復健的一個終極目標,乃是提高病患的功能度,以期他們日後能回到社會中成為獨立的個體。因此,在復健過程中一個良好的功能評估工具,對職能治療師來說是極為重要的。這樣的工具必須具有良好的信度,效度及實用性,如此方能協助治療師評量病患的進步情形,並確定治療的有效性。過去二十年來美國復健領域中,已發展出多種功能評量工具。近幾年,已有較多研究者專注於這些工具的心理測量品質之研究,這個趨勢對整個復健界評估領域的發展將有極佳的助益。 本篇文章的目的乃在應用一個測量理論:羅序分析來探討功能評量工具的建構效度。希望由此應用之例子介紹此一方法於職能治療界,作為日後探索工具心理測量品質的另一種方式。 本研究共收集來自美國復健機構412個病患在LORS-Ⅲ評估工具之分數;包括入院與出院共有824個記錄。羅序分析結果顯示包含20個項目的LORS-Ⅲ共有二個建構內容:日常生活功能與溝通能力,結果並顯示二個量表的項目難度皆不夠,以致無法準確地測出各種程度病患的功能表現,特別是出院時病人由於功能進步,本工具更無法測及其最佳程度。 未來如何應用此種項目反應理論於工具發展的領域中,同時又能充分應用其所提供的優點,是值得職能治療師探討的。本文並討論了如何改進LORS-Ⅲ的幾項建議及未來類似研究之方向。
The goal of rehabilitation is to maximize functional performance of the clients so that they will be able to live independently in the community. Therefore, a well-designed functional assessment is very important for occupational therapists and program managers to document progress and monitor program effectiveness. There have been a proliferation of functional instruments in the past two decades. Recent researches have focused on examining the psychometric quality of those developed instruments, particularly using Rasch measurement model. The trend is beneficial to the whole rehabilitation field that more scientific data can be utilized for research and clinical application. The purpose of this study is to explore construct validity of the Level of Rehabilitation Scale (LOBS-Ⅲ) by using Rasch measurement model. Four hundred and twelve subjects with neurological or orthopedic conditions were recruited in the study; 824 records were used in the Rasch analysis by BIGSTEPS computer program. The results showed that there are two constructs underlying the LOBS-Ⅲ: ADL/mobility and communication. These two scales generally fit the model requirement. However, there are fewer difficult items on both scales to detect the ability level of more able persons. Recommendation for the revision of the scale as well as the use of Rasch model in instrument development are provided.