姿勢控制量表應用於慢性中風病人之再測信度、施測者間信度與隨機測量誤差

Test-retest Reliability, Inter-rater Reliability and Radom Measurement Error of the Balance Assessment in Sitting and Standing Positions in Patients With Chronic Stroke

王怡晴(Yi-Ching Wang) ； 黃千瑀(Chien-Yu Huang) ； 成冠緯(Kuan-Wei Chen) ； 范馨文(Hsin-Wen Fan) ； 呂文賢(Wen-Shian Lu) ； 謝清麟(Ching-Lin Hsieh)

《職能治療學會雜誌》 37卷2期 (2019/12) Pp. 235-253

https://doi.org/10.6594/JTOTA.201912_37(2).0005

摘要

「姿勢控制量表」為國內臨床常使用之平衡能力評估工具，其具備良好之施測效率及建構效度。惟姿勢控制量表之再測信度、施測者間信度及隨機測量誤差尚未驗證，影響此評估工具測量結果的解釋與應用。本研究目的為驗證姿勢控制量表之個別項目層級與總分層級之再測信度與施測者間信度以及總分之隨機測量誤差。共60位慢性中風病人參與研究。研究期間共有前後二次施測，前測由研究助理及職能治療師分別進行評估，以驗證姿勢控制量表之施測者間信度；間隔14天後，後測再由研究助理進行一次評估，以驗證再測信度。姿勢控制量表之再測信度（個別項目weighted Kappa = 0.92-0.96,總分intraclass correlation coefficient [ICC] = 0.98）及施測者間信度（個別項目weighted Kappa = 0.93-0.95,總分ICC = 0.97）良好。再測信度與施測者間信度之最小可偵測變化值（Minimal detectable change, MDC）分別為2.3與2.5羅序分數，MDC%約50%。本研究結果顯示姿勢控制量表應用於中風病人具有良好之再測與施測者間信度，能穩定評估病人之平衡能力；病人的羅序分數改變超過2～3分較能肯定其能力有真實改變。然其隨機測量誤差偏高，一般病人之變化恐難以超過，造成解釋困難。本研究驗證姿勢控制量表為可信之評估工具，且研究結果有助臨床及研究人員正確解釋評估的結果。

關鍵字

施測者間信度 ； 最小可偵測變化值 ； 中風 ； 再測信度

並列摘要

The Balance Assessment in Sitting and Standing Positions (BASS) is a common measure of balance in clinics. Efficiency and construct validity of the BASS have been shown to be adequate; however, the test-retest reliability, inter-rater reliability, and random measurement error of the BASS have not yet been examined. The purpose of this study was to examine the test-retest reliability, inter-rater reliability, and random measurement error of the BASS. Sixty individuals with stroke in chronic stages participated in the study. A repeated-assessments design was used to examine the test-retest and inter-rater reliability. The BASS was administered by a single rater in the test-retest reliability study, and by 2 raters in the inter-rater reliability study. The results of this study indicate that the BASS has good test-retest reliability and inter-rater reliability in patients with stroke. The values of weighted Kappa and intraclass correlation coefficient (ICC) were good for both test-retest reliability (weighted Kappa = 0.92-0.96, ICC = 0.98) and inter-rater reliability (weighted Kappa = 0.93-0.95, ICC = 0.97). The minimal detectable change (MDC) and MDC% of the test-retest and inter-rater reliability study were 2.3 (47.7%) and 2.5 (51.4%), respectively, which indicate a substantial amount of random measurement error. For this measure, a Rasch change score between 2-3 points can be interpreted as a real change. However, the random measurement error is too large to show the patients' change in balance. The MDC value of the BASS is helpful for clinicians and researchers in interpreting the difference in scores between consecutive assessments.

並列關鍵字

Inter-rater Reliability ； Minimal Detectable Change ； Stroke ； Test-retest Reliability