山地藏区成人大骨节病功能量表的制定

目的制定一个适合山地藏区成年大骨节病（Kashin—BeckDisease，KBD）患者的功能量表，用于评价阿坝藏区KBD患者的功能状态和KBD综合防治措施效果的研究。方法由多名骨外科、风湿免疫科及地方病专家组成的课题组通过参考国际上常用的系列功能评分系统，结合当地KBD特点及居民生活文化特点，设立了16个量表条目。2009年6—9月对阿坝洲壤塘县294名KBD患者进行现场量表调查。通过条目答案分布考察、离散度分析、条目一总分相关性分析、内部一致性Cronbach分析和因子分析对量表条目进行筛选。结果获得量表268份，应答率为91．2％，完成率为100％，完成量表平均时间为6．4min。条目答案选项的相同率均未超过80％，没有呈过度集中的趋势。各条目得分的标准差均在0．7以上。各条目得分与总得分之间均有相关性（P〈0．01），相关系数均大于0．2。量表的Cronbachu系数为0．94，只有去除条目“穿袜子和鞋子”后，d系数有轻微上升。主成分因子分析提取了2个公因子，分别代表“下肢功能”和“上肢功能”，解释了量表总变异的68．1％，除条目“穿袜子和鞋子”“跨过门槛”、“立正”和“便后拭净”外，其余条目均有较理想的因子载荷。通过条目筛选结果，去除条目“穿袜子和鞋子”“跨过门槛”、“立正”和“便后拭净”。结论通过本研究初步制定的KBD功能量表有较好的可行性、区分能力、敏感性、代表性和内部一致性，且符合设计结构，旨在为大骨节综合防治措施研究提供一套功能评价标准。

Development of function scale for adult Tibetans with Kashin-Beck Disease in mountain area of China

Objective To develop a function scale for specifically evaluating the functional status of adult Tibetans who suffered from Kashin-Beck disease （KBD） in mountain area of China. Methods 16 items were established by a KBD on-the-spot investigation team consisted of experts of orthopedics, rheumatology, radiology and endemic diseases, which referred the existing international widely used functional scales and were based on the local features of KBD as well as the features of the residents＇ life and culture. From June to September 2009, 294 adult KBD patients in mountainous Aba Tibetan area in China were gathered and investigated on-the-spot. The items were screened through distribution testing of answers, separation analysis, item-to-scale correlation analysis, internal consistency Cronbach analysis and factor analysis. Results 268 questionnaires were gathered. The response rate was 91.2% ; the rate of accomplishment was 100% ; the average time for completing the questionnaire was 6.4 minutes. Less than 80% answers were the same for each item, indicating no excessively concentrating tendency. The standard error for each item was more than 0.7. There was a statistical relationship between the score of each item and the score of the whole scale （P 〈0. 01 ）. All of the correlation coefficients were more than 0.2. The Cronbach a coefficient of the whole scale was 0.94. The coefficient slightly elevated only when removing the item of ＂Putting on socks and shoes＂. Two latent factors representing ＂function of lower limbs＂ and＂function of upper limbs＂ respectively explained 68.1% of the variance of the questionnaire. Each item had satisfactory factor loading except the items of ＂Putting on socks and shoes＂, ＂Stepping over door sill＂ , ＂Standing at attention＂ and ＂Wiping after bowel movement＂. According to the results of item screening, the items of ＂Stepping over door sill＂, ＂Standing at attention＂ and ＂Wiping after bowel movement＂ were removed from the functional scale. Conclusion The functional scale established from this study has satisfactory feasibility, discriminatory power, sensibility, representativeness, and internal consistency ; it also accords with the design structure and can provide a functional evaluation criterion for the integrate control program of KBD.