中文版脑瘫患儿手功能分级系统的信度和效度研究

的确定中文版脑瘫（CP）患儿手功能分级系统（MACS）的信度和效度。方法通过分析现场操作评价和录像评价结果之间的关系确定MACS的重测信度；分析不同评价者间（家长、作业治疗师和康复医生）的评价结果确定MACS的评价者间信度；以CP患儿精细运动能力测试（FMFM）的分值为效标确定MACS的平行效度。结果来自上海2家CP康复机构的124例4—18岁CP患儿参加了此项研究。男77例，女47例；平均（6．7±2．6）岁，4—7岁97例；～12岁24例，～18岁3例。其中痉挛型四肢瘫27例，双瘫48例，偏瘫38例，手足徐动型5例，共济失调2例，肌张力障碍型4例。粗大运动功能分级（GMFCS）Ⅰ级51例，Ⅱ级32例，Ⅲ级15例，Ⅳ级14例，Ⅴ级12例。2名作业治疗师的现场评价与录像评价结果显示，MACS具有良好的重测信度，ICC值分别为0．94（95％CI：0．90～0．96）和0．87（95％CI：0．80～0．92）；同时MACS具有良好的评价者间信度，作业治疗师与家长现场评价间的ICC值为0．85（95％CI：0．77～0．91），2名作业治疗师现场评价间的ICC值为0．99（95％CI：0．99～1．00），不同家长现场评价间的ICC值为0．91（95％CI：0．66～0．98），2名作业治疗师录像评价间的ICC值为0．96（95％CI：0．94～0．97），作业治疗师与康复医生录像评价间的ICC值为0．94（95％CI：0．90。0．97）；MACS与FMFM分值间具有良好的平行效度，Spearman相关系数为-0．71。结论中文版CP患儿MACS具有良好的信度和效度，适用于中国开展CP患儿的手功能分级。在进行MACS评价时应充分考虑环境因素的影响，引导家长参与到MACS的评价工作中来。

Reliability and validity of the Chinese version of the manual ability classification system for cerebral palsy

Objective To evaluate the reliability and validity of the Chinese version of Manual Ability Classification System （MACS）. Methods Patients with cerebral palsy （CP） were involved from two rehabilitation centers in Shanghai. Three assessment methods were used to evaluate the manual function levels, including locale assessment by professional, locale assessment by family career and video assessment by professionals. Eight assessing scenes were set for these children to mimic the normal living activities, including drinking with cups, using spoon , opening and closing small bottles, cleaning face, wringing towels, turning pages of a book, writing, and releasing buttons. Two occupational therapists did the locale assessments. All the activities performed by these children were videotaped and reseored by the same two occupational therapists and one physiatrist at least one week later （ the longest interval between locale assessment and video assessment was 10 months）. The family career read Chinese version of MACS then scored their children according to their performance at home and at locale as well. Professionals explained the terms for parents if needed but they didn＇t discuss the classification resuhs with parents. Test-retest reliability was analyzed by comparing scores of locale assessment and video assessment, Inter-tester reliability was analyzed by comparing scores of different estimator （family career, occupational therapist and physiatrist ）. Criterion-related validity was evaluated by comparing MACS levels with scores of Fine Motor Function Measure （FMFM） . Results One hundred and twenty-four children （77 males and 47 females; mean age： 6.7 years, SD： 2.6 years, age range： 4 to 18 years） with CP were involved from two rehabilitation centers in Shanghai. 97 children in the 4 to 7-year band, 24 children in the 8 to 12-year hand, 3 children in the 13 to 18-year band. Types of CP in these children were spastic quadriplegia （ n = 27 ）, spastic diplegia （ n = 48 ）, spastic hemiplegia （ n = 35 ）, athetotic （ n = 5 ） , dystonia （ n = 4 ） and ataxic （ n = 2）. Gross motor function classification system levels were ： Ⅰ （ n = 51 ） , Ⅱ （n =32）, Ⅲ （n = 15 ）, Ⅳ （n = 14）, and Ⅴ （n = 12）. Chinese version of MACS was found to possess satisfactory test-retest reliability（ ICC =0.94 and 0.87 ） as well as excellent inter-tester reliability （ICC = 0.85 -0.96 ）. Criterion-related validity was moderate between MACS levels and scores of FMFM （Spearman r = - 0.71 ）. Conclusions This study extended reliability and validity of the Chinese version of MACS. Results indicated that Chinese version of MACS was a valid and reliable measure of manual functions in Chinese children with CP. Environment factors should be considered in assessment. Participation of family career in scoring was very valuable. With the help of family careers, the scores might reflect children＇s practical manual function levels more precisely.