身體功能測試於評估社區老人早期功能衰退之切點值及改良式功能前伸之驗證

The cutoff values of physical performance tests to assess early physical function decline in community-dwelling older adults and a modified FR test

林宜泓(Yi-Hung Lin)

指導教授 ： 王靜怡

中山醫學大學/醫學科技學院/醫學檢驗暨生物技術學系碩士班/碩士(2012年)

https://doi.org/10.6834/CSMU.2012.00043

摘要

目的：(1)報告常用於評估社區老人身體功能測試於區分失能與否的最適切點，(2)驗證改良尺進行功能性前伸測試之信效度。方法：500位社區長輩參與切點研究，失能以Katz日常生活活動、工具型日常生活活動及活動度評估，根據執行活動獨立性與否分成「失能」與「無失能」，身體功能表現以三公尺計時起走、計時五次坐站、一般及最快步行速度、功能性前伸及手握力來評估。64位健康年輕人及長輩參與改良尺功能性前伸測試之信度研究，分別以傳統尺及改良尺驗證再測信度及施測者間信度，並比較第一次、前兩次平均值及三次平均值所得結果間之差異。29位健康年輕人參與效度研究，檢驗功能性前伸的距離與足底壓力中心位移之相關性。資料分析：以ROC曲線找出各身體功能測試區分男女失能與否之切點，以組內相關級數分析再測信度及施測者間信度，以皮爾森相關係數分析COP位移及前伸距離之相關性。結果：身體功能測試區分社區老人失能與無失能之切點，與文獻中不同健康指標(如失能、跌倒、死亡等)所報告的參考值類似。兩種尺之兩種信度皆為高信度(ICC=0.89-1.00)且類似，且使用前兩次測試平均值信度與三次測試平均值信度接近。與COP位移的相關性，兩種尺呈低至中度相關。結論：本研究報告的切點可作為偵測早期身體功能衰退使用，作為解讀測驗結果之參考，供民眾自我監測身體功能表現使用。改良尺的前伸距離及信度與傳統尺類似，可考慮取代傳統尺，改善臨床工作者測量之不便，增加測量準確性。且前二次測量平均值與傳統三次平均值具有一樣信度，可節省時間及患者體力。改良尺之效度略低於傳統尺，顯示以改良尺測量前伸距離評估動動態平衡能力與足底壓力中心位移不盡相同，未來須對於可能影響因子進一步釐清。

關鍵字

社區老人 ； 身體失能 ； 切點 ； 功能性前伸測試 ； 信度 ； 效度

並列摘要

Purposes: To report the cutoff values of physical performance tests to differentiate older adults with and without physical disability and to estimate the reliabilities and construct validity of a modified functional reach test (FRT). Methods: 500 community-dwelling elders participated in the cutoff values study. Individual divided into “able” and “disable” groups based on mobility, IADL, and ADL. The physical performance tests were: the timed up & go test, timed 5-chair stand, usual and fastest gait speeds, FRT and grip strength. For the modified FRT, 64 and 29 healthy people participated in the reliability and validity study, respectively. Data analysis: The cutoff values were determined by the ROC curve analysis. The reliabilities were analyzed using the ICC. The Pearson correlation coefficient was used to estimate the correlation between the displacement of COP and reached distances. Results: The cutoff values were found similar to those reference values using other criteria. The reliabilities of the two rulers were similar. The reliabilities were similar when using the mean of the first two trials and the mean of the three trials but significantly lower when using the first trial. Poor to moderate relationship was found between the displacement of COP and the reached distances. Conclusion: The cutoff values could help to identify those experiencing early phase of physical function decline, and for the public to monitor their physical performances. FRT assessed with modified ruler and use the mean of the first two trials as the result was as reliable as the traditional FRT and use the mean of three trials. However, modified FRT may facilitate different strategies to accomplish and worth to be further investigated.

並列關鍵字

community elders ； physical disability ； cutoff values ； functional reach ； reliability ； validity

參考文獻

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