中高齡智能障礙者體適能測驗的調整應用之可行性與信度檢驗

背景：近年來智能障礙者的平均餘命明顯增加，但該群體的健康狀況由於先天或後天病因，以及其它合併障礙交互影響，導致在中年期就得面臨健康狀態急速下滑。為使相關服務單位能及早發現，提供延緩和促進健康之方案，運用體適能測驗初步檢視其健康狀況。然而，目前國內較缺乏對中高齡智能障礙者執行體適能測驗的相關研究，且鮮少基於相關使用單位(社服機構)的觀點考量。目的：本研究之目的為探討應用體適能測驗調整策略於中高齡智能障礙者的可行性，並建立再測信度，使社區實務工作者可用以檢測中高齡智能障礙者的體適能表現變化。方法：共43位財團法人心路社會福利基金會—高雄分會的中高齡智能障礙者參與本研究。首先，研究者調查了每項體適能測驗參與者完成的百分率，包括身體質量組成、握力、30秒坐站測試、護背式坐姿體前彎，及6分鐘走路測試，以了解增列調整策略後的可行性。且使用組內相關係數 (intraclass correlation coefficient, ICC)、測量標準誤 (standard error of measurement, SEM) 和最小可偵測變化值 (minimal detectable change, MDC) 建立再測信度。結果：本研究的體適能測驗具極好之可行性 (>75%)。採間隔兩周的重複測量下，身體質量組成、握力、30秒坐站測試、護背式坐姿體前彎達優良之再測一致性 (ICC = 0.81-0.99)；6分鐘走路測試則達良好之再測一致性 (ICC = 0.79)。然而MDC90%的結果中，卻顯示護背式坐姿體前彎的隨機測量誤差偏高 (MDC90% = 42.4%-45.6%)。結論：本研究的體適能測驗，被驗證可用於機構中多數的中高齡智能障礙者，並具有良好以上的再測一致性。而各測驗的MDC90，可用於判斷中高齡智能障礙者的體適能成績是否發生真實變化。然而，其中柔軟度在臨床上所觀察到的變化，可能存在較多的隨機誤差，建議後續研究宜探討如何降低，以提升其研究及臨床應用價值。

關鍵字

中高齡智能障礙者；體適能測驗；再測信度

並列摘要

Background: Recent years, the average life expectancy of people with intellectual disabilities significantly increased, but their health status has congenital or acquired causes and other combined disabilities, resulting in a rapid decline in health of middle and late-aged individuals. In order to earlier detect and provide solutions on delaying their physical decline for related social service organization. Physical fitness is relevant for their wellbeing and health, but there was relatively few research about the implementation of the fitness test for the middle and late-aged intellectual disability, and was rarely based on the viewpoints of the users in practice of social service organization. Objective: The purpose of the study is to determine the feasibility of the physical fitness test for middle and late-aged intellectual disabilities, and to establish the test-retest reliability for the relevant users in practice of social service organization. Method: A total of 43 middle and late-aged intellectual disability participants from the Kaohsiung Branch of Syin-Lu Social Welfare Foundation participated in the study. First, the investigators investigated the percentages of each tests completed by participants, including body mass index, Jamar dynamometer, 30-s sit and stand test, back saver sit and reach test, 6-minute walk test to learn about the feasibility of the additional adjustments. Furthermore, intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable change (MDC) were used to establish the test-retest reliability. Result: All physical fitness assessment of this study has excellent feasibility (>75%). Measurements at intervals of two weeks showed excellent test-retest reliability (ICC = 0.81-0.99) of the physical fitness in body mass index, Jamar dynamometer, 30-s sit and stand test, back saver sit and reach test; and good retest reliability (ICC = 0.79) in 6-minute walk test. In the MDC results, the random measurement error of back saver sit and reach test is high (MDC90% = 42.4%-45.6%). Conclusion: These adjusted fitness tests are suitable for most of the middle and late-aged intellectual disabilities in the organization, and has a good test-retest consistency. The overall MDC can be used to determine whether the individual's physical fitness performance has changed. However, there may be more random errors in the test of softness. It is recommended that follow-up studies should improve for increasing its research and clinical application value.