脑损伤患者应用洛文斯顿作业疗法认知评定量表的结构效度检测

目的：检测国内脑损伤患者中洛文斯顿作业疗法认知评定量表（中文版）的结构效度。 方法：以2004—05／2005—01在南方医院康复医学科住院的脑损伤患者34例作为病例组，以无中枢神经系统疾病的其他患者和患者家属、陪护人员64例为对照组。运用证实性因子分析的方法对洛文斯顿作业疗法认知评定量表的结构效度进行考察。中文洛文斯顿作业疗法认知评定量表包括6个方面26项条目：①地点定向；②时间定向；③物品识别；④几何图形识别；⑤图形重叠识别；⑥物品一致性辨别；⑦身体方向；⑧与周围物体的空间关系；⑨图片之中的空间关系；⑩运动模仿；（11）物品使用；（12）象征性动作；（13）临摹几何图形；（14）复绘二维图形；（15）插孔拼图；（16）彩色方块拼图；（17）无色方块拼图；（18）碎图复原；（19）画钟面；（20）物品分类；（21）Riska无组织图形分类；（22）Riska有组织图形分类；（23）图片排序A；（24）图片排序B；（25）几何图形排序推理；（26）逻辑问题。其中①-②为定向；③-⑥为视知觉；⑦-⑨为空间知觉，（10）-（12）为动作运用。（13）-（19）为视运动组织，（20）-（26）为思维运作。除了①、②记分为1-8分，（20）-（22）记分为1-5分外，其余记分为1～4分。总分为115分。 结果：两组观察对象均完成测试，进入结果分析。洛文斯顿作业疗法认知评定量表在病例组中有较高的结构效度，病例组6个公因子累积方差贡献率为88．4％，每个条目在其中一个公因予有较高的负荷，地点定向、时间定向负荷于因子5，几何图形识别、图形重叠识别、物品一致性辨别负荷于因子1，临摹几何图形、复绘二维图形、插孔拼图、彩色方块拼图、无色方块拼图、碎图复原负荷于因子1，图片顺序B、图片顺序A、几何图形排序推理、逻辑问题负荷于因子2，与量表设计的6个方面相近。对照组6个公因子累积方差贡献率为68．1％，各条目在6个公因子的负荷分布与洛文斯顿作业疗法认知评定量表设计的6个方面差异大，部分条目因子负荷为负数。说明该量表在对照组结构效度一般。 结论：对于国内脑损伤患者，洛文斯顿作业疗法认知评定量表具有较好的结构效度，适宜在国内临床工作中运用。     

脑损伤患者应用洛文斯顿作业疗法认知评定量表的结构效度检测

目的:检测国内脑损伤患者中洛文斯顿作业疗法认知评定量表(中文版)的结构效度。方法:以2004-05/2005-01在南方医院康复医学科住院的脑损伤患者34例作为病例组,以无中枢神经系统疾病的其他患者和患者家属、陪护人员64例为对照组。运用证实性因子分析的方法对洛文斯顿作业疗法认知评定量表的结构效度进行考察。中文洛文斯顿作业疗法认知评定量表包括6个方面26项条目:①地点定向;②时间定向;③物品识别;④几何图形识别;⑤图形重叠识别;⑥物品一致性辨别;⑦身体方向;⑧与周围物体的空间关系;⑨图片之中的空间关系;⑩运动模仿;紒矠紜物品使用;紝紒矠象征性动作;紞矠紒临摹几何图形;紟矠紒复绘二维图形;紡矠紒插孔拼图;紣矠紒彩色方块拼图;紒矠紤无色方块拼图;紒紥矠碎图复原;紦矠紒画钟面;紓紛矠物品分类;紜矠紓Riska无组织图形分类;紓矠紝Riska有组织图形分类;紞矠紓图片排序A;紟矠紓图片排序B;紡矠紓几何图形排序推理;紓紣矠逻辑问题。其中①～②为定向;③～⑥为视知觉;⑦～⑨为空间知觉,⑩～紒紝矠为动作运用。紞紒矠～紦矠紒为视运动组织,紛紓矠～紓矠紣为思维运作。除了①、②记分为1～8分,紛矠紓～紝矠紓记分为1～5分外,其余记分为1～4分。总分为115分。结果:两组观察对象均完成测试,进入结果分析。洛文斯顿作业疗法认知评定量表在病例组中有较高的结构效度,病例组6个公因子累积方差贡献率为88.4%,每个条目在其中一个公因子有较高的负荷,地点定向、时间定向负荷于因子5,几何图形识别、图形重叠识别、物品一致性辨别负荷于因子1,临摹几何图形、复绘二维图形、插孔拼图、彩色方块拼图、无色方块拼图、碎图复原负荷于因子1,图片顺序B、图片顺序A、几何图形排序推理、逻辑问题负荷于因子2,与量表设计的6个方面相近。对照组6个公因子累积方差贡献率为68.1%,各条目在6个公因子的负荷分布与洛文斯顿作业疗法认知评定量表设计的6个方面差异大,部分条目因子负荷为负数,说明该量表在对照组结构效度一般。结论:对于国内脑损伤患者,洛文斯顿作业疗法认知评定量表具有较好的结构效度,适宜在国内临床工作中运用。     

改良Loewenstein认知评定量表的效度及信度研究

目的:检验改良Loewenstein认知评定量表(MLOTCA)的效度及信度,为其在国内临床应用提供客观依据。方法:对74例脑血管意外后的患者进行测试,2周后由同一评定者进行复测。对该量表内容效度和结构效度,以及内部一致性信度、重测信度进行检测。结果:量表21个项目与总分之间的相关系数为0.496—0.841,P<0.01,具有较好的内容效度;提取3个主成分,这3个主成分的累计贡献率为69.032%,各项目在相应因子上的因子载荷均大于0.5,可以认为该量表有较好的结构效度。MLOTCA Cronbachα系数0.9379,量表内部一致性信度较好;MLOTCA重测信度相关系数0.718—0.967,重测信度较好。结论:改良Loewenstein认知评定量表有较好的效度和信度,可用于临床脑血管意外后认知功能的评定。     

中文版儿童作业疗法认知功能动态评定量表信度和效度的初步研究

目的确定中文版儿童作业疗法认知功能动态评定量表（DOTCA-Ch）的信度和效度,为其临床应用提供理论依据。 方法将英文版DOTCA-Ch翻译成中文。选取佳木斯市某小学109名学生,分别用中文版DOTCA-Ch和中国-比内智力测验法进行评定。以中国-比内智力测验法作为校标分析校标效度,采用因子分析方法进行结构效度分析,采用组内相关系数（ICC）分析方法进行测量者内信度和测量者间信度分析,应用Cronbach α系数进行内部一致性检验。 结果内部一致性检验：DOTCA-Ch总Cronbach α系数为0.8920,测量者内总ICC为0.991,测量者间总ICC为0.989。在旋转后的因子负荷阵中,各领域在一个公因子中有较高负荷。将采用中国-比内智力测验法所得智商与DOTCA-Ch评分进行相关性分析,6岁组智商与总分的相关系数为0.872,11~12岁组智商与总分相关系数为0.870。 结论中文版DOTCA-Ch具有良好的信度和效度,可以作为一种有效测量工具来评定儿童认知功能。     

洛文斯顿作业疗法认知评定量表中文应用软件的研制

目的将洛文斯顿作业疗法认知评定量表（LOTCA）的操作和记分系统开发成计算机软件.方法将LOTCA人工操作和记分转换为计算机的工艺流程,通过整合Basic、C、C^＋＋语言与F1ash虚拟机等技术生成中文应用软件的初步版本,并应用于临床评定,收集反馈意见,对评定中发现的问题及信度与效度不满意的条目进行优化.结果生成了LOTCA中文应用软件,包括测试系统、记分分析系统、数据库管理系统、附属系统四个部分,含有普通话和粤语两种测试语言,可在Windows 2000及Windows XP两种系统下运行.结论洛文斯顿作业疗法认知评定中文应用软件客观、规范、便捷,适合在临床工作中使用.     

康复医学功能评定量表信度和效度研究

介绍康复医学中功能评定量表进行信度和效度的研究方法。各种功能评定量表在临床正式使用之前，需进行量表的信度、效度和敏感度的研究。量表信度是指在相同条件下重复测定结果的近似程度，常用的研究方法包括组内信度和组间信度的检验。量表效度是指量表所测试的结果与它希望测量对象结果的接近程度。常用的研究方法包括表面效度、内容效度、标准效度、结构效度和区分效度等。量表的敏感度是指在内、外环境变化时，被测对象有所变化，则测量结果对比变化做出反应的敏感程度。常用的研究方法包括治疗前后的统计学分析，以及使用效应尺度统计量评价量表的敏感度。     

脑卒中患者P300与洛文斯顿认知评定量表相关性研究

目的探讨脑卒中患者P300与洛文斯顿认知评定量表（LOTCA）的相关性,并分析其临床意义。 方法选取60例脑卒中患者作为病例组,相匹配的30例健康人作为对照组,均行事件相关电位（ERP）P300和LOTCA认知功能检测,并进行相关性比较。 结果病例组P200、N200、P300潜伏期较对照组明显延长（P＜0.01）,P300波幅降低（P＜0.01）;LOTCA总分及各亚项评分均明显低于对照组。病例组P300潜伏期与LOTCA总分呈高度负相关(r=-0.891,P＜0.01),P300波幅与LOTCA总分呈低度正相关（r=0.311,P=0.05）;P300潜伏期与LOTCA各亚项评分均呈中至高度负相关（r=-0.587~-0.846,P＜0.01）;P300与LOTCA各亚项评分、年龄进行逐步多元回归分析,依次以思维运作、动作运用、空间知觉对P300影响较大。 结论P300与LOTCA具有相关性,2者结合可早期、客观、全面的评定血管性认知障碍。P300潜伏期反映认知功能类型不具明显特异性,受思维运作影响最大。     

功能评定量表信度和效度的研究

功能评定(functional evaluation)是康复医学中很重要的组成部分，很多康复治疗的效果是通过功能评定来判断。为了做好功能评定必须有规范化的评定量表，有些评定量表是国际上公认的，而有些量表是本地区、本单位根据需要自行制定的。后者在临床正式使用之前，需要进行该量表的信度、效度和敏感度等的研究，只要通过了这些研究，才能加以临床使用，或进行推广应用。     

康复医学功能评定量表信度和效度研究

介绍康复医学中功能评定量表进行信度和效度的研究方法。各种功能评定量表在临床正式使用之前,需进行量表的信度、效度和敏感度的研究。量表信度是指在相同条件下重复测定结果的近似程度,常用的研究方法包括组内信度和组间信度的检验。量表效度是指量表所测试的结果与它希望测量对象结果的接近程度。常用的研究方法包括表面效度、内容效度、标准效度、结构效度和区分效度等。量表的敏感度是指在内、外环境变化时,被测对象有所变化,则测量结果对此变化做出反应的敏感程度。常用的研究方法包括治疗前后的统计学分析,以及使用效应尺度统计量评价量表的敏感度。     

脑卒中患者姿势评定量表的效度及信度研究

目的探讨脑卒中患者姿势评定量表(PASS)的效度和信度,为临床应用提供客观依据。方法2组受试对象参加了测试,一组为病例组(27例),另一组为对照组(30例)。1周内对两组对象用PASS和Fugl-Meyer量表中的平衡部分(FM-B)进行2次评定,病例组同时用Berg平衡量表(BBS)评定。将PASS结果与FM-B、BBS作相关性检验来验证PASS的效度;对2次PASS结果作相关性分析来测试PASS的重复测量信度。结果PASS和FM-B、BBS总分高度相关(r=0.943-0.944、r=0.957);PASS各项内容2次重复测试结果高度相关,其组内相关系数ICC=0.945-0.962,组间相关系数ICC=0.982-0.992;病例组和对照组的PASS总分分别为(16.43±10.44)分、(35.32±0.95)分,两者间差异有显著性(P<0.05)。结论PASS具有良好的效度和信度,可用于姿势控制能力的评价。     

洛文斯顿作业疗法认知评定中文量表信度和内在效度的初步研究

目的　测试洛文斯顿作业疗法认知评定 (LOTCA)量表 (第 2版 )中文译文的信度和内在效度。方法　将LOTCA(第 2版 )量表翻译成中文后 ,分别由 2名评定员根据其中文译文在 2周内对 3 4例脑外伤患者 (病例组 )和 64例无中枢神经系统疾病者 (对照组 )进行评定 ,对LOTCA量表中文译文的评定员一致性信度、重测信度、组内信度、内容效度和区分效度进行比较。结果　⑴绝大部分项目信度良好 (r >0 .8,P <0 .0 0 1)。⑵病例组的克朗巴哈α信度系数为 0 .977,对照组为 0 .873 ,病例组每个领域的克朗巴哈α信度系数均>0 .9。⑶病例组LOTCA量表内容效度较好 ,各项条目所在领域的相关性好 (r =0 .697～ 0 .975 ,P <0 .0 1)。⑷LOTCA量表具有较高的区分效度 (P <0 .0 0 1)。结论　对于我国脑外伤患者 ,LOTCA量表中大部分项目具有较高的信度和效度 ,适宜在国内临床工作中推广。     

A cluster randomised controlled trial on the efficacy of client-centred occupational therapy in multiple sclerosis: good process,poor outcome

Abstract

Purpose: To assess the efficacy of client-centred occupational therapy (OT) according to a client-centred process framework, as compared to usual care OT, in patients with multiple sclerosis (MS). Method: A multicentre cluster randomised controlled trial with the institution (i.e. hospital or rehabilitation centre) as the unit of randomisation was performed. A total of 269 outpatients with MS, 13 hospitals and rehabilitation centres and 29 occupational therapists participated. Primary outcomes included measures of disability, participation and autonomy. Secondary outcomes included fatigue, generic health-related quality of life, quality and evaluation of therapy, therapy compliance and therapy frequency. Measurements were taken at baseline, four months and at eight months follow-up. Results: Primary outcome measures did not show significant differences between the two interventions. Secondary outcomes revealed significant differences in favour of the usual care OT on fatigue (physical scale and total scale) and health-related quality of life (bodily pain and vitality) at four months. After eight months only significant differences on mental health were found. Process outcomes (i.e. the information scale of therapy quality and the client-centredness of the organisation) were in favour of the client-centred intervention. Conclusion: Because the client-centred intervention resulted in no effects on the primary outcomes and small but negative effects on the secondary functional outcomes, we should seriously reconsider the application of client-centred practice.

• Implications for Rehabilitation

• An increasing number of interventions claim to incorporate client-centred practice. Client-centred practice is associated with improved satisfaction but the effects on functional health-related outcomes have not been fully evaluated.

• The findings of this study show that the process outcomes of therapy were in favour of the client-centred intervention, but no effects were found on the primary outcomes and negative effects on the secondary functional health outcomes.

• It is suggested that the implementation of client-centred practice should be adjusted in order to achieve optimal health outcomes.

     

神经行为认知状态检查表信度与效度的初步测定

目的　引进神经行为认知状态检查表 (NCSE)并测定中文NCSE的信度和效度。方法　以康复科住院病人 2 5例为样本 ,间隔 1周评定重测信度。以康复科因脑损伤而住院的患者 5 5例为样本 ,评定效度。结果　绝大部分项目重测信度好 (r >0 .7,P <0 .0 1) ;5 5例脑损伤患者 ,被神经康复专家临床评定分为两组 (正常组和认知功能障碍组 ) ,认知功能障碍组在中文NCSE中的得分低于正常组 (P <0 .0 1) ;中文NCSE的语言项目与CRRCAE 中国康复研究中心失语症检测结果相关性强 ((r =0 .72 -0 .78,P <0 .0 1) ,记忆项目与Rivermead行为记忆能力评定结果的相关性强 (r =0 .72 ,P <0 .0 1) ;以量表给定的临界值为标准 ,中文NCSE对器质性脑损伤患者认知功能障碍的临床诊断灵敏度为 93 .5 % ,特异度为 65 %。结论　中文NCSE经初步测试 ,信度和效度基本满意 ,尤其适用于器质性脑损伤患者的筛选 ,建议扩大样本临床试用。     

Reliability,validity, and responsiveness of the Balance Evaluation Systems Test (BESTest) in individuals with multiple sclerosis

Background

The Balance Evaluation Systems Test (BESTest) measures various aspects of postural control, but little data exist in persons with multiple sclerosis (MS). The purpose of this study was to determine the psychometrics of the BESTest in MS.

The satisfaction of patients with multiple sclerosis regarding services received from physical and occupational therapists

The purpose of this study was to describe the satisfaction of patients with multiple sclerosis regarding the services they received from their physical and occupational therapists. Eighty-one patients volunteered for the study in response to advertisements and completed the Therapist Evaluation Form (TEF). Subjects had to have been a physical or occupational therapy patient within the last year and also had to have seen the same therapist for a minimum of four treatment visits. Total score and item analysis of the results demonstrated a high degree of satisfaction among the patients surveyed. The content of two open-ended questions on the TEF also showed that patients value therapist characteristics of being friendly and caring. Patients reported less satisfaction with the therapists' technical skills as opposed to rapport issues. These results reinforce the literature, which cites the importance of interpersonal aspects of patient/professional relationships for persons with disabilities. In addition, the initial reliability and validity data on the TEF obtained in this study support its further development as an instrument to measure patient satisfaction in physical and occupational therapy.     

A single-group pilot feasibility study of cognitive behavioural therapy in people with multiple sclerosis with depressive symptoms

Purpose: The aims were to evaluate (a) the feasibility of face-to-face cognitive behavioural therapy (CBT) in people with MS (PwMS) with depressive symptoms; (b) the feasibility of methods and measurements used; and (c) the outcome of the intervention before the conducting of an equivalence study of comparative methods of face-to-face CBT.

Design: A single-group pilot feasibility study.

Patients: PwMS (n?=?15) with sub-threshold to moderate depressive symptoms, recruited at the Karolinska University Hospital, Stockholm, Sweden.

Methods: The intervention consisted of 15–20 sessions of face-to-face CBT. Feasibility outcomes included recruitment rate, recruitment procedure and adverse events. Primary clinical outcome was the Beck Depression Inventory-II (BDI-II). Follow-ups were conducted after 3 weeks and 3 months. An estimated sample size calculation was conducted.

Results: The face-to-face CBT intervention, methods and measurements used were feasible. The outcome on BDI-II indicated that face-to-face CBT is an effective method for alleviating sub-threshold to moderate depressive symptoms in PwMS.

Conclusion: Face-to-face CBT is feasible for use in PwMS aiming at decrease depressive symptoms. For an equivalence study, a screening process for depressive symptoms and two comparative intervention arms including traditional face-to-face CBT and low-intensity face-to-face CBT is recommended. Primary outcomes should include the BDI-II and also assessment of anxiety symptoms.

• Implications for Rehabilitation

• Depression is common among people with MS (PwMS), however, depressed PwMS do not always receive adequate treatment for depression which may lead to increased disability and worse health-related quality of life (HRQL).

• Cognitive behavioural therapy (CBT) is a psychological treatment method that might be beneficial for PwMS with depressive symptoms, but the evidence is still weak and further research is needed.

• The results from our pilot feasibility study demonstrate that for an effectiveness study of face-to-face CBT for PwMS with sub-threshold to moderate depressive symptoms the following points should be acknowledged.

• The design of an effectiveness study should be a randomized controlled trial including two treatment arms: traditional face-to-face CBT and a low-intensity face-to-face CBT.

• To increase the inclusion rate a screening process for depressive symptoms is recommended.

• Primary outcomes besides the Beck Depression Inventory-II should include the Hospital Anxiety and Depression Scale in order to capture anxiety symptoms and the Multiple Sclerosis Impact Scale-29 to capture HRQL.

     

Examining the relationship between physical and occupational therapists and their patients with multiple sclerosis

This study examines the relationship between physical and occupational therapists (referred to collectively as therapists) and their patients with multiple sclerosis. Specifically, the purposes of this study were to quantify the relationship between (a) therapists' attitudes toward persons with disabilities and their patients' satisfaction, and (b) between therapists' general life values and their patients' satisfaction. An additional purpose was to determine which variable type, attitudes or values, was the most effective predictor of patient satisfaction. Seventy-eight patient/professional dyads contributed data, and a statistically significant multiple correlation was evident between therapists' attitudes and their patients' satisfaction (R=.426,F(7,70)=2.21,p<.043). The relationship between therapists' values and their patients' satisfaction was nonsignificant. These results support anecdotal literature indicating that for persons with disabilities, therapists' individual difference variables relate to how patients rate their satisfaction with their health care. In addition, the results suggest the use of attitude change interventions as a way of improving these relationships.     

Loewenstein认知评定量表与简易精神状态检查评定脑损伤患者认知功能的比较

目的　比较Loewenstein认知功能评定量表 (LOTCA )与简易精神状态检查 (MMSE)评定脑损伤患者和同年龄组非脑损伤患者的结果 ,并分析LOTCA的特征。方法　 2组对象参加研究 ,病例组 ( 3 6例 )男 2 8例 ,女 8例 ,平均年龄 ( 61.0± 16.7)岁 ;对照组 ( 4 4例 )男 19例 ,女 2 5例 ,平均年龄 ( 5 5 .4± 2 3 .7)岁。分别采用LOCTA和MMSE对 2组对象评定 ,同时对其评定结果进行相关性和项目内容比较。结果　LOTCA和MMSE总分高度相关 (r =0 .892 ,P <0 .0 0 1) ,LOTCA总分与MMSE子项目 (除了记忆力 )呈中至高度相关 (r =0 .64 0～ 0 .871,P <0 .0 0 1)。对照组MMSE总分正常者中 ,LOTCA评定发现视运动组织项和思维操作项得分明显低于其他几项。完成LOTCA所需时间是MMSE的 3倍。结论　LOTCA较MMSE能更全面地评定认知功能 ,特别是在视运动组织和思维操作方面 ,可作为临床上深入研究认知功能的工具。     

颈椎病临床评价量表的信度与效度研究

目的　制定一种对颈椎病患者的症状、体征和功能状态进行临床评估的临床评价量表(CASCS) ,并探讨其在颈椎病临床评价中的信度及效度。方法　对 92例颈椎病患者 (实验组 )应用CASCS与Vernon颈椎残障指数量表 (NDI)进行信度、效度和敏感度分析 ,同时应用CASCS对 2 0例正常人 (对照组 )进行评测。并对颈椎病患者康复治疗前、后的CASCS评测结果进行对比分析。结果　CASCS总积分与各条目积分间的组内相关系数 (ICC)为 0 .78～ 0 .99,信度系数Cronbachα为 0 .84。该量表与NDI有较好的相关性(r =0 .76,P <0 .0 1)。康复治疗前 ,颈椎病患者与正常人的CASCS评价结果间有极显著性差异 (t =14 .76,P <0 .0 1)。颈椎病患者康复治疗前、后的CASCS评测结果间有极显著性差异 (t =2 1.0 3,P <0 .0 1)。结论　CASCS具有较高的信度、效度和敏感度 ,是临床评价颈椎病的一种客观、行之有效的方法