常用於中風病人臨床試驗研究之執行功能成效評估工具及其心理計量特性回顧

A Review of Psychometric Properties of Executive Function Outcome Measurements Frequently Used in Patients With Stroke

林柏翰(Po-Han Lin) ； 董雅綺(Ya-Chi Tung) ； 林恭宏(Gong-Hong Lin) ； 薛漪平(I-Ping Hsueh) ； 謝清麟(Ching-Lin Hsieh)

《職能治療學會雜誌》 37卷1期 (2019/06) Pp. 7-40

https://doi.org/10.6594/JTOTA.201906_37(1).0001

摘要

執行功能（executive function）缺損是中風病人常見之認知功能障礙，與病人日常生活功能及復健成效相關。使用具良好心理計量特性之成效評估工具，是檢視醫療成效及目標的先決條件。本研究回顧近8年常用於中風病人臨床試驗研究之執行功能成效評估工具，彙整並評析工具之臨床適用性及心理計量特性（信度、效度、反應性及最小重要差異值）。研究者合併檢索中、英文之電子期刊資料庫，找出2010年1月至2017年12月間常用於中風病人臨床試驗研究（被使用6次以上）之執行功能成效評估工具。結果顯示常用之工具共計八種：Trail-making test part A & part B（TMT-A & TMT-B）、Stroop test、category verbal fluency test、phonemic verbal fluency test（Phonemic VFT）、digit-span test-backward、Wisconsin card sorting test（WCST）及Tower of London（TOL）。僅WCST及TOL具建構效度之驗證資料。WCST表現反映三項能力因子，既執行功能中的認知彈性、錯誤修正及維持能力。TOL之表現則反映單一因子，即執行功能中的計畫能力。臨床適用性方面，TMT-A及phonemic VFT的適用性高，施測容易且無語言或文化上的隔閡，具備適用於國內評估中風病人之執行功能之潛力。整體而言，常用於中風病人之執行功能成效評估工具缺乏充份心理計量特性驗證支持，僅兩項工具具有效度驗證。建議未來研究人員可針對八項工具之信度、反應性及最小重要差異值等特性進行驗證，以提供適用於中風病人臨床研究之執行功能成效評估工具。

關鍵字

中風 ； 執行功能 ； 心理計量特性 ； 成效評量

並列摘要

Executive function (EF) deficit is a common cognitive problem in stroke patients, which negatively influences patients' activities of daily-living functions and rehabilitations. EF outcome measurements with good psychometric properties and feasibilities help to identify patients' EF problems and to evaluate the effectiveness of treatments. This study aimed to review and appraise the psychometric properties (i.e., reliability, validity, responsiveness, and minimal important difference, MID) and feasibilities (e.g., measurement materials, assessment time, and culture/language barriers of measurements) of the frequently used (used at least 6 times) EF outcome measurements in empirical studies of stroke. The research consisted of empirical studies that were published from January 2010 to December 2017. According to the citation criteria, a total of 8 EF tests in 3 databases (Medline, PsycINFO, and Index to Taiwan Periodical Literature System) were included: Trail-making test A & B (TMT-A & TMT-B), Stroop test, category verbal fluency test, phonemic verbal fluency test (Phonemic VFT), digit-span test-backward, Wisconsin card sorting test (WCST), and Tower of London (TOL) test. However, the psychometric properties of these measurements were rarely examined. Only two studies examined tests' construct validities. They showed that WCST performance is associated with three EF abilities (mental flexibility, error correction, and maintenance) and that TOL performance is related to EF's planning ability. Regarding to the feasibilities of the eight measurements, TMT-A and Phonemic VFT had better feasibilities (short assessment time and a Chinese version). It is recommended that future studies should exam the psychometric properties of these eight tests in order to provide references for selecting a good EF measurement.

並列關鍵字

Executive Function ； Outcome Measurement ； Psychometric Properties ； Stroke