社区融入问卷在脊髓损伤者中的应用

目的:评估社区融入问卷的信效度并分析脊髓损伤者的社区融入状况。方法:研究对象是在上海市阳光康复中心参加康复训练的脊髓损伤者(145例)。采用社区融入问卷、领悟社会支持量表、自评抑郁及焦虑量表和自拟调查表收集数据。应用信效度分析、描述性统计和多元线性回归进行统计分析。结果:社区融入问卷内部一致性信度良好,复测信度的相关系数在0.6以上。各条目与维度的相关系数在0.55—0.82(除了条目10和11);探索性因子分析结果总体符合预期;效标效度良好。患者各项活动均以他人做或参与做为主;排除已有工作和退休人群后,18—60岁人群中仅有30.2%表示在积极找工作。工作、学历、家庭收入、受伤年份和严重程度是社区融入的影响因素。家庭和朋友支持对社会融入状况有显著影响。结论:社区融入问卷在脊髓损伤人群中的信效度总体良好,但仍有待完善。脊髓损伤者家庭融入水平相对最低,其次是生产力和社会融入。建议个人、家庭和社会共同努力,进一步提升脊髓损伤者的社区融入水平。     

脊髓损伤清洁间歇导尿患者自我管理量表的编制及信度和效度检验

摘要 目的：编制脊髓损伤清洁间歇导尿患者自我管理量表并检验其信度和效度。 方法：第一阶段：通过文献研究、半结构式访谈和Delphi法,初步拟定脊髓损伤清洁间歇导尿患者自我管理量表,并招募10例患者进行预调查。第二阶段：选取266例患者进行问卷调查,并进行信效度检验。 结果：最终形成的量表包括4个维度、37个条目。总量表的内容效度指数为0.939,探索性因子分析提取出4个公因子,4个维度的方差贡献率分别为60.887%、61.291%、64.181%、66.764%。总量表Cronbach α系数为0.969,各维度Cronbach α系数为0.755—0.937,总量表的折半信度为0.912,各维度2周后重测信度为0.733—0.933。 结论：编制的脊髓损伤清洁间歇导尿患者自我管理量表具有较好的信效度,可用于评价脊髓损伤清洁间歇导尿患者的自我管理水平。     

修订版社会影响量表应用于女性尿失禁病人的验证性因素分析

[目的]考察修订版社会影响量表在社区女性尿失禁病人中的结构效度和组合信度.[方法]采用方便抽样的方法,对济南市3个社区506例女性尿失禁病人进行修订版社会影响量表的测评,进行验证性因素分析和组合信度的评估.[结果]量表验证模型各拟合指标分别为x2/df=3.130,GFI=0.917,AGFI=0.888,NFI=0.888,TLI=0.903,CFI=0.920,REMSA=0.065,模型拟合可被接受.各因素的负荷量在0.45～0.87之间,社会隔离、社会排斥和内在羞耻感3个维度的组合信度分别是0.775、0.805和0.870,表明模型内在质量较理想.[结论]修订版社会影响量表具有较好的结构效度和组合信度,可以用于女性尿失禁社会影响的相关研究.     

修订版社会影响量表应用于女性尿失禁病人的验证性因素分析

[目的]考察修订版社会影响量表在社区女性尿失禁病人中的结构效度和组合信度。[方法]采用方便抽样的方法,对济南市3个社区506例女性尿失禁病人进行修订版社会影响量表的测评,进行验证性因素分析和组合信度的评估。[结果]量表验证模型各拟合指标分别为X2／df=3．130,GFI=0．917,AGFI=0．888,NFI=0．888,TLI=0．903,CFI=0．920,REMSA=0．065,模型拟合可被接受。各因素的负荷量在0．45～O．87之间,社会隔离、社会排斥和内在羞耻感3个维度的组合信度分别是0．775、0．805和0．870,表明模型内在质量较理想。[结论]修订版社会影响量表具有较好的结构效度和组合信度,可以用于女性尿失禁社会影响的相关研究。     

普通话版伯明翰认知评估量表在脑卒中恢复期患者中的信效度研究

目的：探讨普通话版伯明翰认知评估（BCo S）量表在恢复期脑卒中患者中的信效度,为其临床应用提供参考。方法：选取60例脑卒中恢复期患者,进行普通话版伯明翰认知评估量表及简易智力状态检查（MMSE）量表、蒙特利尔认知评估（Mo CA）量表、改良Barthel指数（MBI）评估。通过计算Cronbach α系数、重测组内相关系数进行信度分析;通过结构效度、效标效度进行效度分析;通过BCo S与MBI的相关性探讨认知功能与日常生活活动的关系。结果：(1)内部一致性分析Cronbach α=0.875,重测信度总体的组内相关系数ICC=0.906;(2)探索性因子分析共提取出4个公因子,分别为因子1：语言、因子2：空间、因子3：书写、因子4：忽略。累计贡献率为76.7%,BCo S与MMSE、Mo CA总分相关系数呈高度相关（r=0.794,r=0.804,P<0.01）;(3) BCo S与MBI总分相关系数显示无相关性（r=0.143,P>0.05）。结论：普通话版BCo S量表具有良好的信效度,能够全面有效地评估脑卒中恢复期患者的认知功能,值得临床推广使用。     

加拿大作业表现量表在脊髓损伤患者作业活动康复中的应用

目的:观察加拿大作业表现量表在T12～L4平面脊髓损伤(C～D级)患者作业活动康复中的应用。方法:招募T12～L4平面外伤性脊髓损伤(C～D级)患者64例,随机区组法分为观察组和对照组,各32例。每组患者均接受为期6个月的脊髓损伤常规康复治疗,其中观察组辅以加拿大作业表现量表为指导的作业活动康复,主要是对患者自身提出的作业活动问题和康复需求进行相应的分析与治疗。分别于治疗前和治疗6个月后使用改良Barthel指数(MBI)、加拿大作业表现量表(COPM)和脊髓功能独立性评估量表Ⅲ(SCIM-Ⅲ)分别对2组患者的作业活动能力进行评估。结果:治疗6个月后,2组患者的COPM的表现和满意度得分、MBI和SCIM-Ⅲ得分均较组内治疗前均有明显提高(均P0.05),且观察组各项得分均更高于对照组(均P0.05)。结论:在T12～L4平面脊髓损伤(C～D级)患者的常规康复中辅以加拿大作业表现量表应用可以明显改善患者完成作业活动的能力。     

世界卫生组织生活质量-100量表在脊髓损伤人群生活质量评价中的信度和效度

目的:评价世界卫生组织生活质量-100(WHOQOL-100)量表在中国脊髓损伤人群中应用的信度、效度。方法:对1989-01/2002-12在中国康复研究中心进行过康复的386例脊髓损伤患者进行信访方式的问卷调查。采用内在一致性信度Cronbach'sα系数和劈半信度系数分析量表的信度,用因子分析来评价量表的结构效度。结果:回收有效问卷209份。Cronbach'sα系数除生理领域外,在量表的6个领域均高于0.75,而劈半信度系数为0.8360。因子分析显示提取的4个公因子,可解释总方差的64.65%。脊髓损伤者与一般人群在量表的所有领域和22个方面的得分差异有显著性意义。结论:使用WHOQOL-100量表评价脊髓损伤人群的生活质量是有效而可靠的。     

社区脊髓损伤者应用间歇导尿现状及影响因素的调查分析

【】 目的 通过对社区脊髓损伤(SCI)神经源性膀胱者应用间隙导尿(IC)的现状及影响因素的调查,为康复专科护士制订IC规范及实施康复护理提供帮助。方法 对上海社区脊髓损伤康复的“中途之家”SCI神经源性膀胱者76例进行调查,内容包括一般资料、IC应用情况和IC应用的影响因素。结果 48.7%排尿方式应用留置导尿;21.6%采用叩击或腹压排尿;5.3%应用IC。影响IC应用的主要因素：92.1%SCI者担心引发尿路感染;88.2%SCI者担心增加尿道损伤几率;82.9%SCI者认为留置导尿比间隙导尿经济,长期IC耗材费用增加;69.7%SCI者认为IC操作麻烦;65.8%SCI者缺乏专业医务人员的指导;56.6%SCI者认为SCI无法恢复而安于现状;21.1%SCI者对腹压排尿的危害不了解等。结论 康复专科护士根据影响SCI者应用IC的主要因素,制订适合SCI者的健康教育和IC操作规范,提高SCI神经源性膀胱者正确应用IC的认知状态,有利于SCI者正确使用IC,减少并发症的发生,提高SCI者的生活质量。     

简洁版平衡评定系统测试量表汉化及在慢性阻塞性肺疾病患者中的信度与效度检验

目的:对简洁版平衡评定系统测试量表(Brief-BESTest)进行中文版汉化并在COPD患者中进行信效度检验。方法:通过取得原作者授权-翻译-综合-回译-专家评议对英文版Brief-BESTest量表进行汉化,选择20例COPD患者进行预实验,对问卷进行修改和文化调试后,另择150例COPD患者进行测试,检测中文版Brief-BESTest量表的信效度,利用Spearman相关分析测试Brief-BESTest量表与Morse评估量表的相关性。结果:中文版Brief-BESTest量表共有6个条目,其中两个需进行双向计分,探索性因子分析,共提取了3个因子,累计方差贡献率为84.020%。总量表的Cronbachα系数为0.904,折半信度系数为0.836,重测信度为0.936(P0.01,95%CI=[0.839,0.975]),与Morse评估表之间呈显著的负相关(r=-0.494,P0.01)。结论:中文版Brief-BESTest量表具有良好的信效度,适合在中国文化背景下测试COPD患者的平衡能力。     

Validation of the Reintegration to Normal Living Index for community-dwelling persons with chronic spinal cord injury

Hitzig SL, Romero Escobar EM, Noreau L, Craven BC. Validation of the Reintegration to Normal Living Index for community-dwelling persons with chronic spinal cord injury.ObjectiveTo determine the validity (construct, concurrent) of the Reintegration to Normal Living (RNL) Index for measurement of community participation in adults with chronic spinal cord injury (SCI).DesignCross-sectional telephone survey.SettingRehabilitation institute.ParticipantsCommunity-dwelling adult men and women (N=617) with SCI who were at least 1 year postinjury.InterventionsNot applicable.Main Outcome MeasuresRNL Index and Satisfaction With Life Scale (SWLS).ResultsReliability of the RNL Index was determined by using Cronbach α, and construct validity was established through confirmatory factor analysis (CFA). In addition, general linear models to predict RNL Index scores were conducted to establish concurrent validity. The RNL Index is a reliable measure of community participation (α=.87). CFA analyses suggested that the RNL Index loads onto a 2-factor solution and is distinct from the SWLS. Significant predictors of RNL Index score included years post-injury, impairment, ambulatory status, employment, and poor health, which yielded R²=.26 (P<.001).ConclusionsThe RNL Index is a valid and reliable measure of community participation for persons with chronic SCI of traumatic cause.     

Self-concept among persons with long-term spinal cord injury

Seventy-one persons with spinal cord injury who had been injured at least four years before, completed the Tennessee Self-Concept Scale and a questionnaire examining demographic factors and activity levels. Compared to scale norms, respondents had significantly higher Personal Self, Moral-Ethical Self, and Social Self scores and significantly lower Physical Self scores. Perceived independence, provision of one's own transportation, assistance needed, and living arrangements were significantly related to self-concept. Findings were discussed in relationship to past and future research and practice in rehabilitation of individuals with spinal cord injury.     

Symptom burden in persons with spinal cord injury

OBJECTIVE: To determine (1) the frequency, severity, and reported course of 7 symptoms in persons with spinal cord injury (SCI) and (2) the association between these symptoms and patient functioning. DESIGN: Postal survey. SETTING: Community. INTERVENTION: A survey that included measures of the frequency, severity, and recalled course of pain, fatigue, numbness, weakness, shortness of breath, vision loss, and memory loss, as well as a measure of community integration and psychologic functioning was mailed to a sample of persons with SCI. One hundred forty-seven usable surveys were returned (response rate, 43% of surveys mailed). MAIN OUTCOME MEASURES: The frequency and average severity of each symptom was computed, and the frequencies of each type of reported course were noted. Analyses estimated the associations among the symptoms, and between symptom severity and measures of patient functioning. RESULTS: The most common symptoms were pain, weakness, fatigue, and numbness. All symptoms were reported to remain the same or to get worse more often than they were reported to improve once they began. Pain, weakness, fatigue, and memory loss were the symptoms most closely associated with patient functioning. CONCLUSIONS: Patients with SCI must deal with a number of secondary complications in addition to any disability caused by the injury itself. Of 7 symptoms studied, pain, weakness, and fatigue appeared to be most common and most closely linked to patient social and mental health functioning. Research is needed to identify the causal relationships between perceived symptoms and quality of life in patients with SCI and to identify effective treatments for those symptoms shown to impact patient functioning.     

Measuring fatigue in persons with spinal cord injury

Anton HA, Miller WC, Townson AF. Measuring fatigue in persons with spinal cord injury.

Objective

To evaluate the psychometric properties of the Fatigue Severity Scale (FSS) in persons with spinal cord injury (SCI).

Design

A 2-week methodologic study was conducted to assess the internal consistency, reliability, and construct validity of the FSS.

Setting

A tertiary spinal cord rehabilitation facility.

Participants

Forty-eight community-living subjects at least 1 year post-SCI with American Spinal Injury Association (ASIA) grade A or B SCI and no medical conditions causing fatigue. The sample was predominantly male (n=31 [65%]) with tetraplegia (n=26 [54%]) and ASIA grade A injuries (n=30 [63%]). The average duration since injury was 14.9 years.

Interventions

Not applicable.

Main Outcome Measures

The ASIA Impairment Scale, the FSS, a visual analog scale for fatigue (VAS-F), the vitality scale of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Center for Epidemiologic Studies Depression Scale (CES-D).

Results

Mean FSS score ± standard deviation at baseline was 4.4±1.4, with 54% (n=26) scoring greater than 4. The internal consistency of the FSS was excellent (Cronbach α=.89). Two-week test-retest reliability was adequate (intraclass correlation coefficient, .84; 95% confidence interval, .74-.90). The magnitude of the relationship was as hypothesized for the VAS-F (r=.67) and CES-D (r=.58) and lower than hypothesized for the vitality subscore (r=−.48) of the SF-36.

Conclusions

The FSS has acceptable reliability with regard to internal consistency, test-retest reliability, and validity in persons with motor complete SCI.     

Soleus H-reflex recruitment is not altered in persons with chronic spinal cord injury

OBJECTIVE: To determine whether spasticity in persons with spinal cord injury (SCI) is associated with elevated monosynaptic reflex excitability. DESIGN: One-way experimental. SETTING: Research laboratory. PARTICIPANTS: Convenience sample of 9 subjects (8 men, 1 woman) with chronic and complete SCI and 20 persons (14 men, 6 women) with no neurologic impairment. Subjects with SCI exhibited lower-extremity spasticity as indicated by velocity-dependent increased resistance to passive muscle stretch, abnormally brisk deep tendon reflexes, involuntary lower-extremity flexion and/or extension spasms, and clonus. INTERVENTION: Soleus H-reflex recruitment curves were elicited in all subjects. MAIN OUTCOME MEASURES: Soleus H-reflex threshold (HTH), gain (HGN), and amplitude (HPP). RESULTS: There was no difference between subjects with and without SCI in HTH, HGN, or HPP. CONCLUSIONS: Spasticity in people with chronic and complete SCI was not associated with increased excitability of the connections between Ia afferent projections and motoneurons. Factors extrinsic to these connections may have a role in spasticity caused by SCI.     

Mediators of disability and hope for people with spinal cord injury

Purpose: To test potential strength-based mediators of functional disability and hope in adults with spinal cord injury. Method: Two hundred and forty-two participants with spinal cord injury were recruited for this study. The mean age of participants was 44.6 years (standard deviation?=?13.2), and 66.1% were men. Participants completed a survey containing a demographic questionnaire, as well as measures of functional disability, hope, self-esteem, proactive coping, perceived social support and disability acceptance. Mediation analysis was conducted using a bootstrap test for multiple mediators. Results: Proactive coping, self-esteem and perceived social support significantly mediated the relationship between functional disability and hope, while disability acceptance did not. The combination of mediators resulted in functional disability no longer being a significant predictor of hope. Conclusions: The strength-based constructs of proactive coping, self-esteem and social support appear effective in predicting hope regardless of severity of spinal cord injury. Functional disability was no longer predictive of hope after controlling for these strength-based constructs. Disability acceptance did not significantly add to the mediation model. These results provide further evidence for strength-based interventions in rehabilitation.

• Implications for Rehabilitation

• Strength-based constructs of proactive coping, self-esteem and social support are important factors for addressing hope following spinal cord injury, regardless of level of severity.

• Rehabilitation services providers should focus efforts on supporting clients in the accurate appraisal of predictable stressors and then generate means for addressing them as a form of proactive coping.

• Rehabilitation services providers must be cautious when addressing self-esteem to focus on perceived competence and learning processes rather than self-esteem directly or through the accomplishment of goals that may not be achieved.

• Knowing that social supports are related to hope post-spinal cord injury, it is important for rehabilitation services providers to recognize potential social supports early in the rehabilitation process and involve those social supports in the rehabilitation process when possible.

     

Alcohol use by persons with recent spinal cord injury

Detailed drinking histories, prevalence of alcohol abuse, and consequences of alcohol use were studied in 103 persons with recent spinal cord injury. Ninety-five percent of the sample acknowledge prior alcohol use. The mean weekday quantity of alcohol consumed was 5.9 drinks (SD = 4.7), with a range of one to 24 drinks per drinking episode during the six months before disability onset. The median frequency of alcohol use was one to two times per week. The sample's mean Michigan Alcoholism Screening Test (MAST) score was 6.8 (SD = 8.0), above the usual cutoff of 5.0, which is interpreted as indicating problematic alcohol use. Forty-nine percent of the sample had scores equal to or exceeding this cutoff. These results suggest that a significant number of individuals with recent spinal cord injuries have heavy drinking histories and experience behavioral problems resulting from alcohol use. The MAST proved to be an efficient method of assessing alcohol-related problems among those with recent spinal cord injuries. Finally, treatment and hospital policy implications are discussed.