复旦中文版脑瘫幼儿手功能分级系统的信度和效度研究

摘要 目的：建立复旦中文版脑瘫幼儿手功能分级系统（Mini-MACS)的信度和效度。方法：以2017年10月至2017年11月在复旦大学附属儿科医院（我院）康复中心以及上海儿童康复合作群（8家单位）接受康复干预的1~4岁的脑瘫（CP）儿童为研究对象,排除有严重视觉和听觉障碍的CP儿童。通过分析现场操作评价和录像评价结果之间的关系确定Mini-MACS的重测信度;分析不同评估者间［主要照顾者、作业治疗师（OT师）、物理治疗师（PT师）］的评价结果确定Mini-MACS的评估者间信度;以脑瘫儿童精细运动能力测试（FMFM）的精细运动能力分值为效标确定Mini-MACS的平行效度。结果：76例CP儿童进入本文分析,其中我院康复中心18例,上海儿童康复合作群单位共58例;男46例,女30例;平均年龄（2.5±0.9）个月,1~2岁组25例,~3岁组23例,~4岁组28例;痉挛型四肢瘫29例,双瘫11例,偏瘫27例,手足徐动型2例,共济失调型2例,无法分类5例;粗大运动功能分级（GMFCS）Ⅰ级7例,Ⅱ级27例,Ⅲ级16例,Ⅳ级16例,Ⅴ级10例。OT师现场评价与录像评价结果间重测信度ICC值为0.96（95%CI：0.94~0.98）;OT师与PT师间的ICC值为0.97（95%CI：0.94~0.98）,OT师与主要照顾者ICC值为0.92（95%CI：0.86~0.95）;1~2岁组、~3岁组和~4岁组重测信度ICC值0.95~1.00,~4岁组评价者间信度低于1~2岁组和~3岁组,尤其是OT师与主要照顾者间的信度明显低于其他两组（ICC=0.64）。Mini-MACS与精细运动能力分值之间平行效度Spearman相关系数为-0.76。结论：中文版Mini-MACS具有良好的评价者间信度和平行效度,适用于对国内脑瘫幼儿进行手功能分级。     

中文版脑瘫患儿手功能分级系统的信度和效度研究

摘要 目的 确定中文版脑瘫（CP）患儿手功能分级系统（MACS）的信度和效度。方法 通过分析现场操作评价和录像评价结果之间的关系确定MACS的重测信度;分析不同评价者间（家长、作业治疗师和康复医生）的评价结果确定MACS的评价者间信度;以CP患儿精细运动能力测试（FMFM）的分值为效标确定MACS的平行效度。结果 来自上海2家CP康复机构的124例4～18岁CP患儿参加了此项研究。男77例,女47例;平均(6.7±2.6)岁,4～7岁97例;～12岁24例,～18岁3例。其中痉挛型四肢瘫27例,双瘫48例,偏瘫38例,手足徐动型5例,共济失调2例,肌张力障碍型4例。粗大运动功能分级（GMFCS）Ⅰ级51例,Ⅱ级32例,Ⅲ级15例,Ⅳ级14例,Ⅴ级12例。2名作业治疗师的现场评价与录像评价结果显示,MACS具有良好的重测信度,ICC值分别为0.94（95%CI：0.90～0.96）和0.87（95%CI:0.80～0.92）;同时MACS具有良好的评价者间信度,作业治疗师与家长现场评价间的ICC值为0.85(95%CI：0.77~0.91),2名作业治疗师现场评价间的ICC值为0.99(95%CI：0.99~1.00),不同家长现场评价间的ICC值为0.91(95%CI：0.66~0.98),2名作业治疗师录像评价间的ICC值为0.96(95%CI：0.94~0.97),作业治疗师与康复医生录像评价间的ICC值为0.94(95%CI：0.90~0.97);MACS与FMFM分值间具有良好的平行效度,Spearman相关系数为-0.71。结论 中文版CP患儿MACS具有良好的信度和效度,适用于中国开展CP患儿的手功能分级。在进行MACS评价时应充分考虑环境因素的影响,引导家长参与到MACS的评价工作中来。     

中文版脑瘫儿童粗大运动功能分级系统的信度和效度研究

目的 确定中文版脑瘫儿童粗大运动功能分级系统（Gross Motor Function Classification System ,GMFCS）的信度和效度。方法 共有来自上海三家康复机构的91名0-12岁脑瘫儿童参加了此项研究，选择35名脑瘫儿童测定GMFCS的重测信度；以66名脑瘫儿童为对象测定GMFCS的评价者间信度；分别以88名脑瘫儿童的粗大运动功能评估量表（GMFM）和54例脑瘫儿童的Peabody粗大运动发育量表（PDMS-GM）的各项测试结果为效标确定GMFCS的平行效度；对88例同时接受GMFCS和GMFM评价的儿童的测试结果进行结构效度检测，以GMFCS为应变量，GMFM五个功能区的百分比为自变量进行多重逐步回归分析，判断粗大运动中五个分区功能对GMFCS的影响程度。结果 GMFCS具有良好的重测信度（ICC值为0.99），同时具有良好的评估者间信度（ICC为0.95-0.98）；GMFCS与GMFM和PDMS-GM各项分值之间有良好的平行效度，Spearman相关系数在-0.57到-0.84在之间；粗大运动功能中的坐位能力和行走能力是影响GMFCS的主要因素，校正决定系数为0.709（p<0.001）。 结论 中文版脑瘫儿童粗大运动功能分级系统的具有良好的信度和效度，适用于国内对脑瘫儿童进行功能分级。     

复旦中文版神经肌肉疾病运动功能评估量表在儿童和青少年中的信度和效度研究

目的：验证复旦中文版神经肌肉疾病（NMD）运动功能评估量表（MFM）在中国儿童和青少年NMD中的信度和效度。 方法：2013年6月至2017年7月在复旦大学附属儿科医院（我院）神经科经基因检测或肌肉活检明确诊断为各类NMD、＞2岁且在我院康复科接受过复旦中文版MFM 20和MFM 32评估的患儿,排除1年内接受过手术、具有严重认知障碍和测试前3 d内从事过严重影响体力的活动患儿。2名物理治疗师同时进行MFM 20和MFM 32测试,检验不同测试者间的信度;同一评价者在第1次评价后间隔3~7d进行第2次评价,检测重测信度;以6 min步行距离（6MWT）和4项功能性计时测试为效度指标;通过分析MFM分值与之的相关性确定关联效度。通过分析纳入对象中杜氏进行性肌营养不良（DMD）患儿的MFM分值与北极星移动量表（NSAA）分值之间的相关性确定关联效度。 结果：372例患儿符合本文纳入排除标准,平均（6.5±2.7）岁,<7岁222例,男性338例,其中DMD 263例,重测信度（2~7岁16例,>7岁38例）和测试者间信度（2~7岁16例,＞7岁29例）检测结果显示,MFM 32和MFM 20的总分和各分区分值ICC=0.89~0.97。基于372例患儿,MFM 32和MFM 20的总分和D1区分值与6MWT和功能性计时测试结果具有中等和较强的相关性（r=0.48~0.73）,与D2和D3分区的分值相关性为中等和较弱。在263例DMD患儿中,MFM 32和MFM 20的总分和D1区分值与NSAA分值的相关性为强和极强相关性。 结论：复旦中文版MFM量表在儿童和青少年NMD患儿中具有很好的信度和效度,可以有效地测定NMD患儿的运动功能状态。     

中文版儿童生命质量哮喘特异性量表的信度和效度评价

目的：评价简体中文版儿童生命质量（PedsQLTM）哮喘特异性量表家长报告的信度和效度。方法：采用 PedsQLTM 哮喘特异性量表家长报告量表及自设一般情况问卷,对重庆医科大学附属儿童医院哮喘中心就诊的 233 例哮喘患儿及其家长进行问卷调查。用克朗巴赫α系数考核其信度,分别用探索性因子分析、相关分析考核其效度。结果：中文版 PedsQLTM 哮喘特异性量表家长报告全量表、症状相关问题、治疗相关问题、担心相关问题、沟通相关问题的α系数分别为0.86、0.80、0.78、0.89和0.93,表明量表有较好的内部一致性。通过因子分析共提取7个公因子,与量表基本结构一致,主成分累积贡献率接近 66%。4个维度得分与所含条目得分间均有较强的相关关系(r=0.41~0.92, P＜0.01)。结论：中文版PedsQLTM 哮喘特异性量表家长报告有良好的信度和效度,与原语言版本一致,可适用于中国哮喘患儿健康相关生命质量评价。［中国当代儿科杂志,2010,12(12)：943-946］     

婴儿异常运动功能评定表的信度和平行效度研究

目的　评价新编制的“婴儿异常运动功能评定表”重测信度、内部一致信度和平行效度 ,为应用该评定表在婴儿期筛查脑瘫提供简便、可行的工具。方法　对 16例 6～ 9个月龄的脑瘫患儿间隔 1～ 2周评定“婴儿异常运动功能评定表”的重测信度 ,对 36例 1岁内脑瘫患儿检查 ,计算Kuder Richardson系数 (rKR2 0 ) ,评价内部一致性信度。对 16例 6～ 9个月的脑瘫患儿和 6 8例 6个月正常婴儿分别用“婴儿异常运动功能评定表”和Morgan等编制的“早期运动模式量表”进行评定 ,分析两者评分相关性和对脑瘫患儿的区分能力。结果　“婴儿异常运动功能评定表”重测一致率为 97.1% ,Kappa值为 0 92 ;运动里程碑和神经反射 (原始反射与姿势反应 )rKR2 0 分别为0 5 4和 0 6 9。与“早期运动模式量表”同时对脑瘫患儿评分的相关系数为 0 85 (tr=3.0 5 34,P =0 0 0 0 ) ,“婴儿异常运动功能评定表”和“早期运动模式量表”对脑瘫患儿的区分能力分别为 10 0 % (16 / 16 )和 87.5 % (14 / 16 )。结论　“婴儿异常运动功能评定表”信度满意 ,其平行效度不低于国外用于脑瘫早期筛查的量表。     

中文版早产儿准备经口喂养评估量表的信度效度评价

目的 引进并评价中文版早产儿准备经口喂养评估量表的信度和效度.方法 翻译英文版早产儿准备经口喂养评估量表,并将形成的中文版应用于154例早产儿,测量其信度和效度.结果 中文版早产儿准备经口喂养评估量表的内部一致性信度Cronbach's α系数为0.817,评分者间总分一致性系数ICC为0.917(P ＜0.01),Spearman等级相关系数rs为0.927(P ＜0.01).量表的结构合理,可以经口奶瓶喂养和不能经口奶瓶喂养者评分比较,差异有统计学意义(P=0.000).量表诊断受试者工作特征(ROC)曲线下面积为0.858(P=0.000,95％CI:0.775 ～0.941).当评分界值为30分时,灵敏度为0.756,特异度为0.800,总一致性κ值为0.387(P=0.000),为最佳诊断临界点.结论 中文版早产儿准备经口喂养评估量表具有良好的信度和效度,可用于判断早产儿是否可以安全经口奶瓶喂养.     

中文版《婴幼儿社会认知发展筛查量表》的信度和效度评价

目的对中文版《婴幼儿社会认知发展筛查量表》进行信度和效度评价。 方法在广州市和佛山市选取无精神发育疾病、无重大生理疾病的正常婴幼儿843名,选取中山大学附属第三医院儿童发育行为中心确诊为孤独症的幼儿170例,对中文版《婴幼儿社会认知发展筛查量表》进行修订,并且评价量表的信度和效度。结果①信度分析：全量表及4个子量表的Cronbach′s α系数均>0.7;全量表及4个子量表的分半信度系数为0.69～0.94;全量表及4个子量表的重测信度系数为0.79～0.95。②效度分析：各条目与全量表的相关系数为0.31～0.86;除认人子量表与所属条目n10的相关系数为0.40,各子量表与其他所属条目相关系数均＞0.5,但与其他子量表所属条目相关性不强;各子量表间、子量表与全量表间的相关系数均>0.5。因子分析共提取6个公因子,解释总变异的60.63％,因子分析结果与原量表结构基本一致。2～3.5岁正常幼儿全量表和4个子量表得分都显著高于同年龄段孤独症幼儿。结论中文版《婴幼儿社会认知发展筛查量表》具有较好的信度和效度,且操作简便,可用于临床上评价0.5～3.5岁婴幼儿社会认知能力的发展情况。     

中文版《青少女性自我保护意识量表》构建及其信度和效度评价

目的 构建适用于中国文化框架下青少女性自我保护意识量表(SSPAS),并检验其信度与效度。 方法 翻译并主要参考英文版SSPAS量表等文献,确定中国16～18岁青少女为调查人群,结合对中国青少女半结构访谈结果和专家咨询意见,形成中文版SSPAS预实验量表,在中国16～18岁青少女中调查修订为中文版SSPAS验证量表,再在另一中国16～18岁青少女人群中行信度和效度评价。中文版SSPAS预实验和验证量表集中于学校匿名填写,填写问卷时间约10 min。对施测量表条目采用等距5级评分,即从不如此、很少如此、偶尔如此、经常如此和总是如此,分别赋予1、2、3、4和5分,得分越高表示性自我保护意识越好。 结果 中文版SSPAS预实验量表基于321名中国16～18岁青少女学生,有效问卷88.2%;中文版SSPAS验证量表基于560名中国16～18岁青少女学生,有效问卷91.2%。经探索性因子分析,中文版SSPAS量表由22个条目组成,包括性健康态度、性自我概念和性危险行为3个公因子,累计贡献率为72.5%;各条目内容效度指数为0.902～0.922,量表总体内容效度指数为0.918;总量表的Cronbach's α系数为0.842,重测信度为0.886;验证性因子分析,卡方值/自由度为2.218（P<0.001）、拟合优度指数为0.958,近似误差均方根性为0.052,调和拟合优度指数为0.962,正规拟合指数为0.924,比较拟合优度指数为0.936,以上指标均＞0.90,具有较好的适配。 结论 中文版SSPAS量表在中国16～18岁青少女中具有很好的信度与效度,可作为评价中国青少女性自我保护意识情况的量化工具。     

中文版北极星移动评价量表在Duchenne型肌营养不良症患儿的信度和效度研究

目的：确定中文版北极星移动评价量表（NSAA）应用在Duchenne型肌营养不良症（DMD）患儿的信度和效度。方法：纳入对象为2014年1月至2016年1月在复旦大学附属儿科医院康复科接受功能评估的DMD患儿,均经基因检测或肌肉活检明确诊断,能独立行走≥10 m,无严重认知障碍。2名物理治疗师同时对DMD患儿进行测试,检验不同测试者间的信度;同一评价者在第1次评价后3~7 d进行第2次评价,检测重测信度;采用《国际功能、残疾和健康分类》儿童和青少年版（ICF-CY）的类目编码与NSAA的项目概念进行关联,确定NSAA的内容效度;通过分析NSAA的分值与6 min步行距离的相关性进行关联效度分析。结果：2个治疗师对20名DMD男孩的不同测试结果间的信度分析显示,NSAA原始分和线性分信度ICC分别为0.96和0.97;1名治疗师前后3～7 d重测16名DMD男孩,NSAA的原始分和线性分具有很好的重测信度（ICC=0.96）;NSAA17个项目共与8个ICF-CY编码发生了20次关联,8个编码都属于d4（移动）下属,表明NSAA的评价内容主要聚焦于DMD患儿活动能力中的移动能力;143例DMD男孩的NSAA原始分和线性分与6min步行距离具有中等程度的相关性（r分别为0.40和0.38）。结论：中文版NSAA量表无论是原始分还是线性分都具有良好的心理测量学特性,结合其他的评价指标,NSAA可以有效地评价中国DMD男孩的活动能力。     

Reliability and validity of standardized Chinese version of Urban Infant-Toddler Social and Emotional Assessment

Aims

To evaluate the reliability and validity of the Chinese version of Infant-Toddler Social and Emotional Assessment (CITSEA).

Study design

A cross-sectional survey through parent self-administered questionnaires in Chinese urban communities. Fourteen cities from the Southern, Northern, Eastern, Western and Central China were involved.

Subjects

A total of 5323 healthy toddlers (2690 boys and 2633 girls) aged 12 to 36 months from the 14 cities recruited through a multi-stage sampling scheme.

Outcome measures

Self-administered questionnaire was employed to collect the social demographic data, and the Chinese translation of ITSEA was used to collect data on children's social and emotional behavior.

Results

The reliability and validity of CITSEA were examined by standard psychometric methods. 1) The test-retest reliability of four broad domains ranged from 0.78 to 0.89 at the significant level p < 0.001; 2) Split-half reliability ranged from 0.82 to 0.90 (p < 0.001); 3) The alpha coefficient was noticed to range from 0.79 to 0.88, which demonstrated good internal consistency. Furthermore, as is hypothesized, the score of CITSEA domains was significantly correlated with subscale's score of the Child Behavior Checklist 2/3 (CBCL2/3) and dimension's score of China Toddler Temperament. Confirmatory factor analysis demonstrated a good and reliable match of the model, indicating that CITSEA outlines the social and emotional development of Chinese urban children aged 12 to 36 months.

Conclusion

The Chinese version of ITSEA is valid and the psychometric properties of this translated version (including its reliability and validity) are at an acceptable standard. It can be used as an instrument for assessing social and emotional problems, including delays in social-emotional competence for Chinese young children.     

Reliability and validity: Part II

Determining measurement reliability and validity involves complex processes. There is usually room for argument about most instruments. It is important that the researcher clearly describes the processes upon which she made the decision to use a particular instrument, and presents the evidence available showing that the instrument is reliable and valid for the current purposes. In some cases, the researcher may need to conduct pilot studies to obtain evidence upon which to decide whether the instrument is valid for a new population or a different setting. In all cases, the researcher must present a clear and complete explanation for the choices, she has made regarding reliability and validity. The consumer must then judge the degree to which the researcher has provided adequate and theoretically sound rationale. Although I have tried to touch on most of the important concepts related to measurement reliability and validity, it is beyond the scope of this column to be exhaustive. There are textbooks devoted entirely to specific measurement issues if readers require more in-depth knowledge.     

Relationship among the Manual Ability Classification System (MACS), the Gross Motor Function Classification System (GMFCS), and the functional status (WeeFIM) in children with spastic cerebral palsy

The aim of this study was to investigate the relationship among functional classification systems, the Manual Ability Classification System (MACS), the Gross Motor Function Classification System (GMFCS), and the functional status (WeeFIM) in children with spastic cerebral palsy (CP). One hundred and eighty-five children with spastic CP (101 males, 84 females), 65 (35.1%) diparetic, 60 (32.4%) quadriparetic, and 60 (32.4%) hemiparetic children, ranging from 4 to 15 years of age with a median age of 7 years, were included in the study. The children were classified according to the GMFCS for their motor function and according to the MACS for the functioning of their hands when handling objects in daily activities. The functional status and performance were assessed by using the Functional Independence Measure of Children (WeeFIM). A good correlation between the GMFCS and MACS was found in all children (r = 0.735, p < 0.01). There was also a correlation between the GMFCS and WeeFIM subscales according to subtypes and all parameters were correlated at the level of p < 0.01, the same as the MACS. There was no difference in the MACS scores among the age groups of 4–7, 8–11, and 12–15 years (p > 0.05). The use of both the GMFCS and MACS in practice and in research areas will provide an easy, practical, and simple classification of the functional status of children with CP. The adaptation of both of these scales and WeeFIM and using these scales together give the opportunity for a detailed analysis of the functional level of children with spastic CP and reflect the differences between clinical types of CP. This study was presented as a poster presentation in 20^th Annual Meeting, European Academy of Childhood Disability (EACD) in Zagreb, Crotia.     

Reliability and validity of the mother-child neglect scale

The current study offers a new way to ascertain information about child neglect by evaluating a self-report measure of neglectful behaviors, the Mother-Child Neglect Scale (MCNS). The scale was modified from an existing self-report measure, the Neglect Scale (NS), which was originally designed to measure personal histories of neglect. One hundred adolescent mothers were administered the MCNS and NS in two occasions via phone interviews. In addition, maternal abuse potential and the quality of mother-child interactions were assessed when children were age 3 and 5 years. The MCNS had high internal consistency and moderate test-retest reliability. Convergent validity was found between the MCNS and maternal histories of neglect as well as observed parenting behaviors and child abuse potential; those relationships remained after social desirability was controlled. This research tool may prove useful, in conjunction with existing assessment instruments, in determining the type and severity of past neglectful behaviors.     

Reliability and validity of the Harris Infant Neuromotor Test

OBJECTIVE: To examine the reliability and validity of the Harris Infant Neuromotor Test (HINT), a screening tool that can be administered and scored in <30 minutes, with the goal of identifying neuromotor differences in infants aged 3 to 12 months. STUDY DESIGN: Infants, aged 3 to 12 months (n = 54), were assessed in 2 high-risk infant follow-up programs in Vancouver, British Columbia. Inter-rater, test-retest, and intra-rater reliability were examined. Concurrent and predictive validity of the HINT with the Bayley Scales of Infant Development-II (BSID-II) were evaluated by using the Pearson product-moment correlation. RESULTS: Intraclass correlation coefficients for reliability for the Total HINT Score ranged from 0.98 to 0.99. Concurrent validity of the HINT with the BSID-II Mental Scale during the first year was r = -0.73 (P <.01), and with the BSID-II Motor Scale, r = -0.89 (P <.01). The predictive relationships between the HINT and the BSID-II at 17 to 22 months were r = -0.11 for the BSID-II Mental Scale and r = -0.49 (P <.01) for the BSID-II Motor Scale. CONCLUSIONS: The HINT is reliable for screening infant neuromotor performance and has strong concurrent validity with the Bayley-II Mental and Motor Scales. HINT scores during the first year accounted for 24% of the variance of Bayley-II Motor scores at 17 to 22 months.