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Peanson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a=0．822，各项之间a=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&;lt;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。     

康复护理ADL评定量表的信度和效度研究

目的　研究探讨康复护理ADL(ADLS RN)量表在患者日常生活活动功能评测中的信度与效度。方法　对 40例住院康复患者用ADLS RN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Cronbachα计算 ;并分别用ADLS RN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。结果　ADLS RN评测者内部和评测者之间的信度良好 ,重测信度和评测者之间的相关系数 (ICC)范围分别为 0 .966～ 0 .998和 0 .996～ 0 .997;内部一致性信度系数α =0 .82 2 ,各项之间α =0 .92 5 ,ADLS RN内部一致性较好。ADLS RN和MBI的比较研究得出 :出、入院ADLS RN与MBI改变值间相关性良好 ,r =0 .89,P <0 .0 0 1。结论　ADLS RN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。     

康复护理ADL量表的有效性研究

目的　研究康复护理ADL量表在ADL评测中的有效性。方法　对 6 0例患者采用改良BI指数和康复护理ADL评定两种量表进行测评 ,用pearson分析计算入院、出院、出入院改变值及改变值之间相关性 ,对康复护理ADL量表各项目计算组内相关系数。结果　两量表在出入院评测结果有较高相关性 ,入院时r =0 .94 7,P <0 0 0 1,出院时r =0 .94 4 ,P <0 .0 0 1。出入院改变值呈显著相关 ,r =0 .890 ,P <0 .0 0 1。MBI出入院改变值 32 84± 13.2 4 ,RNADL39.0 3± 14 .2 7。两次测评各项目间相关系数r =0 .92 4～ 0 .96 8,P <0 .0 0 1。结论　康复护理ADL量表重测信度高 ,内部一致性较好 ,是一种有效性较好的ADL评定量表     

脑性瘫痪儿童日常生活活动康复护理评定量表的信度和效度研究

目的:研究探讨脑性瘫痪(脑瘫)儿童日常生活活动(ADL)康复护理评定量表在脑性瘫痪儿童日常生活活动能力评定中的信度与效度。方法:选择2017年3月—2017年9月到佳木斯大学附属第三医院住院治疗的痉挛型脑瘫儿童256例,采用脑瘫儿童ADL康复护理评定量表、儿童功能独立性测量量表(Wee FIM)、Gesell婴幼儿发展量表进行评定。ADL量表信度和二级类目分信度检验采用Kappa一致性分析方法;ADL与Wee FIM、Gesell同步效度采用Spearman相关分析。结果:脑瘫儿童ADL康复护理评定量表9个二级类目的整体Kappa值为0.869,信度优;二级类目分信度中,Kappa值最高项目为床上运动翻身0.914,最低项目为认知交流0.833;评估者间信度为0.702—0.875,信度中到优。脑瘫儿童ADL康复护理评定量表和Wee FIM、Gesll的比较研究得出两者相关性良好,P0.01。结论:脑瘫儿童ADL康复护理评定量表具有很高的重测信度,内部一致性较好,与Wee FIM量表、Gesell量表有良好的关联效度。采用ADL康复护理评定量表对脑瘫康复护理日常生活活动能力评定可靠、有效。     

RNADL量表与MBI指数量表间的比较分析

康复功能评定是康复医学中的重要组成部分之一。在康复l临床实践中，l临床工作常需使用各种可靠的量表对患功能状况进行评定，如对患的日常生活活动（Activities of Daily Living，ADL）能力进行评定是了解其身体功能、残存能力的重要评定方法之一。要得到客观、真实的ADL评定结果必须有规范化的评测量表，目前临床上使用的ADL评定量表中，有些评定量表是国际上公认的，有些评定量表则是自行研制的，如功能综合评定量表（Functional Comprehensive Assessment,FCA）、康复护理日常生活活动（rehabilitative nursing activities of daily living．RNADL）量表等，     

康复护理ADL量表简介

康复评定是康复程序中重要的环节，康复临床常使用客观评定量表对患者的功能状态进行评定。康复护理除对患者一般状况、心理、社会等方面的评估外，主要对患者进行日常生活活动(activity of daily living，ADL)能力的评定。根据评定结果，制定康复护理计划、指导、督促ADL能力训练。本文主要通过对康复护理ADL(rehabilitative nursing activity of daily living，RNADL)量表的介绍，为其在临床应用提供参考。     

改良Barthel指定（简体中文版）量表评定脑卒中患者日常生活活动能力的效度和信度研究

目的探讨改良Barthel指数（MBI）简体中文版评定脑卒中患者日常生活活动能力（ADL）的效度、信度和敏感度,为其临床广泛应用提供客观依据。 方法共选取40例脑卒中患者,其中男26例,女14例;年龄（59.65±11.68）岁;病程(21.20±19.44)d。2名评定员使用MBI、原始Barthel指数（BI）和功能独立性测定（FIM）中的运动部分（M-FIM）对上述患者进行ADL评定,各量表分别评定3次。将MBI结果分别与BI、M-FIM结果进行Spearman相关性分析以检验MBI的效度;对不同评定员间的MBI结果进行等级间相关系数（ICC）分析以检验MBI的内部信度和评定员之间信度;对治疗前、后的MBI结果进行符号秩和检验和配对t检验,从而分析MBI敏感度。 结果MBI结果与BI各项及总分均具有高度相关性（r=0.816~1.000,P<0.01）,与M-FIM总分也有高度相关性（r=0.935~0.981,P<0.01）;MBI在同一评定者及不同评定者间均有良好的信度（ICC=0.866~0.997）;患者经治疗后,发现其MBI评定中的进食、修饰、穿衣、床椅转移、上下楼梯及总分项目与治疗前比较,差异均有统计学意义(P<0.05),而BI评定中仅上下楼梯及总分项目差异具有统计学意义(P<0.05),表明MBI敏感度优于BI。 结论MBI量表具有良好的效度、信度和敏感度,对评定脑卒中患者ADL具有重要意义。     

RNADL评定量表在脑卒中患者康复训练中的应用

目的评价RNADL评定量表在脑卒中后偏瘫患者康复中的应用。方法采用RNADL评定量表在68例脑卒中偏瘫患者入院时、康复训练1个月时及出院时三次进行ADL功能评定,针对ADL功能评定存在的功能障碍进行个性化的康复训练。结果68例脑卒中患者经康复训练后ADL能力均显著提高,RNADL总分由入院时的(37.73±3.61)分提高到出院时的(81.79±18.69)分(P<0.01)。结论RNADL评定量表对评估脑卒中患者提高ADL能力具有指导作用。     

简体版改良Barthel指数在脑卒中恢复期中的信度与效度研究

目的:观察简体版改良Barthel指数量表(MBI)在评定脑卒中患者恢复期基础性日常生活活动(BADL)的信度和效度。方法:由2名研究员对100名符合入选标准的脑卒中恢复期患者进行BADL评定。在患者入院的次日,上午由评定员A、B使用MBI分别对每位患者的BADL进行评定,下午由评定员A使用MBI、评定员B使用BI分别对每位患者的BADL进行再次评定,收集整理数据并加以分析。采用相关系数(ICC)值描述评价者的重测信度、评价者间信度,采用Cronbach’sα系数进行计算量表的内部一致性;邀请6名高级职称康复专家对简体版MBI的内容效度(CVI)进行评估,采用Spearman相关性检验分析简体版MBI的校标效度(以BI为金标准),采用KMO检验、Bartlett球形检验和因子分析方法来分析构想效度。结果:6名专家对简体版MBI的条目水平CVI为0.83~1,量表水平CVI均值为0.95;简体版MBI各个条目、总分的重测信度为ICC=0.909~0.991;简体版MBI各个条目、总分的评定者间信度为ICC=0.880~0.992;简体版MBI内部一致性Cronbach’α系数为0.929;以BI为金标准,简体版MBI的校标效度(Spearman相关系数)依次为:进食(0.562)、个人卫生(0.701)、洗澡(0.715)、如厕(0.785)、穿衣(0.684)、大便控制(0.690)、小便控制(0.630)、床椅转移(0.925)、步行/轮椅(0.864)、上下楼梯(0.877)、总分(0.941),均P<0.001;简体版MBI构想效度结果显示,KMO统计量为0.877,Bartlett球形检验拒绝相关阵是单位阵(P<0.05),80.28%的总方差可由2个公因子解释,旋转后因子1有:洗澡、穿衣、如厕、床椅转移、步行/轮椅、上下楼;旋转后因子2有:进食、个人卫生、大便控制、小便控制。结论:简体版MBI量表不仅具有良好内容效度、重测信度、评定者间信度、内部一致性、校标效度和构想效度,而且易于掌握、使用方便。     

功能综合评定量表的研究(二)信度研究

目的 :探讨功能综合评定量表 (functionalcomprehensiveassessment ,FCA)在评测脑血管意外患者中的可信性。方法 :对已明确诊断的 2 0例脑血管意外患者进行评测者内部和评测者之间的信度分析 ,并对FCA的内部一致性进行分析。结果 :FCA评测员内部和评测员之间的信度较好 ,各选项组内相关系数 (ICC)范围在 0 .78— 0 .99(ICC总分 >0 .90 0 )。FCA的内部一致性较好 ,(运动功能α=0 .93 ,认知功能α=0 .98,FCA总分α =0 .96)。结论 :FCA具有很好的重测信度和内部一致性 ,是脑血管意外患者综合功能评定一项可信的评测量表     

康复护理干预对老年脑卒中病人日常生活活动的影响

[目的]探讨早期康复护理治疗对老年脑卒中病人运动功能、日常生活活动(ADL)能力恢复的影响。[方法]随机将70例脑卒中病人分为干预组和对照组各35例,两组病人采用相同的药物治疗,干预组在病人生命体征稳定3d~7d后进行康复护理治疗,采用Bobath和Rood技术训练。采用Brunnstrom分级评定、简式Fugl-Meyer(FMA)运动评分、改良的巴式指数(MBI)进行康复评价。[结果]Brunnstrom、FMA、MBI评分在治疗前两组病人差异无统计学意义(P>0.05),治疗后较治疗前改善明显(P<0.01),干预组优于对照组(P<0.05)。[结论]康复护理治疗可明显促进运动功能、ADL能力恢复,但干预组疗效优于对照组。     

Inter-observer reliability of clinical outcome measures in a lower limb amputee population

Purpose : In an attempt to find a more clinically useful functional outcome measure specifically tailored for lower limb amputees undergoing inpatient prosthetic rehabilitation, a 6-month prospective assessment of inter-rater reliability for Harold Wood - Stanmore Mobility Scale Data, including two handicap scales, was undertaken. An analysis of the data is presented in this paper. Methods : An inter-rater reliability study was undertaken using four observers to complete admission and discharge scores for the three disability/handicap scales on 14 consecutive patients over 6 months. Results : The disability mobility scale demonstrated perfect observer agreement on admission and at discharge the inter-rater reliability for this measure was high (0.83). By contrast, reliability between observers for admission scores on the handicap mobility scale was poor at 0.49 but reasonably high on discharge (0.83). On admission, inter-rater reliability for handicap physical independence was very low (0.15). At discharge, reliability improved to 0.69 being more consistent with results achieved for the other axes. Conclusions : This study confirms the good inter-rater reliability demonstrated previously in the literature but reveals poor inter-rater reliability for the two handicap scales. The latter will require modification before they can be used with confidence in conjunction with the disability scale.     

Inter-observer reliability of clinical outcome measures in a lower limb amputee population

Purpose : In an attempt to find a more clinically useful functional outcome measure specifically tailored for lower limb amputees undergoing inpatient prosthetic rehabilitation, a 6-month prospective assessment of inter-rater reliability for Harold Wood - Stanmore Mobility Scale Data, including two handicap scales, was undertaken. An analysis of the data is presented in this paper.

Methods : An inter-rater reliability study was undertaken using four observers to complete admission and discharge scores for the three disability/handicap scales on 14 consecutive patients over 6 months.

Results : The disability mobility scale demonstrated perfect observer agreement on admission and at discharge the inter-rater reliability for this measure was high (0.83). By contrast, reliability between observers for admission scores on the handicap mobility scale was poor at 0.49 but reasonably high on discharge (0.83). On admission, inter-rater reliability for handicap physical independence was very low (0.15). At discharge, reliability improved to 0.69 being more consistent with results achieved for the other axes.

Conclusions : This study confirms the good inter-rater reliability demonstrated previously in the literature but reveals poor inter-rater reliability for the two handicap scales. The latter will require modification before they can be used with confidence in conjunction with the disability scale.     

脑卒中患者康复训练依从性与日常生活活动能力康复程度的相关性研究

目的 探讨脑卒中患者在病房内康复训练依从性与患者日常生活活动能力康复程度的相关性。 方法 用自行研发的脑卒中患者康复执行情况观察表和改良的Barthel指数(MBI)评定表对300例脑卒中患者进行观察,根据患者康复训练执行情况把患者分为依从性好组和依从性差组。 结果 两组患者入院MBI值、出院MBI值、出院与入院的MBI改变值以及出院与入院的MBI值改变有显著差异性。 结论 脑卒中患者的康复训练执行力与患者的日常生活活动能力有关,提示在康复治疗过程中提高患者康复训练的依从性。     

康复护理日常生活活动评定在小儿脑性瘫痪术后护理中的价值

目的探讨康复护理日常生活活动（RNADL）评定在小儿脑性瘫痪（脑瘫）手术后护理的价值。方法选择2012年6月-10月200例脑瘫术后患儿为研究对象,随机分为观察组和对照组,每组lOO例,采用RNADL对两组患儿进行功能障碍分型判断及障碍等级评定,并分别实施相应治疗方案及护理措施,并就2个月后的康复效果进行评价。结果与入组时比较,观察组患儿在2个月时的RNADL评分显著增高（P〈0．01）,其2个月时重度障碍的患儿较对照组明显减少（P〈O．05）。结论RNADL评定是脑瘫患儿康复治疗的前提和基础,通过正规RNADL评定后采取合理有效的康复治疗方案能明显改善患儿的日常生活能力。     

基于ICF的失能评估工具在临床应用中的信度研究

目的验证基于国际功能、残疾和健康分类(ICF)的功能评定工具在失能评估中的信度。方法选取江苏钟山老年康复医院存在功能障碍的住院患者371例参与本研究,以基于ICF的功能评定工具对患者进行失能评估,以数字化评定量表(0~10分)评估条目失能程度。分析失能评定工具的内在一致性、评估者间信度、评估者内信度。结果基于ICF的失能评定量表的Cronbach′sα系数为0.89,评估者间信度分析显示量表总分的组内相关系数(ICC)为0.85,量表包含的20个条目的ICC在0.78~0.94(P<0.01);评估者内信度分析显示量表的总分ICC为0.95,除b230听力外,量表包含的其它条目ICC在0.72~0.97(P<0.01)。结论基于ICF的失能评定工具与数字评定量表联合在临床失能评估应用中具有良好的内在一致性及评估者间信度和评估者内信度。     

Reliability and validity of the Northwick Park Dependency Score (NPDS) Swedish version 6.0

OBJECTIVE: To translate, to test inter-rater and intra-rater reliability and concurrent validity of the Basic Care Needs (BCN) section of the Northwick Park Dependency Score (NPDS). DESIGN: Test-retest reliability and validity testing. Observed data were collected by the staff (nursing staff, occupational therapists). SETTING: Three rehabilitation units. SUBJECTS: Forty inpatients between 16 and 65 years of age with brain injury were included. MAIN MEASURES: Inter-rater and intra-rater reliability was calculated by percentage agreement (PA) and unweighted kappa measure. Concurrent validity was examined by computing Goodman-Kruskal's gamma, a nonparametric statistic for degree of association between the BCN score and the total score of the Functional Independence Measure (FIM). RESULTS: Inter-rater reliability showed a good percentage agreement between nursing staff. Between nursing staff and occupational therapists the percentage agreement was lower especially in one item. Intra-rater reliability showed a good percentage agreement for all assessors. Concordance was good with a gamma--0.83 and an asymptotic error (ase) of 0.04, for nursing staff and for occupational therapists -0.87, ase 0.04. CONCLUSION: The BCN section of NPDS was found to be inter-rater and intra-rater reliable, to have concurrent validity. Further studies are needed on clinical utility. The instrument can be used for assessment of dependency for individual patients with brain injury, and information when transferring between different caregivers. Further studies need to investigate the sensitivity of the instrument.     

上肢动作研究量表在脑卒中患者中的信度

目的探讨上肢动作研究量表（ARAT）在脑卒中患者中的评价者间信度、评价者内信度和内在一致性。方法由两位评价者各自独立的对30例慢性脑卒中患者进行ARAT的评价。检验ARAT的评价者间信度、评价者内信度和内在一致性。结果ARAT的评价者间信度和评价者内信度ICC值分别为0.992和0.987。内在一致性分析结果Cronbach＇sα系数为0.936。结论ARAT在脑卒中患者中具有良好的评价者间信度、评价者内信度和内在一致性。     

A simple bedside test for upper extremity impairment after stroke: Validation of the Utrecht Arm/Hand Test

Purpose. To examine the intra- and inter-rater reliability, criterion validity and responsiveness of the Utrecht Arm/hand Test (UAT), a quick and easy assessment method for upper extremity impairment after stroke.

Method. Study 1 (N = 29): Repeated administration of the UAT at admission and discharge; comparison with scores on the Fugl-Meyer test (FM), Action Research Arm test (ARA) and Self-Care scale of the Functional Independence Measure (FIM). Study 2 (N = 192): Admission of the UAT and Frenchay Arm Test at admission (FAT) and discharge. Computation of Spearman correlations between UAT and FAT and comparison of the Effect Size and the Standardised Response Mean of both measures.

Results. Study 1: Spearman correlations between UAT and FM were 0.93 at admission and 0.94 at discharge. Correlations with ARA and FIM were also high: 0.90 and 0.76 at admission, and 0.89 and 0.73 at discharge. Inter-rater and intra-rater reliability were excellent (weighted κ 0.98–0.99). Study 2: Correlations between UAT and FAT were 0.93 at admission and 0.90 at discharge. The mean UAT score improved from 3.7 at admission up to 4.6 at discharge (p < 0.001). The Effect Size and Standardised Response Mean of the UAT were better than those of the FAT.

Conclusion. The UAT is a simple, valid and reliable bedside test for the evaluation of upper extremity impairment after stroke.     

Intra-rater and Inter-rater Reliability of Mandibular Range of Motion Measures Considering a Neutral Craniocervical Position

[Purpose] The aim of this study was to determine the inter-rater and intra-rater reliability of the mandibular range of motion (ROM) considering the neutral craniocervical position when performing the measurements. [Subjects and Methods] The sample consisted of 50 asymptomatic subjects. Two raters measured four mandibular ROMs (maximal mouth opening (MMO), laterals, and protrusion) using the craniomandibular scale. Subjects alternated between raters, receiving two complete trials per day, two days apart. Intra- and inter-rater reliability was determined using intra-class correlation coefficients (ICCs). Bland-Altman analysis was used to assess reliability, bias, and variability. Finally, the standard error of measurement (SEM) and minimal detectable change (MDC) were analyzed to measure responsiveness. [Results] Reliability was good for MMO (inter-rater, ICC= 0.95−0.96; intra-rater, ICC= 0.95−0.96) and for protrusion (inter-rater, ICC= 0.92−0.94; intra-rater, ICC= 0.93−0.96). Reliability was moderate for lateral excursions. The MMO and protrusion SEM ranged from 0.74 to 0.82 mm and from 0.29 to 0.49 mm, while the MDCs ranged from 1.73 to 1.91 mm and from 0.69 to 0.14 mm respectively. The analysis showed no random or systematic error, suggesting that effect learning did not affect reliability. [Conclusion] A standardized protocol for assessment of mandibular ROM in a neutral craniocervical position obtained good inter- and intra-rater reliability for MMO and protrusion and moderate inter- and intra-rater reliability for lateral excursions.Key words: Reliability, Range of motion, Temporomandibular joint