比較中風病人上肢動作量表及運動學分析之再測信度

背景與目的：臨床常用量表和儀器評量中風後上肢動作功能恢復情況。本研究目的為比較福格邁爾上肢次量表(Upper Extremity Subscale of the Fugl-Meyer Motor Function Assessment, UE-FM)與三維Zebris超音波動作分析儀器測量中風病患上肢伸手取物過程運動學參數之再測信度。方法：共徵召30位慢性期中風病患，分別給予兩次上肢動作量表評估及儀器測量，前後間隔一星期。使用Zebris超音波感應式動作分析系統取得上肢伸手取物過程的運動學參數，包括最大速度(Peak Velocity, PV)、動作時間(Movement Time, MT)和標準化手部位移距離(Normalized Movement Trajectory, NMT)等參數。採用級內相關係數(Intraclass Correlation Coefficient, ICC)及最小可偵測變化值(Minimal Detectable Change, MDC)驗證再測信度。結果：UE-FM和Zebris測量參數的再測信度ICCs≧0.89紗，顯示兩次評量結果一致性良好。UE-FM之MDC%為13.8%(5.5/39.8)，Zebris之NMT為10.2%(7.2170.6)，PV和MT分別為22.8%(0.3/1.3)和30.7%(0.4/1.3)。結論：本研究結果發現UE-FM量表評估和Zebris NMT參數值有良好的測量誤差，二種評估工具之MDC數值可做為臨床治療師評估中風患者上肢伸手取物動作功能進步量是否超過測量誤差的參考閾值。

Keywords

中風；上肢；心理計量；運動學

Parallel abstracts

Background and Purpose: Clinical scales and laboratory tools to evaluate functional recovery of upper extremity (UE) in patients with stroke are common in rehabilitation clinic. This study compared the test-retest reliability of the Upper Extremity subscale of the Fugl-Meyer assessment (UE-FM) with UE reaching kinematic data from motion analysis system for stroke patients. Methods: The measures were administered to thirty chronic participants (28.8±22.7 months after stroke) at baseline and 7 days later. Reaching kinematic data including peak velocity (PV), movement time (MT), and normalized movement trajectory (NMT) were acquired using the ultrasound-based computerized motion analysis system. The Intraclass Correlation Coefficient (ICC) and the Minimal Detectable Change (MDC) were used to examine the test-retest reliability. Results: Test-retest agreements were excellent for the UE-FM measure, PV, MT and NMT (ICCs≥0.89). Furthermore, the MDC%s of UE-FM and NMT were 13.8% (5.5/39.8) and 10.2% (7.2/0.6), respectively, indicated smaller measurement errors than PV 22.8% (0.3/1.3) and MT 30.7% (0.4/1.3). Conclusion: The UE-FM and NMT have high agreement between the test-retest measurements with acceptable measurement errors. The two measures can be used for clinicians to assess the UE reaching performance and monitor changes over time in stroke patients.

Parallel keywords

Stroke ； Upper extremity ； Psychometric property ； Kinematic

Read-around

Chao, C. P. (2009). 合併制動療法對中風後上肢功能表現之運動學分析 [master's thesis, National Taiwan University]. Airiti Library. https://doi.org/10.6342/NTU.2009.01228
楊清棼（2015）。電腦化中風病人上肢動作功能訓練系統使用者滿意度分析〔碩士論文，高雄醫學大學〕。華藝線上圖書館。https://doi.org/10.6832/KMU.2015.00081
王詩涵、賴薇合、何境祥（2020）。肌電驅動之機器輔助治療於慢性中風患者上肢動作功能改善：個案報告。臺灣職能治療研究與實務雜誌，16(1)，65-73。https://doi.org/10.6534/jtotrp.202006_16(1).0006
Cheng, H. J., Lin, T. A., Lee, M. T., Huang, Y. F., Hsieh, Y. W., Wu, C. Y., & Lin, K. C. (2014). 中風患者於雙側機器輔助療法之上肢動作功能療效：文獻回顧. 臺灣職能治療研究與實務雜誌, 10(2), 115-127. https://doi.org/10.6534/jtotrp.2014.10(2).115
Tang, Y. C., Lin, F. J., Chen, S. M., Lin, S. F., Tung, C. L., & Lin, J. H. (2016). Comparisons of Effects between Thermal Stimulation and Neuromuscular Electrical Stimulation on Motor Recovery of Upper Extremity in Patients with Chronic Stroke. 物理治療, 41(2), 123-124. https://doi.org/10.6215/FJPT.2016.O13

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