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  • 學位論文

中文版發展協調問卷之發展暨信效度研究

The development of a Chinese version of the Developmental Coordination Disorder Questionnaire: A reliability and validity study

指導教授 : 曾美惠

摘要


背景與目的:發展協調障礙在國外之盛行率為4%至10%,而在台灣地區7至8歲國小學童DCD之盛行率為3.5%,9至10歲為17.9%,根據我國教育部的統計,台灣地區九十三學年度國小學童人口約為188萬人,因此估計約有7至34萬名學童需要專業的協助,但目前真正已被篩檢出的發展協調障礙孩童仍十分有限,其原因之一為國內仍缺乏快速且可有效篩檢的問卷。本研究分為兩部份,研究一的目的為敘述「中文版發展協調問卷」的翻譯過程,並且檢驗其信度及因素結構;研究二的目的為檢驗「中文版發展協調問卷」的區辨效度、同時效度、敏感性與特定性。 方法: 研究一:首先在原作者同意下,由五位熟悉感覺統合理論和兒童動作發展之專家經過中譯與回譯的過程,以盡可能接近原意並符合文化風俗的翻譯方式修訂「中文版發展協調問卷」。之後,發給五間小學共1562名一至三年級學童家長說明信、動作協調問卷及問卷填寫說明,並於一週後回收,共回收1388份問卷,有效問卷共1082份,二週後隨機抽樣42名孩童,請家長再次填寫問卷以作再測信度研究,共回收37份問卷。研究二:對象來自於發展協調障礙孩童之感覺統合功能之大型研究,共八所小學117名學童參與,這些孩童在2至5天內分別接受布朗尼氏動作能力測驗及兒童動作能力測驗施測,施測員皆接受嚴格的施測訓練且不知道孩童的發展協調問卷得分。 結果:研究一:不同性別在發展協調問卷的總分上有顯著的差異(F = 12.32, p < 0.001, df = 1),但年級(F = 0.509, p = 0.601, df = 2)及性別和年級之交互作用(F = 0.028, p = 0.972, df = 2)在發展協調問卷的總分上並沒有顯著差異。整體問卷的Cronbach α值為0.84,代表有高度的內部一致性。再測信度為0.93 (p < 0.001)。因素分析結果顯示,中文版發展協調問卷包含三個因素:第一個因素為移動時的控制技巧,可解釋38.62%的變異量;第二個因素為精細動作/書寫,可解釋6.27%的變異量;第三個因素為協調障礙,可解釋5.51%的變異量。研究二:區辨效度的部份,發展協調障礙組、疑似發展協調障礙組及配對正常組在15題之「中文版發展協調障礙問卷」總分有統計上顯著差異(F = 6.65, p = 0.002, df = 2)。事後比較(Post Hoc Tests)的結果,使用Bonferroni correction,配對正常組在15題中文版發展協調問卷總分上顯著較發展協調障礙組(p = 0.004)及疑似發展協調障礙組(p = 0.049)的問卷總分高,但發展協調障礙組與疑似發展協調障礙組在15題問卷總分上则無統計上顯著差異(p = 1.00)。同時效度的部份,問卷總分(去除第11及14題後)與布朗尼氏動作能力測驗之三個分項分數(整體動作、粗動作、精細動作)呈低至中度相關(r = 0.272至0.423, p < 0.01),與兒童動作能力測驗之障礙分數亦呈中度相關(r = -0.450, p < 0.01)。有關中文版發展協調問卷三種切點(10%、15%及低於平均值1個標準差)之敏感性及特定性(黃金標準為當布朗尼氏動作能力測驗及兒童動作能力測驗兩個測驗皆判定為發展協調障礙者視為發展協調障礙孩童,其餘為非發展協調障礙孩童),敏感性的範圍為22%-47%、特定性的範圍為77%-90%。 結論:中文版發展協調問卷在台灣地區亦有良好的信效度,因此建議診斷發展協調障礙孩童最適當的方法為將發展協調問卷當作篩檢工具,再輔以動作測驗作為確定診斷的工具。

並列摘要


Background and purpose: The prevalence of Developmental Coordination Disorder (DCD) is estimated as 4% to 10%. In Taiwan, the prevalence of DCD between age of 7 to 8 is about 3.5%, and that between age of 9 to 10 is about 17.9%. According to the census of Ministry of Education in Taiwan between 2004 and 2005, there are about 1.88 million school-aged children. It is estimated that about 7 to 34 thousand students need professional support and intervention. How to detect children suffering from coordination disorders for timely intervention is thus an important issue for professionals working with children. However, there is still no gold standard for identifying these children. Furthermore, there has been a concern about a lack of standardized instruments for screening children with motor coordination problems. The purpose of Study 1 was to illustrate the translation procedure and to assess the reliability and the factor structure of the Chinese version of Developmental Coordination Disorder Questionnaire(DCDQ). The purpose of Study 2 was to examine the discriminant validity, concurrent validity, sensitivity and specificity of the Chinese version DCDQ. Method: Study 1: With Wilson’s permission, a committee consisting of five faculty members who were specialized in sensory integration theory and treatment translated the DCDQ into Chinese. After the committee confirmed the original version, translated version, and back-translated version, the Chinese DCDQ was administered to 1562 students from Grade 1 to 3 in five primary schools in Taipei. One week later, 1388 questionnaires were returned. In order to examine test-retest reliability, 42 parents were asked to fill out the questionnaires again with a 2-week interval. Thirty-seven parents returned the questionnaires. Study 2: The participants were from a larger study which was to investigate sensory integrative function in children with Developmental Coordination Disorder. One hundred and seventeen children who were from eight schools and had parental consent participated in this study. They were tested individually in two sessions with a two-to five-day interval by testers who had received a rigorous training of the test administration of the BOTMP and the MABC and were blind to the DCDQ-C scores of children. Results: Study 1: The results showed significant difference on the total scores of the Chinese DCDQ between girls and boys(F = 12.32, p < 0.001, df = 1), but no significant differences main effect of grade (F = 0.509, p = 0.601, df = 2) and interaction effect between sex and grade(F = 0.028, p = 0.972, df = 2). The Cronbach’s α coefficient for the Chinese DCDQ was 0.84 indicating high internal consistency. The test-retest reliability was 0.93. The result of exploratory factor analysis showed that the Chinese DCDQ contained three factors. The first factor, “Control during movement”, accounted for 38.62% of the total variance. The second factor, “Fine motor/Handwriting”, accounted for 6.27% of the total variance. The third factor, “Coordination dysfunction”, accounted for 5.51% of the total variance. Study 2: An ANOVA revealed significant group differences on the total score of the Chinese DCDQ(F = 6.65, p = 0.002, df = 2). Post-hoc group comparisons showed that the non-DCD group scored significant higher than the DCD(p = 0.004) and the suspect DCD group(p = 0.049). As to the concurrent validity, the total score of the Chinese DCDQ showed low to moderate correlated with the three scores of the BOTMP(r = 0.272 to 0.423, p < 0.01), and moderate correlated with the total impairment score of the M-ABC(r = -0.450, p < 0.01). The sensitivity of the Chinese DCDQ ranged from 22%-47%, and the specificity of the Chinese DCDQ ranged from 77%-90%. Conclusion: The reliability and validity of the Chinese DCDQ appeared to be acceptable for use on children aged from 6 to 9 years in Taiwan. This study showed that the Chinese DCDQ could be a useful motor coordination screening tool in an epidemiological survey.

參考文獻


林冠宏、吳昇光,台灣地區七至八歲發展協調障礙兒童之研究,台灣物理治療學會雜誌2002;27(5): 238-248。
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被引用紀錄


李曜全(2007)。台灣兒童動作評估測驗之信效度分析與常模建立〔碩士論文,中國醫藥大學〕。華藝線上圖書館。https://www.airitilibrary.com/Article/Detail?DocID=U0013-0006202200000059

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