以ICF為架構編製之日常生活量表之信、效度研究

Reliabilities and Validities of Scale of Activities of Daily Living developed based on ICF

施書驊(Shu-Hua Shih)

指導教授 ： 吳亭芳

國立臺灣師範大學/教育學院/復健諮商研究所/碩士(2010年)

摘要

我國於民國96年「身心障礙者權益保障法」修法時，採用了世界衛生組織頒布的ICF障礙分類系統之「八大身心功能障礙類別」取代原先由醫師診斷的方式做為身心障礙鑑定之依據。為了因應新法之施行，行政院衛生署委託台北醫學大學進行「國際健康功能與身心障礙分類系統(ICF)推動計畫」，以發展適合台灣本土的ICF編碼標準以及鑑定工具。其中自我照顧和居家生活部分之對應工具為「日常生活量表」。但由於該量表甫完成，尚未有信、效度之建立，因此本研究之目的為建立該量表之施測者間信度、再測信度以及效標關聯效度。
研究者實際施測中風個案，以檢定「日常生活量表」之施測者間信度以及再測信度，並以「巴氏量表」和「工具性日常生活功能」做為效標，考驗「日常生活量表」之效標關聯效度。
研究結果發現「日常生活量表」的施測者間一致性百分比均介於70%-100%之間（Kappa值介於0.449-1）；再測信度之一致性百分比介於73.3%-100%之間(Kappa值介於0.571-1)，顯示「日常生活量表」有不錯的施測者間信度及再測信度。效標關聯效度部分，「日常生活量表」的自我照護部分，與巴氏量表及工具性日常生活量表均達顯著相關（Speearman相關係數達0.44-0.835）。但居家生活部分的效度表現則較不理想，未達顯著相關。
由以上研究結果得知，「日常生活量表」應用於中風個案之評估具有良好的信度，但居家生活領域部分的題目仍須進行修改。未來的研究建議將此量表應用於不同診斷及障礙類的個案別並建立其信、效度，以增進該量表未來的可用性。

關鍵字

信度 ； 效度 ； 國際健康功能與身心障礙分類系統 ； 日常生活活動

並列摘要

People with Disabilities Rights Protection Act revised in 2007 has adopted ICF as a framework to determinate the eligibility of persons with disabilities in Taiwan. In order to assure a standardized process for eligibility, several scalses were developed to fulfill the pourpose. The “Scale of Activities of Daily Living” was developed as one of scales for disability eligibility. It was developed from the chapter 5 (self-care) and chapter 6 (domestic life) of the part of activities and participate from ICF. The aims of this study are to establish the inter-rater reliability, test-retest reliability and concurrent validity of the “Scale of Activities of Daily Living”. The inter-rater reliability was established from 2 occupational therapists to evaluate the clients at the same time and the test-retest reliability was established to assess the same client twice 2 weeks apart. In addition, the concurrent validity was established to compare the test results of the “Scale of Activities of Daily Living” to that of the “Barthel Index” and “Instrumental Activity of Daily Living”.
50 stroke patients age between 33 and 90 years from out-patient rehabilitation clinics participated in this study. All the participants were eligible as physical disabilities. Data was analyzed by SPSS 18.0. The results indicated the followings:
1.The inter-rater reliability of the “Scale of Activities of Daily Living” indicated by the consistence rates of 2 raters were between 0.7-1.00(Kappa=0.449-1).
2.The test-retest reliability of the “Scale of Activities of Daily Living” indicated by the consistence rates of the first and the second assessments were between 0.73-1.00(Kappa=0.571-1).
3.The spearman correlation of the “Scale of Activities of Daily Living” and “Barthel Index” were between 0.44-0.835.
4.The spearman correlation of the “Scale of Activities of Daily Living” and “Instrumental Activity of Daily Living” were 0.312.
The results explicated the “Scale of Activities of Daily Living” possesses satisfactory inter-rater reliability and test-retest reliability, yet the concurrent validity of domestic life were not good. Further studies should recruit more clients from different diagnosis and disabilities to enhance the usabilities of the “Scale of Activities of Daily Living”.

並列關鍵字

reliability ； validity ； International Classification of Functioning, disability and Health (ICF) ； activities of daily living (ADL)

參考文獻

World Health Organization. (2001). International Classification of Functioning, Disability and Health. Geneva: Author.

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