中風復健動作評估量表的心理計量特性分析

Analysis of the psychometric properties of the Stroke Rehabilitation Assessment of Movement (STREAM)

李素(Su Lee)

指導教授 ： 林昭宏

高雄醫學大學/健康科學院/行為科學研究所/碩士(2006年)

https://doi.org/10.6832/KMU.2006.00045

摘要

研究目的：本研究的目的為全面性分析中風復健動作評估量表
（Stroke Rehabilitation Assessment of Movement，STREAM）之心理計量特性，包含適用性、同時效度、收斂效度、預測效度、反
應性和再測信度。研究方法：第一部份主要徵召復健科住院中風
病人50 名，利用斯皮爾曼相關係數( Spearman ρ)來檢定入院與
出院時STREAM 與相關量表（包括福格梅爾動作量表、中風病人姿勢評估量表、巴氏量表）之效度；以標準化反應平均（standardized response mean, SRM）檢定STREAM 在住院期間之反應性；第二部分主要徵召復健科門診慢性期中風病人50 名，每位病人皆接受前後二次的STREAM 測量，二次測量的時間間隔一週。利用組內相關係數（intra-class coefficient, ICC）檢視再測信度，同時計算測量標準誤（standard error of measurement,SEM）及最小真正改變量（smallest real difference, SRD）。研究結果：入院與出院時STREAM 總分分布並無上限與下限效應，表示住院期間沒有適用性的問題；與入院及出院福格梅爾動作量表得分比較，具有高度相關的同時效度（ρ≧ .88）；與入院及出院代表平衡能力中風病人姿勢評估量表及代表日常生活功能巴氏量表比較，分別具有高度及中度相關的收斂效度(ρ≧ .81；ρ≧ .76)；入院時STREAM 得分對於中風病人出院時福格梅爾動作量表、中風病人姿勢評估量表、及巴氏量表的得分表現具有高度相關的預測效度(ρ≧ .83)。此外，STREAM 在住院期間各個次量表分數變化都具有高度效應強度的反應性(SRM≧ .78)；再測信度ICC 值0.989（95% 信賴區間為0.981~0.994），
顯示兩次測量之間有很好的一致性；代表判斷受試群體的真實變
化值的測量標準誤與代表單一個案真正改變值的最小真正改變
量分別為2.0 與5.5，可作為判斷病人療效是否真正進步的參考依
據。結論：本研究結果證實STREAM 具有良好同時效度、收斂
效度、預測效度、反應性和再測信度的心理計量特性，可以提供
臨床治療師和研究人員做為測量中風病人動作功能時一項合適
簡便的評估工具。

關鍵字

中風 ； 心理計量 ； 動作量表 ； 測量誤差

並列摘要

Purpose: The purpose of this study was to examine comprehensively the psychometric properties of the Stroke Rehabilitation Assessment of Movement (STREAM) for stroke patients, including acceptability, concurrent validity, converge validity, predictive validity, responsiveness and test-retest reliability. Methods : First, fifty stroke
inpatients from department of rehabilitation were tested at admission and discharge. Spearman correlation coefficients (ρ) were used to evaluate validity between STREAM and relative scales (including Fugl-Meyer motor scale, Postural Assessment Scale for Stroke Patients, Barthel Index). Standardized response mean (SRM) was
used to examine the change in score of the STREAM. Second, fifty stroke outpatients were tested twice, seven days apart. Inter-class correlation coefficient (ICC) was used to examine the level of agreement between test and retest. Absolute reliability indices, including the standard error of measurement (SEM) and the smallest real differences (SRD), were used to determine the extent. Results:
There are neither ceiling effect nor floor effect in the distribution of STREAM total scores, indicating that there is no acceptability at admission and at discharge. STREAM showed the high concurrentvalidity with FM-motor ( ρ ≧ .88), the high convergent validity with PASS (ρ≧ .81), and the moderate convergent validity with BI (ρ≧ .76) at admission and at discharge. The scores of the STREAM at admission showed the high predictive validity with the
scores of the FMA, PASS and BI at discharge(ρ≧ .83).
Responsiveness of the STREAM from admission to discharge washigh (SRM ≧ .78). ICC was 0.989(95% CI=0.981~0.994),
indicating good test-retest agreement. The SEM of the STREAM was 2.0, representing the smallest change threshold that indicates a real improvement for a group of individuals. The SRD of the STREAM was 5.5, exhibiting the smallest change threshold that indicates a real improvement for a single individual. Conclusion : The STREAM has high levels of acceptability, validity, and responsiveness and high agreement between the test-retest measurements with acceptable measurement errors. This suitable and brief assessment tool can be used for clinicians and researchers to assess the motor function of the stroke patients.

並列關鍵字

Stroke ； Psychometric ； Motor scale ； measurement error

參考文獻

參考文獻

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