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比較中風病患姿勢評估量表及短版於復健住院者之反應性
Comparison of Group- and Individual-Level Responsiveness of the Original and Short-Form Postural Assessment Scale for Stroke Patients in Individuals in Rehabilitation Wards
摘要
反應性(responsiveness)是評估工具偵測受測者功能改變之能力，亦為成效指標必備的心理計量特性。中風病患姿勢控制評估量表(Postural Assessment Scalefor Stroke Patients, PASS)及其短版(Short Form-PASS, SFPASS)是為中風病人特製且具良好心理計量特性之平衡功能測驗，具臨床常態使用之潛能。昔日研究曾比較PASS 與SFPASS之團體與個別層級反應性於中風後14天且間隔二週的病患。然而，單一研究無法斷定評估工具之反應性，且PASS與SFPASS應用於復健住院病患的個別層級反應性尚屬未知。因此，本研究目的為：交叉驗證PASS與SFPASS應用於中風復健住院時期之團體與個別層級反應性。共379位中風病患參與本研究，其分別於復健住院後及出院前一周評估PASS共二次；SFPASS則擷取自PASS。團體層級反應性指標為t檢定驗證團體層、凱濟斯效應值 (Kazis' effect size) 及標準化平均反應值 (standardized response mean,SRM)；個別層級反應性指標則為進步超過最小可偵測差異值 (minimal detectablechange, MDC) 之人數比例。PASS與SFPASS於前、後測之平均分數差異顯著 (p ＜ .001)，且效應值相似(Kazis' effect size：0.74與0.70；SRM：1.09 與1.00)。PASS可呈現較多進步超過MDC(63.0 %比53.0 %) 之病患，且此差異顯著 (p ＜ .001)。本研究結果顯示PASS與SFPASS皆具良好的團體層級反應性，但SFPASS之個別層級反應性較PASS差。我們建議使用者宜採用PASS做為復健住院病患之療效評估工具；而SFPASS則可用以追蹤病患群體之平衡功能以提升施測效率。
並列摘要
Responsiveness is the ability of measures to detect people’s change, which is necessary for outcome measures. The Postural Assessment Scale for Stroke Patients (PASS) and Short-Form PASS (SFPASS) were developed for stroke patients with sound psychometric properties, which have a potential for routine clinical assessments. A previous study has examined the group-level and individual-level responsiveness of the PASS/SFPASS in patients at 14 days after stroke. However, the individual-level responsiveness of the PASS/SFPASS was unclear. Thus, the purpose was cross-validation of the group- and individual-level responsiveness of the PASS and SFPASS in inpatients receiving rehabilitation. A total of 397 participants were recruited. The PASS was assessed within one week after admission and before discharge from the rehabilitation ward, and the SFPASS was derived from PASS. Group-level responsiveness was examined using paired t-test, Kazis’ effect size, and standardized response mean (SRM). Individual-level responsiveness was examined through the proportion of people whose change in balance function was larger than minimal detectable change. Mean differences of the PASS and SFPASS between pre- and post-test were significant (p ＜ .001). Both measures had similar effect size (Kazis’ effect size: 0.74 and 0.70; SRM: 1.09 and 1.00). The PASS is more sensitive at detecting people’s change (63.0 %; 53%), and the difference was significant (p ＜ .001). PASS had better individual-level responsiveness than SFPASS while the group-level responsiveness was similar. We suggest that the PASS is better for detecting the change of balance function for individual, while SFPASS is more efficiency for group change.
延伸閱讀
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