肌肉失養症機能損傷與活動能力評估量表 之驗證

A new rating scale of functional impairment and activity specific for muscular dystrophy: from integration to validation

呂怡靜(Yi-Jing Lue)

指導教授 ： 楊瑞成 ； 陳順勝

高雄醫學大學/醫學院/醫學研究所/博士(2006年)

摘要

本研究主要目的為建立量化評估肌肉失養症機能損傷與活動能力的方法，發展「肌肉失養症功能評估量表」並檢測「肌肉失養症功能評估量表」心理計量特性。
研究可分為兩大部分，第一部份是為傳統肌肉失養症功能評估研究，包括多種肌肉失養症類型之病患研究，分別研究單一類型肌肉失養症病患之肌力、運動功能與日常生活能力之表現，由研究結果探討發展「肌肉失養症功能評估量表」應如何設計。第二部份是發展「肌肉失養症功\能評估量表」並檢測其心理計量特性。研究方法包括三個階段，第一階段為測驗項目之編製、第二階段為題目分析及修改、第三階段為檢測本量表之信效度及反應性。測驗項目編製來源包含依據傳統肌肉失養症功能評估研究結果之建議、文獻相關回顧、實際進行觀察、擬定測試架構、詢問專家意見、受試對象與家屬之反應，測驗項目經過多次重複修訂後訂定預試題庫。題目分析及修改方面包含預試與刪題過程，項目分析採描述統計分析、鑑別度分析、因素分析、考慮內部一致性及考慮題目的重複性、精簡程度及各向度的比重。檢測信度方面包含內部的一致性及再測結果的穩定性，再測結果的穩定性使用的方法包括施測者間信度與再測信度。以建構效度檢測效度，包含以因素分析檢驗架構之正確性，與構念相關之量表及其他量測結果之相關性檢驗其正確性。反應性之評估以第一次測量後，經過一段時間再做第二次測量，比較兩次之差異，以檢測量表是否能敏感的偵測出病患功能變化。
研究結果顯示：第一部份傳統肌肉失養症功能評估研究發現，需特別設計上肢運動功能題庫，設計困難度較廣的移動功能與日常生活功\能題庫，以及建構機能損傷之題庫。第二部份「肌肉失養症功能評估量表」發展方面，正式題目共有33題，分為移動能力、日常生活能力、上肢功能及機能損傷四個向度。信效度檢驗方面有很高的內部一致性、施測者間信度與再測信度，不論在因素分析方面、其他量表及其他量測相關性方面，都顯示本量表有良好之建構效度。反應性方面也顯示呈現大的效應值，可敏感的偵測出病患功能的變化。因此「肌肉失養症功能評估量表」是個具有信度且能有效評量肌肉失養症病患功\能的量表。

關鍵字

功能評估 ； 量表 ； 肌肉失養症

並列摘要

The purposes of this research were to develop a reliable and valid new rating scale for measuring functional impact of muscular dystrophy (MD). This research included two parts of studies and combined prospective and longitudinal investigations. The first part of studies was to explore patterns of functional deficits associated with different types of MD. The second part of studies was to develop Muscular Dystrophy Functional Rating Scale (MDFRS). The results of first part would greatly contribute to the later development of the MDFRS.
Scale development consisted of three stages. In stage I, a preliminary pool of 53 items was generated from patient interviews (n = 25), literature review, existing functional rating scales, and expert opinion. In stage II, these items were administered to 85 patients with MD. The resulting data were analyzed to construct the MDFRS that encompassed four unidimensional constructs: mobility, basic activities of daily living, arm function, and impairment. In stage III, the measurement properties of this rating scale were assessed in 121 MD patients different from those examined with the preliminary instrument.
Statistical techniques such as Cronbach’s alpha, Spearman’s correlation, Intraclass correlation coefficients, coupled with exploratory and confirmatory factor analyses were performed to delineate the psychometric properties of the MDFRS.
Internal consistency reliability was excellent for all domains of the final 33-item scale, with values of Cronbach’s alpha ranging from 0.84 to 0.97. Intraclass correlation coefficients for test-retest and inter-rater reliability were 0.99 for all domains of the MDFRS. The MDFRS showed moderate to high correlations with a range of functional rating scales measuring similar aspects and impairment parameters (Spearman’s rho = 0.65-0.91; p < .001, each). Confirmatory factor analysis supported a unitary construct of the four-dimensional MDFRS. The MDFRS had small floor and ceiling effects in the study samples. Sensitivity to change was confirmed by large standardized response means for the MDFRS total score. In conclusion, the MDFRS is a reliable and valid disease specific measure of functional status for patients with MD.

並列關鍵字

functional evaluation ； muscular dystrophy ； scale

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