洛文斯坦認知評估第二版國內信效度之檢驗：中風與頭部外傷病患

本研究主要目的在檢驗洛文斯坦認知評估工具第二版（Loewenstein Occupational Therapy Cognitive Assessment- II, LOTCA-II）中文版之國內信效度，樣本為中風組 (n = 31)、頭部外傷組 (n = 33)及正常組(n = 31)。本測驗有26 題，分為 6個分量表，包括定向感、視知覺、空間知覺、動作計畫、視覺動作組織以及操作思考，總分為128分。結果顯示中風組各分量表內部一致性α係數為 .43到 .84之間，全測驗的α係數為 .91；頭部外傷組各分量表內部一致性α係數為 .56到 .94之間，全測驗的α係數為 .94。相隔一周的重測信度係數，中風組在 .63到1.00之間；頭部外傷組在 .89到 .98之間。施測者間信度係數，中風組達 .91到 1.00之間；頭部外傷組在 .99到1.00之間，皆達 .001顯著水準。在效度方面，魏氏智力測驗全量表分數與中風組與頭部外傷組在本測驗總分皆達中度相關。簡短式智能評估總分與中風組的LOTCA-II全測驗總分達中度相關，與頭部外傷組的全測驗總分則達高度相關。視知覺技能測驗的各分測驗與中風組的全測驗總分達中至高度相關，與頭部外傷組全測驗總分除視覺記憶外皆達中至高度相關。威斯康辛卡片分類測驗三項分數（固著反應、固著錯誤、完成分類組數）與中風組的LOTCA-II之全測驗分數達到中度相關，四項分數（固著反應、固著錯誤、正確觀念反應、完成分類組數）與頭部外傷組的LOTCA-II 之操作思考分量表分數亦達到中度相關。班達視覺保留測驗正確分數與中風組及頭部外傷組的 LOTCA-II之全測驗分數達到中度相關。區辨效度方面，LOTCA-II可區辨頭部外傷組與正常組，但中風組與正常組並沒有顯著差異。此外，在各分量表中只有操作思考可以區辨中風與正常組。區辨左右腦傷部分，中風組與頭部外傷組的左右腦傷患者在本測驗的表現幾乎無顯著差異。結構效度以探索性因素分析來進行分析，結果支持LOTCA-II的一個向度之認知結構。總結而言，洛文斯坦認知測驗第二版中文版具有良好之信效度，可用於臨床腦傷病人的認知功能評量。關鍵詞：洛文斯坦認知評估工具第二版，信度，效度，中風，頭部外傷

關鍵字

效度；信度；洛文斯坦認知評估

並列摘要

The purpose of this study was to examine the reliability and validity of a Chinese version of the Loewenstein Occupational Therapy Cognitive Assessment-Second Edition for neurological patients. LOTCA-II consisted of 26 items categorized into six subtests, including Orientation, Visual Perception, Spatial Perception, Motor Praxis, Visuomotor Organization, and Thinking Operations. Three groups of subjects participated in the study. They were: stroke (n = 31), traumatic brain injury (TBI)(n = 33), and normal controls (n = 31). Our findings showed that internal consistency using Cronbach's alpha ranging from .43 to .84 for the subtests and .91 for the total in the stroke group, whereas Cronbach's alpha ranged from .56 to .94 for the subtests and .94 for the total in the TBI group. Test-retest reliability coefficients over a one-week time span ranged from .63 to 1.0 in stroke group, and from .89 to .98 in TBI group. Inter-rater reliability coefficients were excellent for both patient groups, as well. All coefficients reached statistical significance at the .001 level. With regard to concurrent validity, LOTCA-II was moderately correlated with full-scale score on the Chinese version of the Wechsler Adult Intelligence Scale, Mini-Mental State Examination score, Test of Visual Perception total score, total accuracy score of the Benton Visual Retention Test as well as three scores on the Wisconsin Card Sorting Test (Perseverative Responses, Perseverative Errors, and Categories Completed) in stroke group. For TBI group, moderate to high correlations were found between LOTCA-II and the above-mentioned measures. Concerning discriminant validity, significant differences in the LOTCA-II performance were noted between TBI and normal groups, but not between CVA and normal groups. LOTCA-II Thinking Operations subtest significantly differentiated stroke patients from controls. On the other hand, no significant hemispheric effects were seen on the LOTCA-II performance regardless of diagnostic groups. Lastly, the results of exploratory factor analysis lent support for an unitary factor structure of the LOTCA-II. Taken together, LOTCA-II is a reliable and valid tool for the evaluation of general cognitive abilities in the stroke and TBI groups. Recommendations for future research were made, along with clinical implications. Keywords: Loewenstein Occupational Therapy Cognitive Assessment-Second Edition, Reliability, Validity, Stroke, Traumatic Brain Injury