腕关节患者功能自评量表的设计及其信度与效度评价  

Design, sensitivity and validity of wrist patient self-evaluation instrument

作　　者：刘路 魏绮珮 李秋雅 白帆 王志新[1] 刘畅[1] 陈山林[1] Liu Lu;Wei Qipei;Li Qiuya;Bai Fan;Wang Zhixin;Liu Chang;Chen Shanlin(Department of Hand Surgery,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院手外科,北京100035

出　　处：《中华骨科杂志》2023年第5期300-307,共8页Chinese Journal of Orthopaedics

摘　　要：目的设计适合中国患者使用的腕关节患者自评量表并对其信度和效度进行评价。方法参考现有国外量表和国内腕关节专家意见,建立初选条目池。11名手外科医生及10例腕关节疾病患者对条目池进行评价及取舍,构建量表的基本框架,形成初始测试量表。采用方便取样法,抽取2015年9月至2016年11月于北京市积水潭医院手外科住院的100例腕关节疾病患者进行问卷调查。总结问卷调查结果的条目应答率、条目区分度、条目-维度归属度、变异度、反应度、条目整体归属情况、内部一致性及因子负荷共8项指标,对各条目取舍,得到腕关节患者功能自评量表。使用重测信度、Cronbach系数、专家评分、KMO值、替代性检验指数(χ2/df)、近似均方根误差(root mean square error of approximation,RMSEA)、比较拟合指数(comparative fit index,CFI)对量表的信度及效度进行评价。结果对备选条目池共40个主观条目进行取舍,形成初始测试量表,共32个条目(A1~D4),分为生理、安全、疼痛、情感与归属四个维度。92例患者完成问卷调查,全部条目的应答率>90%。条目区分度中,只有B10条目的高分组得分[(3.20±0.577)分(范围1~3分)]与低分组[(2.68±0.627)分(范围2~5分)]比较差异无统计学意义(t=5.11,P=0.340),被删除。条目-维度归属度结果中考虑删除A1、A2、A5、A6、A7、A8、A9、A10、A11、A12、B4、B6、B7、C5、D1、D2、D3,共17个条目。共11个条目的变异度<0.65:A4(0.645)、A7(0.593)、B1(0.590)、B5(0.617)、B8(0.578)、B9(0.612)、B10(0.526)、D1(0.644)、D2(0.320)、D3(0.169)、D4(0.526)。不符合反应度要求的条目为A2、A4、A6、A8、B4、B6、D1、D2、D3、C2、C3、C4、C5、C6。因子负荷<0.4的条目包括D2(-0.051)、D3(-0.127)、D4(0.267)。内部一致性不符合要求的条目为C4(0.026)、C5(0.023)、D1(0.103)、D2(0.434)、D3(0.387)、D4(0.062)。多元线性回归分析中共19个条目未被纳入最终的Objective To design a patient self-rating wrist scale suitable for Chinese patients,and evaluate its reliability and validity.Methods The primary entry pool was established by referring to the existing foreign scales and the opinions of domestic experts.Opinions of 11 hand surgeons and 10 patients with wrist diseases were referred to select better items into the primary scale.During September 2015 to November 2016,100 inpatients with wrist diseases in the hand surgery department of Beijing Jishuitan Hospital were selected by convenient sampling method,and the primary scale was conducted on them.Eight indices including item response rate,item differentiation,item-dimension attribution,variability,responsiveness,overall item attribution,internal consistency and factor loading were summarized.All the 8 indices were evaluated to establish the wrist patient self-evaluation instrument for Chinese.Test-retest reliability,Cronbach coefficient,expert score,KMO value,explanatory power,χ2/df,root mean square error of approximation(RMSEA)and comparative fit index(CFI)were used to evaluate the reliability and validity of the scale.Results A total of 40 subjective items in the primary entry pool were selected to form the primary scale,including 32 items(A1-D4),and 4 dimensions(physiology,safety,pain and emotion).There were 92 valid scale results in 100 cases.All cases'response rate were over 90%.In terms of item differentiation,only the high grouping score[3.20±0.577 points(range,1-3 points)]and the low grouping score[2.68±0.627 points(range,2-5 points)]of item B10 had no statistical significance(t=5.11,P=0.340).There were 17 items:A1,A2,A5,A6,A7,A8,A9,A10,A11,A12,B4,B6,B7,C5,D1,D2,and D3 were considered to be deleted according to the result of item-dimension attribution.A total of 11 items had a variation less than 0.65:A4(0.645),A7(0.593),B1(0.590),B5(0.617),B8(0.578),B9(0.612),B10(0.526),D1(0.644),D2(0.320),D3(0.169),D4(0.526).A2,A4,A6,A8,B4,B6,D1,D2,D3,C2,C3,C4,C5,C6 did not meet the reactivity requirements.Items with f

关 键 词：腕关节 结果可重复性 诊断性自我评价 

分 类 号：R684[医药卫生—骨科学]