- 學位論文
多種平衡測驗工具於思覺失調症患者之信效度探討
Reliability and Validity of Different Balance Assessments in Individuals with Schizophrenia
摘要
背景與目的：思覺失調症患者存在有動作協調障礙，包括較差姿勢控制和平衡能力。平衡障礙對生理功能和社交功能會產生嚴重影響。在精神科住院病患也發現有較高跌倒發生率，特別在老年病患。然目前探討平衡工具在此族群的信效度及平衡功能與每日身體活動項的相關之文獻卻很有限。本研究之目的有二：（一）驗證五種常見的臨床平衡測驗工具使用於思覺失調症患者之再測信度、同時效度及區辨效度。平衡測驗工具包含：星狀伸展平衡測驗 (Star excursion balance test)、單腳站立測驗 (One-leg stance)、功能性伸取測驗 (Functional reach test)、計時起身行走測驗 (Timed up-and-go test)、縱列行走測驗 (Tandem walking test)。（二）探究思覺失調症患者之平衡與身體活動量之間的關聯性。 研究方法：本研究共招募26位，年齡介於38歲至62歲之思覺失調症患者，其中一年內無跌倒史組及有跌倒史組各為13人。每位受試者會接受上述五種臨床平衡測驗工具兩次相隔7~14天的測試，以建立再測信度，並與力板之身體壓力中心 (center of pressure，COP) 相關參數進行同時效度之驗證。比較有無跌倒史的兩組表現來檢驗區辨效度。最後，使用電子計步器 (Omron HJ-720ITC) 測量七天身體活動量，並探討身體活動量與平衡的相關性。研究資料以SPSS統計軟體系統進行分析。 結果：五種平衡測驗工具之再測信度ICC值介於.66~.99；ICC值最高為星狀伸展平衡測驗 (ICC=.98~.99) 及計時起身行走測驗 (ICC=.99)，其次為單腳站立測驗 (ICC=.89) 和功能性伸取測驗 (ICC值.89)，最低為縱列行走測驗之睜眼項目 (ICC=.66~.92)。測量標準誤差%（SEM%）與最小可偵測變化值%（MDC%）值部分，最高為單腳站立測驗，SEM%分別為睜眼13.52%及閉眼32.09%，MDC%分別為37.48%~88.95%；其餘四種測驗之SEM%介於2.30%~9.18%，MDC%介於6.38%~25.44%。與力板COP各項參數之同時效度達顯著項目最多者為星狀伸展平衡測驗之後內側方向，其次為計時起身行走測驗，顯著相關項目最少者為單腳站測驗和縱列行走測驗之閉眼項目。區辨效度以星狀伸展平衡測驗最高 (各方向p值皆<.001)，次為單腳站立測驗睜眼項目、計時起身行走及功能性伸取測驗 (p值<.05)，單腳站立測驗閉眼項目及縱列行走測驗則未達顯著。與身體活動之關聯性僅有假日每日步數與單腳站立測驗閉眼及縱列行走測驗閉眼項目達到顯著。 結論：星狀伸展平衡測驗、單腳站測驗、功能性伸取測驗及計時起身行走測驗等四種工具有較佳再測信度、同時效度及區辨效度。與身體活動相關性部分，僅在單腳站立測驗及縱列行走測驗僅有尚可程度相關性。考量臨床使用便利性，除了星狀伸展平衡測驗施測步驟較複雜和施測時間較長，其餘三種測驗 (單腳站測驗、功能性伸取測驗及計時起身行走測驗)的施測方法簡單且快速，適合臨床人員使用。但是，單腳站測驗之SEM%及MDC%較高，可能會有較大誤差，進而影響測驗結果之準確性。本研究結果可提供臨床專業人員選擇工具之指引。
並列摘要
Background and purpose：Patients with schizophrenia have motor coordination disorders, including poor control of posture and balance. Balance disorders can have serious influence on physical function and social function. It also found a higher rate of falls in inpatients at psychiatric units, particularly among geriatric patients. But studies examining the psychometric of balance assessments for schizophrenia and the relationship between balance and physical activity level are limited. The purposes of this study are (1) to examine the test-retest reliability, concurrent validity and discrimination validity of five balance assessments commonly used in clinical in patients with schizophrenia,. The balance assessments included Star excursion balance test (SEBT), One-leg stance (OLS), Functional reach test (FRT), Timed up-and-go test (TUG), and Tandem walking test (TW), and (2) to investigate the correlation between balance function and physical activity in patients with schizophrenia. Methods：Twenty six individuals with schizophrenia aged 38-62 years old were recruited and assigned into two groups based on their past year of fall occurrence. All participants received the five balance assessments protocol on two occasions within a period of 7 to 14 days to establish the test-retest reliability. A force platform was administered once between two test occasions to examine the concurrent validity. The balance assessments performance between fallers and non-fallers was examined for discrimination validity. The level of physical activity was objectively measured using a digital pedometer (Omron HJ-720ITC) and used to investigate the correlation with balance. All data were analyzed using the SPSS, version 18.0. Results：Intraclass correlation coefficients (ICC) of test-retest reliability for the five balance assessments were .66-.99；The ICC values were good for the SEBT (ICC=.98-.99), TUG (ICC=.99), OLS (ICC=.89) and FRT (ICC=.89), and poor for the TW (open eyes) (ICC=.66-.92). The standard error of measurement % (SEM%) and minimal detectable change % (MDC%) for the OLS were large (SEM%=13.52% in closed eyes and =32.09% in open eyes；MDC%=37.48% in closed eyes and =88.95% in open eyes). For the remaining four assessments, the SEM% ranged 2.30%-9.18% and MDC% ranged 6.38%-25.44%. The concurrent validity with force platform parameters was high for the SEBT and TUG and was low for the OLS and TW (open eyes). The discrimination validity was significant for the SEBT (p<.001), OLS (open eyes), TUG and FRT (p<.05) and non-significant for the OLS (closed eyes) and TW. The significant correlation between balance and physical activity only presented for the OLS (closed eyes) and TW (closed eyes) with the daily step counts in the weekend. Conclusion：The SEBT, OLS, FRT and TUG had better test-retest reliability, concurrent validity, and discrimination validity. The correlation between balance and physical activity only showed fair relationship for the OLS (closed eyes) and TW (closed eyes). Considering the convenient utilization in clinical settings, except the slightly complex steps and longer time taken for the SEBT, the rest three balance assessments (OLS, FRT and TUG) are easy and quick to administer. The higher values of SEM% and MDC% for the OLS may result in higher measurement errors. The results of this study can help clinicians in the selection of balance assessments.