姿勢控制量表應用於中風病人：羅序分析

The Balance Assessment in Sitting and Standing Positions Used in Patients with Stroke: A Rasch Analysis

吳佳樺(Chia-Hua Wu) ； 黃千瑀(Chien-Yu Huang) ； 李士捷(Shih-Chieh Lee) ； 陳佳琳(Chia-Ling Chen) ； 尤菀薈(Wan-Hui Yu) ； 謝清麟(Ching-Lin Hsieh)

《職能治療學會雜誌》 34卷2期 (2016/12) Pp. 250-264

https://doi.org/10.6594/JTOTA.2016.34(2).06

摘要

姿勢控制量表為國內常用以評量神經損傷個案平衡功能之工具。此量表有四個題目，評量簡單且快速，實用性高。迄今僅一篇研究以羅序分析(Rasch analysis)檢驗此量表之心理計量特性，因此其心理計量特性仍缺充分實證。本研究目的為利用羅序分析交叉驗證姿勢控制量表之心理計量特性，包括建構效度（單向度，unidimensionality）與羅序信度，另驗證各項目之差異題目功能(differential item functioning, DIF)。我們擷取193位中風個案職能治療病歷資料，再以羅序分析之部分計分模式檢驗個案於四個題目得分之羅序模型適配度（0.6 ＜ infit mean square, MNSQ與outfit MNSQ ＜ 1.4）、羅序信度以及分析性別與中風患側有無DIF。結果顯示：個案平均平衡功能稍差，於姿勢控制量表四個題目分數的羅序模式適配度良好(infit MNSQ = 0.96～1.15, outfit MNSQ = 0.79～0.97)、具有高羅序信度(0.89)，且於性別、中風患側（左側、右側）皆無DIF。並且，依據本研究與過去研究參數所估計之個案平衡分數二者之相關極高(Pearson r=0.99)。本研究再次確認姿勢控制量表四題目為單向度－可加總計分以表示中風個案之平衡能力，其估計之個案能力與過去研究相似，表示此量表可準確評量平衡能力。此外，姿勢控制量表之估計參數適用於不同性別與患側之個案。本研究結果強化姿勢控制量表之心理計量特性，臨床人員可用總分呈現個案之平衡能力。

關鍵字

羅序分析 ； 平衡 ； 中風

並列摘要

The four-item Balance Assessment in Sitting and Standing Positions (BASS) is commonly used to assess balance function in patients with neurological impairments in Taiwan. The BASS is ease-of-use and fast to administer so that its utility is high. Only one study examines psychometric properties of the BASS so that the psychometric evidence of the BASS is limited. We aimed to cross-validate the psychometric properties of the BASS using Rasch analysis, including unidimensionality, Rasch reliability, and differential item functioning (DIF). We retrieved the BASS data from occupational therapy records of 193 patients with stroke. The balance function of these patients, on average, was moderately impaired. Rasch analysis with partial credit model was applied. Results revealed that the four items fit the assumptions of the Rasch model (infit MNSQ = 0.96~1.15, outfit MNSQ = 0.79～0.97) and that the scores had high Rasch reliability (0.89). The four items showed no significant DIFs of sex and affected side. High correlations existed between the estimates of balance function in this study and those in a previous study (r = 0.99). This study further verified the scores of four items of the BASS could be summed as an index presenting overall balance function. Moreover, the BASS showed suitable to be used across sex and affected side of patients with stroke. Combining the advantage of fast to administer of the BASS, the BASS could reliably assess balance function with limited burdens. Therefore, the BASS could be useful in research and clinical settings.

並列關鍵字

Rasch Analysis ； Balance ； Stroke