一种新型ADL量表可靠性的研究

采用一种新型的ADL量表的4级评定法对59例脑血管病偏瘫患者进行评定,将其与标准量表评定结果、重复试验、基本项与附加项以及量表内各项目之间的关系用Spearman等级相关分析法进行分析,其结果表明:新型ADL量表是有效的和可靠的。所以,此量表的脑卒中后偏瘫ADL功能评价中具有理论和实践意义。     

护理活动评分表的信度和效度研究

[目的]翻译“护理活动评估量表”(NAS),评价其信度、效度及文化相关性,提供一种有效方便的护理工作量评估的中文版问卷。[方法]应用专家小组评定法进行问卷文化相关性、语言一致性及内容效度的评价。对126例重症监护病房(ICU)病人应用问卷对其结构效度进行评价,对其中30例病人进行重测信度评价。[结果]中文版NAS问卷中所有条目均具有较好的文化相关性,其中1个条目重新修订,且具有较好的信度和效度。因子分析显示中文版NAS具有与原英文版量表一致的结构效度。[结论]中文版护理工作量评估表是一种具有较高信度、效度的ICU专用护理工作量评估量表,可以为广大护理管理者提供可靠的理论依据和数据支持。     

护理活动评分表的信度和效度研究

[目的]翻译“护理活动评估量表”（NAS），评价其信度、效度及文化相关性，提供一种有效方便的护理工作量评估的中文版问卷。[方法]应用专家小组评定法进行问卷文化相关性、语言一致性及内容效度的评价。对126例重症监护病房（ICU）病人应用问卷对其结构效度进行评价，对其中30例病人进行重测信度评价。[结果]中文版NAS问卷中所有条目均具有较好的文化相关性，其中1个条目重新修订，且具有较好的信度和效度。因子分析显示中文版NAS具有与原英文版量表一致的结构效度。[结论]中文版护理工作量评估表是一种具有较高信度、效度的ICU专用护理工作量评估量表，可以为广大护理管理者提供可靠的理论依据和数据支持。     

四个脑卒中量表信度与效度的对比研究

目的　通过纵向对比,研究比较四个具代表性的脑卒中量表在我国使用的信度和效度。方法　对100例连续住院急性脑卒中患者进行脑卒中量表的评定。信度检验用kappa相关。内容一致性检验用Cronbachα相关。结构效度用Spearman相关。预测效度应用协方差分析和logistic回归。结果　脑卒中患者神经功能缺损评分标准(以下简称“评分标准”)最省时,脑卒中病损评估记录(strokeimpairmentassessmentset,SIAS)最费时。四个量表均有较好的信度、内容一致性、结构效度和预测效度。只有“共济失调”评定者间信度一致性差(k=-0.04)。美国国立卫生研究院卒中量表(theNIHstrokescale,NIHSS)的预测能力最充分,是唯一所含项目均有预测值的量表。NIHSS评定的神经功能缺损范围最大。结论　在多中心的临床研究中,推荐修订后使用NIHSS。     

Interrater reliability of the Physical Ability Scale for patients after stroke: A pilot study

This study aimed to evaluate the interrater reliability of the Physical Ability Scale (PAS) and secondly to test the statistical methods to analyse the scoring. Williamson () stated that the PAS measures the degree of compatibility of the trunk with gravity and the supporting surface through investigation of limb, head, and posture in five different positions, each with six levels of ability. Four experienced physiotherapists observed a video of 10 inpatients from a general hospital stroke unit being assessed with the PAS up to 5 months after a stroke. The intraclass coefficient (ICC) for the total scores was 0.7 (95% CI 0.35–0.91) with the highest individual position scores in standing 0.86 (95% CI 0.68–0.96) and long sitting 0.74 (95% CI 0.46–0.92). The ICC for the levels of ability indicated good agreement in standing 0.79 (95% CI 0.55–0.93) and long sitting 0.77 (95% CI 0.52–0.93). Kappa values for each body part yielded the highest values in long sitting (0.62) and standing (0.56). Interrater reliability is variable, with the greatest level of agreement in long sitting and standing but with poor to fair agreement in sitting, prone, and supine. The study has also shown that the scoring can be analysed to yield meaningful repeatable results. Further investigation is needed to examine validity and reliability with a larger sample of diverse ability, therapists with varying clinical experience, and with direct observation of the assessment.     

'Seeking': a key activity for new family carers of stroke survivors

Stroke is one of the major causes of disability in the United Kingdom and considerable numbers of stroke survivors need help and support from family carers. The sudden and unexpected nature of stroke means that there is very little time for family members to prepare for a caring role. This paper draws on data from 37 interviews with 14 new carers of stroke survivors and highlights the uncertainty and lack of confidence that family members experience in adopting a caring role. During the initial period following the stroke carers engage in a number of different 'seeking' activities in order to try and ensure that they feel competent, confident and safe to provide care and that they understand the likely future demands they may face. Rather than being facilitated by staff, carers' efforts often go unnoticed or are overlooked, resulting in carers feeling that they are 'going it alone'. Staff need to be more aware of carers' 'seeking' behaviour and actively encourage the formation of partnerships with family members.     

Interrater reliability of the Physical Ability Scale for patients after stroke: a pilot study

This study aimed to evaluate the interrater reliability of the Physical Ability Scale (PAS) and secondly to test the statistical methods to analyse the scoring. Williamson ( 1993a ) stated that the PAS measures the degree of compatibility of the trunk with gravity and the supporting surface through investigation of limb, head, and posture in five different positions, each with six levels of ability. Four experienced physiotherapists observed a video of 10 inpatients from a general hospital stroke unit being assessed with the PAS up to 5 months after a stroke. The intraclass coefficient (ICC) for the total scores was 0.7 (95% CI 0.35-0.91) with the highest individual position scores in standing 0.86 (95% CI 0.68-0.96) and long sitting 0.74 (95% CI 0.46-0.92). The ICC for the levels of ability indicated good agreement in standing 0.79 (95% CI 0.55-0.93) and long sitting 0.77 (95% CI 0.52-0.93). Kappa values for each body part yielded the highest values in long sitting (0.62) and standing (0.56). Interrater reliability is variable, with the greatest level of agreement in long sitting and standing but with poor to fair agreement in sitting, prone, and supine. The study has also shown that the scoring can be analysed to yield meaningful repeatable results. Further investigation is needed to examine validity and reliability with a larger sample of diverse ability, therapists with varying clinical experience, and with direct observation of the assessment.     

Evaluation of ideomotor apraxia in patients with stroke: a study of reliability and validity.

OBJECTIVE: This aim of this study was to determine the reliability and validity of an established ideomotor apraxia test when applied to a Turkish stroke patient population and to healthy controls.Subjects: The study group comprised 50 patients with right hemiplegia and 36 with left hemiplegia, who had developed the condition as a result of a cerebrovascular accident, and 33 age-matched healthy subjects. METHODS: The subjects were evaluated for apraxia using an established ideomotor apraxia test. The cut-off value of the test and the reliability coefficient between observers were determined. RESULTS: Apraxia was found in 54% patients with right hemiplegia (most being severe) and in 25% of left hemiplegic patients (most being mild). The apraxia scores for patients with right hemiplegia were found to be significantly lower than for those with left hemiplegia and for healthy subjects. There was no statistically significant difference between patients with left hemiplegia and healthy subjects. CONCLUSION: It was shown that the ideomotor apraxia test could distinguish apraxic from non-apraxic subjects. The reliability coefficient among observers in the study was high and a reliability study of the ideomotor apraxia test was therefore performed.     

Development of a new tool to correlate stroke outcome with infarct topography: A proof-of-concept study

Improving the ability to assess potential stroke deficit may aid the selection of patients most likely to benefit from acute stroke therapies. Methods based only on ‘at risk’ volumes or initial neurological condition do predict eventual outcome, but not perfectly. Given the close relationship between anatomy and function in the brain, we performed a proof-of-concept study to examine how well stroke outcome correlated with infarct location and extent. A prospective study of 60 patients with ischemic stroke (38 in the training set and 22 in the validation set), using an implementation of partial least squares with penalized logistic regression (PLS-PLR), was performed. The method yielded a model relating location of infarction (on a voxel-by-voxel basis) and neurological deficits. The area under the receiver operating characteristics curve (AUC) method was used to assess the accuracy of the method for predicting outcome. In the validation phase, this model indicated the presence of neglect (AUC 0.89), aphasia (AUC 0.79), right-arm motor deficit (0.94), and right-leg motor deficit (AUC 0.94) but less accurately indicated left-arm motor deficit (0.52) and left-leg motor deficit (0.69). The model indicated no to mild disability (Rankin ≤ 2) versus moderate to severe disability (Rankin > 2) with AUC 0.78. In this proof-of-concept study, we have demonstrated that stroke outcome correlates well with infarct location raising the possibility of accurate prediction of neurological deficit in the individual stroke patient using only information on infarct location and multivariate regression methods.     

Test-retest reliability, validity, and sensitivity of the Chedoke arm and hand activity inventory: a new measure of upper-limb function for survivors of stroke

OBJECTIVES: To estimate the test-retest reliability and validity of the Chedoke Arm and Hand Activity Inventory (CAHAI) and to test whether the CAHAI was more sensitive to change in upper-limb function than the Impairment Inventory of the Chedoke-McMaster Stroke Assessment (CMSA) and the Action Research Arm Test (ARAT). DESIGN: Construct validation process. SETTING: Inpatient/outpatient rehabilitation facilities. PARTICIPANTS: Stratified sample of 39 survivors of stroke: 24 early (mean age, 71.4 y; mean days poststroke, 27.3) and 15 chronic (mean age, 64.0 y; mean days poststroke, 101.7). INTERVENTION: Regular therapy. MAIN OUTCOME MEASURES: Intraclass correlation coefficients (ICCs), receiver operating characteristic (ROC), standard error of measurement, and correlation coefficients. RESULTS: High interrater reliability was established with an ICC of .98 (95% confidence interval [CI], .96-.99). The minimal detectable change score was 6.3 CAHAI points. Higher correlations were obtained between the CAHAI and the ARAT and CMSA scores compared with the CMSA shoulder pain scores (1-sided, P=.001). Areas under the ROC curves were as follows: CAHAI, .95 (95% CI, 0.87-1.00); CMSA, .76 (95% CI, .61-.92); and ARAT, .88 (95% CI, 0.76-1.00). CONCLUSIONS: High interrater reliability and convergent and discriminant cross-sectional validity were established for the CAHAI. The CAHAI is more sensitive to clinically important change than the ARAT.     

Step count accuracy and reliability of two activity tracking devices in people after stroke

Background/Purpose: The increasing popularity of activity tracking devices presents an opportunity to monitor physical activity in patients after stroke. We sought to determine the reliability and accuracy of the Garmin Vivofit and Fitbit Zip for adults after stroke. Methods: Twenty-four participants with stroke-induced hemiparesis wore a Fitbit Zip on the nonparetic hip and Garmin Vivofits on both wrists during a 6-minute walk test to determine the accuracy of the devices against video-determined step counts. Participants also wore the devices during two trials of exactly 50 steps to determine the reliability of the devices. Results: Fitbit Zip showed excellent reliability (ICC_2,1 = 0.974) and accuracy (4.2% error) for participants who walked faster than 0.35 m/s. Garmin Vivofit (nonparetic side) had excellent reliability (ICC_2,1 = 0.964) but poor accuracy (≤?16.0%) for all participants. Garmin Vivofit (paretic side) had excellent reliability (ICC_2,1 = 0.858) and accuracy (?4.0% error) for faster walkers (>0.48 m/s) but poor accuracy (?68.2%) for slower walkers. Conclusion: Fitbit Zip was more accurate and reliable for persons with stroke than Garmin Vivofit, but slower walking speeds were associated with greater undercounting of steps for both devices. The Fitbit Zip is appropriate for counting steps in adults poststroke who range from household to community ambulators.     

A new approach to stroke management

Stroke incidence has declined in recent decades, largely as a result of risk factor management rather than any stroke-specific therapy. Despite improved diagnostic techniques, aggressive management of transient ischemic attack and asymptomatic carotid disease has proved to be costly and of questionable benefit. The emphasis in the clinical approach to stroke should shift to acute intervention and "cerebral resuscitation."     

A quasi-experimental study on a community-based stroke prevention programme for clients with minor stroke

Aim. The aim of this study was to determine the effectiveness of a community‐based stroke prevention programme in (1) improving knowledge about stroke; (2) improving self‐health‐monitoring practice; (3) maintaining behavioural changes when adopting a healthy lifestyle for stroke prevention. Background. People with minor stroke (or transient ischaemic attack) tend to under‐estimate the long‐term impact of this on their health. The challenge for nurses is to prevent subsequent strokes by finding ways to promote and sustain appropriate behaviours. Educational intervention is of paramount importance in equipping those at risk with relevant knowledge and self‐care strategies for secondary stroke prevention. Design. This study adopted a quasi‐experimental design. Method. One hundred and ninety subjects were recruited, of whom 147 (77 in the intervention group and 70 in the control group) completed the study. Data were obtained at three time points: baseline (T₀); one week after (T₁) and three months after (T₂) the intervention. The intervention programme consisted of eight weekly two‐hour sessions, with the aims of improving the participants’ awareness of their own health signals and of actively involving them in self‐care management of their own health for secondary stroke prevention. Results. Significant positive changes were found among participants of the intervention group in the knowledge on stroke warning signs (P < 0·001); treatment seeking response in case of a stroke (P < 0·001); medication compliance (P < 0·001); self blood pressure monitoring (P < 0·001) as well as lifestyle modification of dietary habits (reduction in salted food intake, P = 0·004). No significant improvement was found in walking exercise participation in the intervention group, yet a significant decrease was detected among the control group. Conclusion. This study found a three‐month‐sustained effect of positive changes in knowledge and skill from participants who undertook a nurse‐led community‐based stroke prevention programme. Relevance to clinical practice: Effective educational intervention by professional nurses helped clients integrate their learned knowledge into their real‐life practice. This empowering, that is, the taking of responsibility by clients for their own self‐care management on a daily basis, affirms that patient education has moved beyond teaching people facts.     

The intra-rater reliability of the balance performance monitor when measuring sitting symmetry and weight-shift activity after stroke in a community setting

OBJECTIVE: To examine the intra-rater reliability of sitting symmetry and weight-shift activity measurements in poststroke adults. DESIGN: An intra-rater reliability study. SETTING: A community setting. SUBJECTS: Adult stroke survivors attending stroke support groups within the community of Nottingham (U.K.). MAIN MEASURES: The Balance Performance Monitor used to measure sitting symmetry and weight-shift activity. Intraclass correlation coefficients (ICCs) and their 95% confidence intervals (95% CI) were calculated. The Bland Altman method for assessing agreement is also presented. RESULTS: We tested 49 participants (median age 73 years; interquartile range 68-81 years). Between-test reliability for sitting symmetry was high: ICC (1,1) = 0.93 (95% CI 0.87 < or = ICC < or = 0.96). The mean difference between the measures (d) was -0.08 (95% CI -0.48 < or = d < or = 0.31); the standard deviation of the differences (SDdiff) was 1.383. The coefficient of repeatability was 2.76; the 95% limits of agreement were -2.850 and 2.682. Between-test reliability for weight-shift activity was also high: ICC (1,1) = 0.86 (95% CI 0.77 < or = ICC < or = 0.92). Bland-Altman d = -0.08 (95% CI -0.19 < or = d < or = 0.35), SDdiff = 0.936. The coefficient of repeatability was 1.87; the 95% limits of agreement were -1.792 and 1.952. CONCLUSIONS: The 95% CI for d for both parameters crossed zero, indicating that between-test bias is unlikely. Sitting symmetry and weight-shift activity measures demonstrated acceptable levels of reliability.     

Physical activity profiles and sedentary behaviour in people following stroke: a cross-sectional study

Purpose: To measure and compare physical activity profiles and sedentary time between community dwelling stroke survivors and healthy volunteers. Methods: Twenty-two stroke survivors (10 men, age 55.3?±?9.9 years; 4.2?±?4.0 years since their stroke) were recruited from local stroke support groups, and 22 controls were matched for sex, age and body mass index (BMI). All participants wore an ActivPAL? physical activity monitor for seven days and from these data activity profiles, including the number of steps per day, time spent sedentary and time in different cadence bands, were recorded. Results: Stroke survivors took significantly fewer steps per day than the controls (4035?±?2830 steps/day versus 8394?±?2941 steps/day, p?p?onclusions: Community dwelling stroke survivors spent more time sedentary, took fewer steps and walked at a slower self-selected cadence. Interventions to increase walking and reduce sedentary time following stroke are required which may have the added benefit of reducing cardiovascular risk in this group.

• Implications for Rehabilitation

• Stroke survivors are predisposed to reduced physical activity and increased cardiovascular risk.

• This study showed that community dwelling stroke survivors spent more time sedentary, took fewer steps and walked at a slower self-selected cadence.

• Interventions are required which focus on reducing sedentary time as well as increasing step counts in people following stroke.