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  • 學位論文

電腦化空間順序記憶測驗用於精神分裂症病患之再測信度

Test-retest reliability of the Computerized Point Digit Span Test in patients with schizophrenia

指導教授 : 陳美香

摘要


目的:本研究之目的在驗證電腦化空間順序記憶測驗(computerized point digit test, CPDT`)應用於精神分裂症病患之再測一致性與最小可偵測之變化值(MDC),使未來能有效的提供臨床及研究人員於精神分裂症病患記憶力評估之工具選擇以及數據解釋之參考依據。 方法:樣本來源為中部某精神醫療中心,共徵召37名精神分裂症患者,每位個案間隔一週接受CPDT前後二次測驗,利用配對t檢定、組內相關係數、Bland-Altman圖及MDC進行統計分析,呈現其再測信度。 結果:(1)本研究使用配對t檢定檢驗CPDT前後兩次得分,結果t值為-1.388(p=0.18),前後測分數未達顯著差異,代表受測群體之前後兩次的記憶力表現穩定、未出現系統性誤差。(2)組內相關係數(ICC)驗證CPDT前後二次評量分數,統計後為ICC=0.52(95%CI=.136~.768);顯示其具備"中等"的再測一致性,信賴區間範圍顯得較大,代表結果並不穩定。(3)Bland-Altman分析其平均差值(‾d)=0.64、二次分數差之標準差(SD_diff)=2.15、95%信賴區間為-3.57~4.85,信賴區間包含0代表二次測量結果沒有系統性的偏誤,平均差值接近於0代表學習效應低,但信賴區間界限相較於平均分數之百分比分別為-54%與73%,顯示CPDT的信賴區間過大,其前後測一致性偏低。(4)MDC%=63%,明顯高於可接受標準30%,代表CPDT之測量誤差未達可接受之範圍。 結論: CPDT首次使用於測量慢性住院之精神分裂症病患的短期空間工作記憶力表現,相隔一周前後兩次測量結果發現僅具”中等”之再測一致性,且隨機誤差較大,使得臨床工作者較難以應用CPDT作為偵測病患功能改善與否之指標。 建議臨床人員使用時可藉由CPDT施測時間短、學習效應低的優勢,評估時改變施測方式(連續施測多次取其平均值),以減少隨機測量誤差之干擾。

並列摘要


Objective: The objective of the study was to examine the testing and retesting consistency and minimal detectable change (MDC) in the usage of a computerized point digit test (CPDT) on patients with schizophrenia. The results would help practitioners and researchers select effective tools to assess the memory of schizophrenic patients and interpret the test results. Methods: The study sample was collected from a psychiatric center in central Taiwan. A total of 37 patients with schizophrenia were recruited, with each subject receiving two CPDT testing in sequence separated by a one-week interval. The data were analyzed using the paired t-test,intraclass correlation coefficient (ICC), Bland-Altman plot, and MDC, to reveal the test-retest reliability. Results: (1) The t value was -1.388 (p=0.18), and thus the difference between the scores of the first and second CPDT was insignificant. This means that the test subjects demonstrated stable memory in the two tests without any systematic bias. (2) The ICC was 0.52 (95%CI = 0.136 - 0.768). This result indicates a medium level test-retest consistency. The confidence interval was relatively large, suggesting that the results were unstable. (3) The data were also analyzed using the Bland-Altman plot, and the results suggested that the mean difference (‾d) was 0.64, the standard deviation of difference between the two scores (SD_diff) was 2.15, and that the 95% confidence interval was -3.57 – 4.85 . The mean difference was close to 0, indicating a low learning effect. Compared to the mean scores, the percentages of the upper and lower limits of the confidence interval were -54% and 73% respectively. This finding indicates that the consistency of testing and retesting results of the CPDT was relatively low. (4) The MDC% was 63%, indicating that the measurement error of CPDT was not acceptable. Conclusions: It was the first time that the CPDT was applied to test short-term spatial working memory in inpatients with chronic schizophrenia. A moderate consistency was found between the two tests given in sequence with a one-week interval; furthermore, there was a large random error. As a result, the CPDT was not a good clinical measure for inpatients with chronic schizophrenia. The investigator suggests to clinical staff to take advantage of the fast and low learning effect of the CPDT. In addition, the method of assessment should be altered (by administering multiple assessments and using the mean) to reduce the influences from random measurement errors.

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