上肢动作研究量表在脑卒中患者中的效度

目的验证上肢动作研究量表（ARAT）在脑卒中患者中的会聚效度、区分效度和同时效度。方法对30例慢性脑卒中患者进行上肢动作研究量表、Fugl-Meyer评价量表和动作活动记录量表（MAL）的评价，进行相关分析。结果ARAT得分与Fugi—Meyer量表上肢得分显著相关（p-0．906，P〈0．001），Fugl-Meyer量表上肢得分〈33分组和≥33分组的ARAT得分之间有非常高度显著性差异（t=6．614，P〈0．001），ARAT与MAL的使用量量表（AOU）和动作质量量表QOM之间显著相关（p=0．894和0．761，均P〈0．001）。结论ARAT在脑卒中患者中具有良好的会聚效度、区分效度和同时效度。     

中文版上肢活动量表在脑卒中上肢痉挛患者应用中的信度和效度研究

摘要目的：汉化上肢活动量表（arm activity measure,ArmA）并分析其信度和效度,为评估脑卒中患者痉挛后上肢功能障碍提供简单、有效的工具。方法：对英文版ArmA进行翻译和文化调试,并使用中文版ArmA对50例脑卒中患者进行自我评估,对其结果进行重测信度、内在一致性和效度分析。结果：试验共入组50例脑卒中患者,平均年龄（52.32±14.83）岁。中文版ArmA量表被动部分与主动部分Cronbach α系数分别为0.718和0.831;重测信度的总分组内相关系数ICC为0.990,各条目的ICC值范围为0.902—1.000;每个条目与其所在维度的相关系数均在0.4以上（P<0.05）,且均高于与其他维度的相关系数;结构效度主成分分析的结果共提取4个公因子;通过spearman相关分析发现,中文版ArmA量表主动部分与上肢Fugl-Meyer量表具有一定相关,与改良Ashworth量表（modified Ashworth scale, MAS）相关性无显著性差异（P>0.05）。结论：中文版ArmA量表在脑卒中患者中具有良好的信度和效度,且评测可操作性高,适用于评估我国脑卒中患者痉挛后上肢的活动功能。     

中文版运动功能状态量表用于评定脑卒中上肢运动功能的信度研究

目的:研究中文版运动功能状态量表(motor status scale,MSS)评定脑卒中上肢运动功能的评定者间信度及内部一致性信度。方法:2名经过MSS规范化培训的评定者使用MSS对36例脑卒中偏瘫上肢运动功能障碍患者进行评定。采用组内相关系数检验MSS的评定者间信度;采用Cronbachα系数和分半信度检验MSS的内部一致性信度。结果:MSS评定者间信度为0.998(0.997—0.999);MSS的内部一致性信度Cronbachα系数为0.910;MSS的前后分半系数为0.702,奇偶分半系数为0.972。结论:MSS具有良好的评定者间信度及内部一致性信度。     

Berg平衡量表在脑卒中患者中的内在信度和同时效度

目的：探讨Berg平衡量表在脑卒中患者中的内在信度和同时效度。方法：40例符合入选标准的脑卒中偏瘫患者参与本研究。对患者进行Berg平衡量表、计时起立-步行测验和Barthel指数的评价。结果：Berg平衡量表的Cronbach α系数为0.864,14项目的Cronbach α系数范围为0.844—0.869,Berg平衡量表折半信度系数为0.915。Berg平衡量表与效标工具计时起立-步行测验和Barthel指数之间显著相关。结论：Berg平衡量表在脑卒中患者中具有良好的内在信度和同时效度。     

量表在脑卒中上肢运动功能康复中的应用

上肢运动功能障碍是脑卒中后常见的功能障碍之一。这一功能与人们的日常生活息息相关,然而它恢复较难、较慢,是卒中康复过程中的一大难点。合理、有效的康复评定有助于了解上肢运动功能障碍的程度及患者的生活状态,从而指导医师采取针对性的治疗方案,促进患者的康复。因此,本文在查阅相关文献的基础上,整理并分析卒中后上肢运动功能障碍的常用量表,旨在为临床和科研工作者提供参考。     

中文版改良躯干损伤量表在脑卒中患者中的信度与效度研究

目的:翻译挪威版改良躯干损伤量表(the Trunk Impairment Scale-modified to Norwegian Version,mTIS),并探讨其在脑卒中患者应用中的信度与效度,为其临床应用提供客观依据.方法:将挪威版mTIS翻译为中文版mTIS.共入组30例病例,在入组第一天,评定者A与B同时但...     

Wolf运动功能测试量表评定脑卒中急性期患者上肢功能的效度和信度研究

目的：探讨Wolf运动功能测试量表（WMFT）评定脑卒中急性期患者上肢功能的效度和信度,为临床应用提供客观依据。方法：脑卒中急性期患者共23例自愿参加本研究;1周内对所有病例应用WMFT和Fugl-Meyer量表中上肢运动功能测试部分(U-FMA)进行2次评定。将WMFT结果与U-FMA作相关性检验来验证WMFT的效度;对2次WMFT结果作相关性分析来测试WMFT的重复测量信度。结果：WMFT总分和U-FMA总分的高度相关（r=0.922、0.929,P＜0.001）。WMFT各项内容的时间中位数和等级均数的2次重复测试结果高度相关,其组间相关系数ICC=0.989、0.997,组内相关系数ICC=0.980、0.991。结论：Wolf 运动功能测试量表具有良好的效度和信度,可用于脑卒中急性期患者的上肢功能的评价。     

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。     

脑卒中后吞咽困难9个评价量表的信度及效度研究

目的：研究脑卒中后9个吞咽困难量表在国内使用的信度和效度。方法：56例连续住院的神经内科住院患者进行量表的评定及电视透视检查。量表的信度用kappa相关，校标效度用Spearman相关分析，预测效度用分组方差分析、Logistic回归分析及Spearman相关。敏感度采用效应尺度分析，量表间的相关性用Spearman相关分析。结果：所有量表均具有统计学意义的重测信度及评定者间信度。量表2的信度最好(重测信度Kappa值=0．87，P&;lt;0．01；评定者间信度Kappa值=0．665，P&;lt;0．01)，但量表2，5，6，7，9的效度指标(与VF下分级的相关性、误吸预测准确率、与住院期间肺炎和出院时皮脂厚度的相关性)总体来讲不满意，量表1和4的结构及侧重点相似，相关性较好(r=0．728，P&;lt;0．01)，但前者效度优于后者。量表3是9个量表中信度效度均佳的量表。     

简易平衡评定系统测试的汉化及在脑卒中患者中的信度

目的汉化简易平衡评定系统测试(mini-BESTest),测试中文版的信度。方法遵循翻译、逆向翻译、文化调适、预试验的程序,翻译及修订mini-BESTest。由2 名专业人员对61 例脑卒中患者进行mini-BESTest 测试;在首次评估48 h 后,选取其中30 例进行第二次测试。分别计算评定者间及重测组内相关系数(ICC)。计算量表总分和4 个维度Cronbach's α系数。结果测量者间ICC=0.856~0.978 (P<0.01),重测ICC=0.795~0.951 (P<0.01);量表总分和4 个维度间Cronbach's α=0.794~0.905,4 个维度两两之间的相关系数=0.742~0.827。结论中文版mini-BESTest对脑卒中患者具有较好信度。     

功能性电刺激对中风偏瘫患者肩关节半脱位和上臂功能恢复的影响

对32例中风软瘫期继发肩关节半脱位患者随机分为对照组和实验组各16例，以评价功能性电刺激（FES）疗法对肩关节半脱位和上臂功能的作用效果。2组接受常规物理治疗后，实验组再接受2个疗程的FES治疗。结果显示实验组肌张力的增加、上臂功能的恢复及肩关节半脱位缓解程度较对照组有显著性差异。表明FES能有效地减轻肩关节半脱位和促进上臂功能的恢复。     

Reliability and validity of the Intercollegiate Stroke Audit Package

The aim of this study was to assure the validity and reliability of the Intercollegiate Stroke Audit Package as used in the National Sentinel Audit of Stroke. The Intercollegiate Working Party for Stroke, which included most stakeholders, including patients, devised the audit standards. These were submitted to a formal consensus (modified Delphi) survey before the audit questions were developed and piloted for validity and reliability. Following the pilot, Help Booklets were developed to promote the involvement of all disciplines as auditors in the national sentinel audit of stroke and ensure inter-rater reliability. During the national audit each Trust was asked to double rate the first five cases with auditors of different disciplines working independently. A total of 886 case notes were double-rated in 184 separate sites (median 5, range 1-5 per site). Trusts used auditors from different disciplines in 77% of cases. After excluding the 'No answer' cases the kappa score for items ranged from 0.49 to 0.87 (median 0.70, IQR 0.63-0.78). Very good agreement was found for seven of the 45 items, good agreement for 30 items, and moderate agreement for eight items. This large study, across a range of hospital sites and involving many disciplines, demonstrates that careful piloting of audit tools, with use of clear instructions to auditors, promotes the reliability of data.     

卒中患者照顾者照顾感受的质性研究

目的深入了解我国卒中患者照顾者的照顾感受,以探索促进照顾者身心健康的相关措施。方法采用质性研究中的现象学研究方法,对10名卒中患者的照顾者进行非结构访谈,并用现象学分析方法进行资料分析。结果通过阅读、分析、反思、分类和提炼主题,得出4个主题：承受巨大的压力与痛苦;不断调整自己,以适应变化;全身心投入照顾中;在照顾中感受真情。结论我国卒中患者照顾者的照顾感受包括消极和积极两个方面,研究结果同时揭示了照顾者感受的发展历程和中国文化对我国照顾者感受的影响。因此,需要对卒中患者照顾者提供医疗支持、社会支持和经济帮助。     

The Bucket Test Improves Detection of Stroke in Patients With Acute Dizziness

BackgroundIt is challenging to detect posterior circulation strokes in patients presenting to the emergency department (ED) with acute dizziness. The current approach uses a combinatorial head-impulse, nystagmus, and test-of-skew method and is sensitive enough to differentiate central causes from peripheral ones. However, it is difficult to perform and underused. Further, magnetic resonance imaging (MRI) of the brain is not always available and can have low sensitivity for detecting posterior circulation strokes.ObjectivesWe evaluated the feasibility and utility of the bucket test (BT), which measures the difference between patient's subjective perception of the visual vertical and the true vertical, as a screening tool for stroke in patients presenting to the ED with acute dizziness.MethodsIn this work, we prospectively enrolled 81 patients that presented to our academic medical center ED with dizziness as their chief complaint. The BT was performed 3 times for every patient.ResultsSeventy-one patients met the study criteria and were included in the analysis. Ten patients were excluded because of a history of drug-seeking behavior. There were no reported difficulties performing the BT. Six patients (8%) were diagnosed with ischemic stroke on MRI and 1 additional patient was diagnosed with transient ischemic attack and found to have a stroke on subsequent MRI. All 7 patients with dizziness attributed to cerebrovascular etiology had an abnormal BT, resulting in a sensitivity of 100% (95% confidence interval [CI] 59–100%). The specificity of the BT was 38% (95% CI 24–52%). The positive predictive value of the BT for detecting stroke was 18% (95% CI 15–21%).ConclusionsThe BT is an easy, cheap, safe, and quick test that is feasible and sensitive to screen acutely dizzy patients for stroke in the ED.     

运动再学习方案改善脑卒中患者平衡功能的疗效观察

目的探讨运动再学习方案（MRP）对脑卒中患者平衡功能的影响。方法60例脑卒中患者随机分为TRP组和对照组各30例，对照组采用常规本体感神经肌肉促进法（PNF），MRP组采用MRP方法进行康复训练。于训练前后测评两组患者的Fugl—Meyer平衡功能评分。结果训练后，两组患者的Fugl—Meyer平衡功能评分均较训练前提高（P〈0．05），但MRP组的评分高于对照组（P〈0．05）。结论MRP对脑卒中患者平衡功能的恢复有促进作用。     

影响脑卒中患者日常生活活动能力社区康复效果的相关因素

目的探讨影响脑卒中患者日常生活活动能力（ADL）社区康复效果的相关因素。方法202例脑卒中患者随机分为社区康复组103例和对照组99例，社区康复组进行康复治疗和随访，包括对高危因素的药物控制、康复治疗、卫生宣教、心理疏导等，对照组只进行随访。于入组时和治疗5个月后，应用巴氏指数（BI）、神经功能缺损量表及综合功能评定（FCA）中的认知项，对两组患者进行评定。将所有患者最后一次ADL评分作为因变量，分组情况、病程、高血压、高血脂、糖尿病、吸烟、发病部位、文化程度、性别、年龄、饮酒、睡眠质量、FCA认知功能（入组时）、FCA运动功能（入组时）、BI（入组时）、神经功能缺损程度评分（入组时）做为自变量，进行多元回归分析。结果分组情况、发病前是否饮酒、病程（入组时间早晚）、神经功能缺损评分及综合功能评分（运动功能和认知功能）与患者日后的ADL恢复存在相关性。结论早期社区康复治疗对提高脑卒中患者的ADL作用显著；认知障碍对患者的ADL有显著影响。     

Interrater and Intrarater Reliability of the Balance Computerized Adaptive Test in Patients With Stroke

Objective

To examine the interrater and intrarater reliability of the Balance Computerized Adaptive Test (Balance CAT) in patients with chronic stroke having a wide range of balance functions.

Reliability of the Physical Performance Test in People with Dementia

ABSTRACT

Purpose. Approximately 30% of older adults have dementia. Disease progression has been found to be the largest predictor of function, and dementia has been found to influence fall risk. In order to identify individuals with dementia who may benefit from interventions to increase function and decrease fall risk, assessment tools for these domains that are validated in this population are necessary. The 7-item Physical Performance Test (PPT) is a valid measure of balance and function in older adults; however, its reliability has not been established in those with dementia. The purpose of this study was to establish intra-tester, inter-tester, and test–retest reliability of the 7-item PPT in people with dementia. Methods. Thirty-three subjects with a diagnosis of dementia and a Mini-Mental State Examination (MMSE) score between 10 and 24 were tested with the PPT on two separate days with performance on the second day videotaped. One tester scored the videotaped performance on two separate occasions and intra-tester reliability was determined using an intraclass correlating coefficient (ICC) (3,1). Two testers independently scored the videotaped performances and inter-tester reliability was determined using an ICC (2,1). Scores from the first and second testing days were compared and test–retest reliability was determined using an ICC (3,1). Results. All subjects completed both testing sessions and reliability was established for intra-tester, inter-tester, and test–retest with ICCs of 0.99, 0.96, and 0.90, respectively. Conclusion. The 7-item PPT is reliable for use in people with mild to moderate dementia as defined by MMSE scores between 10 and 24.