ICF康复组合的身体功能成份在骨科患者功能评定中的Rasch分析研究  

Rasch Analysis of the Body Function Component of the ICF Rehabilitation Set in Functional Assessment of Orthopedic Patients

作　　者：王文轩 徐桂荣 何杏辉[3] 李琨[1] 王颖敏[3] WANG Wenxuan;XU Guirong;HE Xinghui;LI Kun;WANG Yingmin(School of Nursing,Sun Yat-sen University,Guangzhou,Guangdong 510089,China;Shenzhen Longcheng Hospital,Shenzhen,Guangdong 518172,China;Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou,Guangdong 510120,China)

机构地区：[1]中山大学护理学院,广东广州510089 [2]深圳龙城医院,广东深圳518172 [3]中山大学孙逸仙纪念医院,广东广州510120

出　　处：《康复学报》2022年第5期394-400,共7页Rehabilitation Medicine

基　　金：广东省自然科学基金项目(2021A1515011800);国家自然科学基金青年项目(71603293)。

摘　　要：目的:采用Rasch分析检验《国际功能、残疾和健康分类·康复组合》(ICF-RS)中“身体功能”成份作为骨科患者功能评定工具的可行性。方法:采用方便抽样方法,选择2018年7月-2019年11月于深圳龙城医院住院的骨科患者119名,应用ICF-RS中的“身体功能”成份(9个类目)对其进行评定。采用RUMM 2030版软件对评定结果进行Rasch分析,统计指标包含Rasch模型整体拟合度、各类目拟合度、个人分离指数、项目功能差异、个人-项目阈值分布图。结果:第1轮Rasch分析发现,ICF-RS中“身体功能”成份总体拟合度较差(χ^(2)=39.01,P=0.0028,Bonferroni校正后显著性水平为0.05/9=0.0056),项目拟合和个人拟合残差分别为(0.36±1.34)和(-0.24±0.62),个人分离指数为0.55,类目“b130能量和驱力功能”的项目拟合残差为3.642>2.5,不拟合Rasch模型。通过删除类目“b130能量和驱力功能”后,进行第2轮Rasch分析,ICF-RS的“身体功能”成份总体拟合度较好(χ^(2)=25.60,P=0.0599,Bonferroni校正后显著性水平为0.05/8=0.0063),项目拟合残差和个人拟合残差分别为(0.40±0.90)和(-0.27±0.59),个人分离指数为0.58。剩余各类目的项目拟合残差均值均在±2.5以内,差异无统计学意义。在年龄、性别、病程、婚姻情况方面没有发现项目功能差异。个人-项目阈值分布图显示,类目坐标基本涵盖患者坐标。在各类目的表现中,患者在类目“b280痛觉”上表现最差,在类目“b640性功能”上表现最好。结论:通过删除类目“b130能量和驱力功能”后,ICF RS中“身体功能”成份剩余8个类目与Rasch模型的拟合度良好,可以作为骨科患者的功能评定工具。Objective:To examine the feasibility of the Body Function component in the International Classification of Func-tioning,Disability and Health Rehabilitation Set(ICF-RS)as a functional assessment instrument for orthopedic patients by using Rasch analysis.Methods:A total of 119 orthopedic inpatients hospitalized in Shenzhen Longcheng Hospital were recruited from July 2018 to November 2019 through convenient sampling method.The component of Body Function(9 categories)of the ICF-RS was used to assess the patients.Rasch analysis was performed using the RUMM 2030 software.The psychometric properties were reported including overall goodness of fit,goodness of fit for each item,person separation index,differential item functioning,and person-item threshold distribution map.Results:The first-round Rasch analysis found that the overall goodness of fit for the Body Func-tion component of the ICF-RS was poor(χ^(2)=39.01,P=0.0028,the significance level after Bonferroni correction was 0.05/9=0.0056),the item-fit and individual-fit residuals were(0.36±1.34)and(-0.24±0.62),respectively.The person separation index was 0.55.The residuals of the category b130 Energy and Drive Function was 3.642,more than 2.5,and it fit the Rasch model poorly.After deleting the category b130 Energy and Drive Function,the second-round Rasch analysis found that the overall goodness of fit for the Body Function component of the ICF-RS was satisfied(χ^(2)=25.60,P=0.0599,the significance level after Bonferroni correction was 0.05/8=0.0063),the item-fit and individual-fit residuals were(0.40±0.90)and(-0.27±0.59),respectively.The person separation index was 0.58.The residuals of the remaining items were all within±2.5 with a nonsignificant P value.The results showed no differential item functioning in terms of age,gender,course of disease,and marital status.The person-item threshold distribution map showed that the categories basically covered the patient coordinates.The patients performed the worst in the category b280 Pain Sensation and the best i

关 键 词：国际功能、残疾和健康分类 康复 身体功能 评定 RASCH模型 

分 类 号：R68[医药卫生—骨科学]