簡易上肢評估工具使用於手傷族群之再測信度及效度探討

Test-retest Reliability and Validity of Simple Test for Evaluation Hand Function in Hand Injury

朱娟滿(Chuan-Man Chu)

指導教授 ： 張志仲

高雄醫學大學/健康科學院/職能治療學系碩士在職專班/碩士(2016年)

摘要

在ICF的概念下將結果的評估重點轉向個案在生活中參與及執行職能活動的健康表現，過去臨床上國內手傷病人的手功能評估多著重基本生理能力的恢復，然而肌肉和關節活動度不能讓我們了解個案手部操作的功能表現。故本研究主要的目的在探討由日本所發展的評估工具STEF（Simple Test For Evaluation Hand Function）之再測信度，並檢定與其他臨床常用手功能評估工具之間是否具有同時效度，以提供臨床上更加操作簡易、評估到多面向的靈巧度功能的評估工具選項。招募30位以上手部創傷的個案評估STEF、Jebson-Taylor、Purdue、ARAT，同時採隨機抽樣取17位於一週後再次評估STEF。資料以受傷手進行分析，使用組內相關係數（Intraclass correlation coefficients,ICC）分析再測信度，研究結果顯示總分達到r = .946 的高度相關。皮爾森相關係數（Pearson’s correlation coefficient）分析同時效度，各別與STEF皆有顯著相關性Jebsen ( r = -.617 ,p﹤.001)、Purdue ( r = .823, p﹤.001)、ARAT( r = .912, p﹤.001)。以重複測量變異數分析四項評估工具區辨受傷與非受傷手的能力，其Purdue(η2＝.516 , p﹤.001)、STEF(η2＝.342 , p﹤.001)、ARAT(η2＝.317 , p=.001)，、Jebsen(η2＝.225 , p = .005)。經研究發現STEF施測在手部受傷的個案上具有良好的再測信度與同時效度，且有良好的手功能區辨能力。建議未來臨床上可使用STEF作為手功能療效評估的工具，並發展適合國內的常模如此致該評估工具能更具良好信效度。

關鍵字

手功能評估工具 ； STEF ； 再測信度 ； 同時效度

並列摘要

The result of the hand function outcome assessment has shifted to focus on the person’s participation in basic daily activity and the performance of occupation under the concept of ICF (International Classification of Functioning, Disability and Health).The hand function assessment of the hand-injury patients in Taiwan, however, mostly focuses on the rehabilitation of basic physical function such as range of joint motion and muscle strength, while muscles and range of joint motion cannot help us understand the functional performance of a person’s hand performance.The purpose of the study is to investigate the test-retest reliability of STEF (Simple Test for Evaluation Hand Function) developed in Japan, as well as the concurrent validity among other common clinical hand function assessment tools, in order to provide more convenient hand functional assessment tool in clinics.The study recruited and assessed more than thirty hand-injured participant, using STEF, Jebsen-Taylor Hand Function Test (JTHT), Purdue Pegboard Test (PPT), Action Research Arm Test (ARAT). Seventeen of the recruited participants were randomly chosen and reassessed using STEF after one weekfor test-rest reliability analysis. The test-retest reliability was analyzed by Intraclass Correlation Coefficients on the injured hand, and the result was highly correlated (ICC=.946). Concurrent validity was analyzed using Pearson’s Correlation Coefficient and all revealed significant with STEF. (JTHT, r=-.617, p<.001; PPT, r=.823, p<.001; ARAT, r=.912, p<.001). Repeated measures ANOVA were used to assess the differential ability of the four assessment tools on injured and non-injured hands (PPT, η2=.516, p<.001; STEF, η2=.342, p<.001; ARAT, η2=.317, p=.001; JTHT, η2=.225, p=.005).The study found that STEF has high test-retest reliability and concurrent validity on assessing hand-injured patients, as well as good at hand-function differential ability. It is suggested that STEF could be used clinically on hand function recovery assessment. Norm development with Taiwanese subjects, researchof STEF is also suggested in order to provide better reliability and validity for this assessment tool.

並列關鍵字

hand-function assessment tool ； STEF ； test-rest reliability ； concurrent validity

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