改良的Barthel指数(MBI)进行出、入院各项目评定,用Pearson分析入院、出院及出入院之间的相关性.主要观察指标RNADL评定量表的信度和效度检测结果.结果RNADL评测者内部和评测者之间的信度良好,各项组内相关系数(ICC)范围为0.966～0.998,r=0.996～0.997;内部一致性信度系数α=0.822,各项之间α=0.925,RNADL内部一致性较好.RNADL和MBI的比较研究得出出、入院RNADL与MBI改变值间相关性良好(r=0.89,P＜0.001).结论RNADL具有很高的重测信度,内部一致性较好,与MBI有良好的关联效度,是康复护理日常生活活动能力可信、有效的评测量表.

Reliability and validity of rating scale on rehabilitative nursing in activities of daily living

BACKGROUND: There were many evaluation scales on activities of daily living(ADL) in rehabilitation medicine, but scale according with rehabilitative nursing programs was less. Therefore, a rehabilitative nursing ADL(RNADL) evaluation scale was studied and designed by the Rehabilitation Center of Zhejiang Province from 2000, and the evaluation content and standard were instituted as well.OBJECTIVE: To make an exploratory discussion of the re-measurement reliability, internal concordance, and reliability of rehabilitative nursing ADL evaluation scales in the assessment of patients' ADL.DESIGN: Design of repeated-measurement.SETTING: Wangjiangshan Convalescent Hospital, Zhejiang Province. Rehabilitation Center, Zhejiang Province.PARTICIPANTS: Forty disordered ADL patients, received rehabilitation care in the Rehabilitation Medical Department of Wangjiangshan Convalescent Hospital, Zhejiang Province from April 2001 to April 2003.METHODS: Intra-rater agreement and inter-rater reliability were undertaken by nurses in 40 residential rehabilitative patients with RNADL scale. Internal concordance was calculated with Cronbach α; evaluation of each item of discharge and admission was performed with RNADL and modified Barthel index(MBI), and then the correlation of admission, discharge and their relationship were analyzed with Pearson.MAIN OUTCOME MEARSURES: Results of reliability and validity detected with the RNADL scale.RESULTS: Reliability of RNADL, intra-rater and inter-rater, was good;each interclass coefficient correlation (ICC) was within 0. 966 -0. 998, r= 0. 996 - 0. 997; The index of intra-rater agreement α = 0. 822; and that of inter-rater reliability α = 0. 925, RNADL internal concordance was good.Comparative study on RNADL and MBI showed that RNADL and MBI changes in discharge and admission had a good dependability( r = 0. 89, P ＜ 0. 001 ).CONCLUSION: RNADL has a high re-measurement reliability, and its internal concordance is good. It has a good correlative validity with MBI, and is a confident and valid scale for the evaluation of rehabilitative nursing ADL.