醫師與護理師對巴氏量表評分一致性的研究

Inter-Rater Reliability of the Barthel Index Scoring between Nurses and Doctors

林瑛釗(Ying-Chao Lin) ； 戴玉慈(Yu-Tzu Dai) ； 王亭貴(Tyng-Guey Wang)

《台灣復健醫學雜誌》 48卷2期 (2020/12) Pp. 123-132

https://doi.org/10.6315/TJPMR.202012_48(2).0006

摘要

巴氏量表為目前台灣地區用來評估日常生活活動功能狀態最廣為運用的評估量表，除了用於評估病人日常生活能力外，並且是聘僱外籍看護工之評估皆以巴氏量表為依據。在臨床住院照護中，醫師及護理師是最常評估患者日常生活的醫護人員，但是綜觀相關之研究卻缺乏了探討醫師與護理師評估巴氏量表一致性之報告，本研究的目的在於探討醫師及護理師評估巴氏量表的一致性及可能影響其一致性的相關因子。本研究以北部某醫學中心之復健科病房進行，以實際上參與病人照護之住院醫師與護理師為量表的評估者。以結構式問卷調查病人與照顧者之基本資料，病人資料包括年齡、診斷、性別、教育程度、簡短智能測驗分數等；照顧者資料包括年齡、照顧病人的時間、性別與教育程度；評估者則收集年齡、性別、本院工作年資、職級與接受過巴氏量表評估在職教育時數等資料進行描述性與推論性之統計。本研究自2014年8月至2014年9月，共收集67對病人與照顧者、評估表含住院醫師15名、護理師20名。結果顯示醫師與護理師利用巴氏量表進行病人日常生活之評估總分具有良好之一致性（ICC=0.95），而分項目中，僅「個人衛生」、「如廁」、「洗澡」與「平地走動」等四個項目屬中等一致性（ICC=0.50-0.70），其餘六項「進食」、「移位」、「上下樓梯」、「穿脫衣褲」、「大便控制」與「小便控制」具有良好的一致性（ICC=0.80-0.95）。評估的一致性和評估的背景及被評估者的生理教育背景無關。我們總結，醫師與護理師使用巴氏量表進行日常生活活動功能評估具有良好的評估者間一致性。

關鍵字

巴氏量表（Barthel Index） ； 評估者間一致性（inter-rater reliability） ； 日常生活（daily life）

並列摘要

The Barthel Index is not only used to assess the status of activities of daily living and the planning of rehabilitation program but also to hire foreign health aids as a qualification standard for patients in Taiwan. However, studies on the inter-rater reliability of the Barthel Index are lacking between nurses and doctors, who are common specialties in evaluating the Barthel Index in Taiwan. The present study evaluates the inter-rater reliability of the Barthel Index and related influential factors of assessment. This study was conducted in a rehabilitation ward of a medical center in the northern part of Taiwan from August 1, 2014 to September 30, 2014. Sixty-seven patients and their caregivers were included in this study, and the demographic information of patients, including age, diagnoses, gender, education level, and Mini-Mental State Examination (MMSE) scores and age, duration of care, gender, and education level of their caregivers were collected. Thirsty-five medical personnel, the so-called 'assessors' in this study, which, comprised of 15 doctors and 20 nurses, were included. They participated in the care of the patients. Basic information of the assessors, including age, gender, length of service at the hospital, seniority, and whether or not they have received in-service education on the Barthel Index and the number of times of receiving education were recorded. Data were analyzed using descriptive and inferential statistics. The results showed that the total scores for the Barthel Index evaluated by doctors and nurses have good consistency (intraclass correlation coefficient (ICC= 0.95). The four sub-items of the Barthel Index, namely, 'grooming,' 'toilet,' 'bathing,' and 'ambulation,' had moderate consistency (ICC =0.50~0.70). The other six sub-items, namely, 'feeding,' 'transfer,' 'up and down the stairs,' 'dressing,' 'bowel,' and 'bladder,' had good consistency (ICC =0.80~0.95). No influential factors such as MMSE, education level, seniority, and the number of times of receiving education were significantly associated with the Barthel Index scores. This study confirmed that the Barthel Index has a good inter-rater reliability between doctors and nurses. No influential factors affected the scores of evaluation.

並列關鍵字

Barthel index ； inter-rater reliability ； activities of daily living

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