中文版脑瘫粗大运动功能测试量表项目难度改良及反应度和精确度研究

目的：重新确定复旦中文版GMFM的项目难度顺序，并与GMFM-66进行反应度和精确度比较，改良后的GMFM项目难度顺序可以更好地适宜所有年龄脑瘫患儿。 方法：本研究用于分析的数据来自于2001至2017年复旦大学附属儿科医院（我院）康复中心及其上海儿童康复合作群中的21家合作单位接受康复治疗和教育的脑瘫患儿，每例至少有1次诊断脑瘫18个月以后的评估数据。粗大运动功能评估由指定治疗师或医师在安静、独立、采光较好的房间采用复旦中文版GMFM-88进行。由GMAE（version1.0）得出GMFM-66分值。分别将每个GMFM-88项目转化为3个小项，从而将GMFM-88转化为含264个测试小项的GMFM-264，每项1个评分点（0、1）。采用Rasch分析中的等级量表模型分析GMFM-264测试结果与264个小项，生成经改良的复旦中文版GMFM量表项目难度顺序。采用分层随机抽样方法确定纳入反应度和精确度分析的研究对象，通过分析＜3岁和~6岁组各次评估结果间的GMFM-264与GMFM-66的分值差异比较两种计分方法的反应度和精确度。 结果：1 198例脑瘫患儿3 498次GMFM评估结果纳入分析，男801例，首次评估时平均年龄（4.5±3.8）岁。Rasch分析结果显示，GMFM-264小项中不适合项目占总项目的2.3%(6/264)，表明本量表中的绝大多数项目具有良好的单维性，最终形成包括264小项的复旦中文版GMFM改良项目难度顺序，＜3岁组中，GMFM-264的反应度和精确度明显高于GMFM-66。 结论：改良后复旦中文版GMFM项目难度顺序扩展了与标准化评估相结合的脑瘫患儿粗大运动干预目标制定项目池，提升了GMFM在脑瘫患儿尤其是婴幼儿脑瘫儿童中的反应度和精确度，为进一步推进智能化脑瘫患儿粗大功能评估与干预系统提供了基础模型与数据。

The study of items difficulty order,responsiveness and precision of Fudan Chinese version gross motor function measure

Objective：To re-determine items difficulty order of the Fudan Chinese version gross motor function measure(GMFM), and to compare the responsiveness and precision with the GMFM-66, in order to improve the items difficulty order of the GMFM to suit children with cerebral palsy in all age groups better. Methods：The data used for the analysis in this study were from children and adolescents with cerebral palsy undergoing rehabilitation therapy and education in rehabilitation center of Children's hospital of Fudan University and other 21 cooperative units in Shanghai Children's Rehabilitation Cooperative Group from 2001 to 2017. Each one of the cases had at least one time GMFM assessment and was diagnosed as cerebral palsy after 18 months. GMFM assessment was performed by a designated therapist or physician in a quiet, independent, well-lit room using Fudan Chinese version GMFM-88.The GMFM-66 score was derived from GMAE (version 1.0). Each GMFM-88 item was converted into three sub-items, and the GMFM-88 was converted into GMFM-264 containing 264 test items, with a score point (0, 1) for each. The rating scale model in Rashi analysis was used to analyze the GMFM-264 test results and 264 items, and generate the improved Fudan Chinese GMFM scale items difficulty order.Stratified random sampling method was used to determine the subjects included in the analysis of responsiveness and precision, and the difference in the scores of GMFM-264 and GMFM-66 were used to compare the responsiveness and precision of two score methods by comparing each assessment results of the below 3-year-old group and the above 6-year-old group. Results：A total of 3 498 GMFM assessment results of 1 198 children with cerebral palsy were included in the analysis. Among them, 801 were males. The average age was (4.5±3.8) years old when they had their first assessment. Rasch analysis showed that the unsuitable items of the total items was 2.3% in GMFM-264 tiny items, indicating that most of the items in this scale have good unidimensionality and form improved Fudan Chinese version items difficulty order containing 264 tiny items. In the <3 year old group, the responsiveness and precision of GMFM-264 was significantly higher than that of GMFM-66. Conclusion：The improved Fudan Chinese GMFM items difficulty order expands the target pool for the development of gross motor intervention in children with cerebral palsy combined with standardized assessment, and improves the responsiveness and precision of GMFM in children with cerebral palsy, especially infants with cerebral palsy. The result+ provide a basic model and data for the further promotion of intelligent function assessment and intervention systems for children with cerebral palsy.