康复分级诊疗评定量表在脑卒中患者中的信效度检验及应用价值研究  

Reliability and validity test and application value of hierarchical diagnosis and treatment rating scale in rehabilitation medicine in stroke patients

作　　者：薛凯文 吕星[1] 王玉龙[1] XUE Kaiwen;LYU Xing;WANG Yulong(Department of Rehabilitation Medicine,the Second People's Hospital of Shenzhen(The First Affiliated Hospital of Shenzhen University),Shenzhen,Guangdong 518035,China)

机构地区：[1]深圳市第二人民医院(深圳大学第一附属医院)康复医学科,广东深圳518035

出　　处：《中华全科医学》2023年第7期1215-1219,共5页Chinese Journal of General Practice

基　　金：国家重点研发计划“主动健康和老龄化科技应对”重点专项项目(2020YFC2008700);深圳市医疗卫生“三名工程”项目(SZSM202111010)。

摘　　要：目的检验康复分级诊疗评定量表A、B版的信效度及截断值,并确定更适用的版本。方法2022年4月在深圳市四家康复机构开展研究,使用Cronbach′sα系数、组内相关系数(ICC)、Kaiser-Meyer-Olkin(KMO)、Bartlett球形检验、Spearman相关系数和ROC曲线对量表进行检验。结果A、B版量表的Cronbach′sα系数分别为0.740和0.694,ICC>0.75。A、B版量表的KMO值分别为0.659和0.660,Bartlett球形检验P<0.01。A、B版量表与美国国立卫生院卒中量表(NIHSS)相关性>0.75,而与改良Rankin量表(mRS)相关性为-0.101和-0.063。NIHSS>20分对应A、B版量表疾病项得分为2.5分和7.5分,AUC分别为0.775(95%CI:0.677~0.855)和0.840(95%CI:0.750~0.908)。A版量表功能项对应龙氏日常生活能力评定量表(LS)床上人和社会人得分为7.5分和5分,AUC分别为0.541(95%CI:0.435~0.645)和0.575(95%CI:0.469~0.677);B版功能项对应LS量表床上人和社会人得分为10分和5分,AUC分别为0.500(95%CI:0.395~0.606)和0.555(95%CI:0.448~0.658)。结论康复分级诊疗评定量表A、B用于脑卒中患者均具有良好的信度和效度,但功能项评定内容仍需调整。分级诊疗评定量表B更适用于评定脑卒中患者转诊需求。Objective To evaluate the reliability,validity and cut-off points of version A and B of the hierarchical diagnosis and treatment rating scale,and to determine a more applicable version.Methods The study was conducted in four rehabilitation facilities in Shenzhen in April 2022,and the scales were tested using Cronbach′sαcoefficient,interclass correlotion coefficient(ICC),Kaiser-Meyer-Olkin(KMO)and Bartlett's spherical test,Spearman correlation coefficient and ROC curves.Results The Cronbach'sαcoefficients for version A and B were 0.740 and 0.694,respectively,with ICC greater than 0.75.The KMO values for version A and B were 0.659 and 0.660,respectively,with Bartlett spherical test P<0.01.The correlation between the scale(version A and B)and the National Institute of Health Stroke Scale(NIHSS)was greater than 0.75,while the correlation between the scale(version A and B)and modified Rankin scale(mRS)were-0.101 and-0.063 respectively.NIHSS>20 points corresponded to disease item scores of 2.5 and 7.5 points in the A and B version of the scale,with AUCs=0.775(95%CI:0.677-0.855)and 0.840(95%CI:0.750-0.908).The functional items of version A corresponded to the scores of 7.5 and 5 for bedridden group and community group of Longshi scale(LS),with AUC=0.541(95%CI:0.435-0.645)and 0.575(95%CI:0.469-0.677);The functional items in version B corresponded to the scores of 10 and 5 for bedridden group and community group of LS,with AUCs=0.500(95%CI:0.395-0.606)and 0.555(95%CI:0.448-0.658).Conclusion Both hierarchical diagnosis and treatment rating scale A and B have good reliability and validity for application with stroke patients.However,the functional components of the scale need further adjustment.Items in version B are more appropriate for assessing patients'rehabilitation needs and referral directions.

关 键 词：康复分级诊疗评定量表 分级诊疗 脑卒中 信度 效度 

分 类 号：R743.3[医药卫生—神经病学与精神病学] R49[医药卫生—临床医学]