重症监护室患者身体功能测评工具在早期康复中的反应度及最小临床重要差值研究  

The responsiveness and minimal clinically important difference of physical function assessment tools for ICU patients in early-stage rehabilitation

作　　者：刘明月 方芳[1] 杨富[1] 郭军 钱青青[1,2] LIU Mingyue;FANG Fang;YANG Fu(Shanghai General Hospital,Shanghai,200080)

机构地区：[1]上海市第一人民医院护理部,上海市200080 [2]苏州大学

出　　处：《中国康复医学杂志》2025年第1期38-45,共8页Chinese Journal of Rehabilitation Medicine

基　　金：上海市申康医院发展中心技术规范化管理和推广项目(SHDC2022219)。

摘　　要：目的:探讨中文版Chelsea物理功能评估量表(the Chelsea critical care physical assessment tool,CPAx)、Perme危重患者活动评分量表(the Perme intensive care unit mobility score,Perme Score)、监护室活动量表(ICU mobility scale,IMS)在ICU患者早期康复中的反应度及最小临床重要差值(minimal clinically important difference,MCID),为量表的临床应用提供更加完备的证据支持。方法:本研究为前瞻性观察研究。采用便利抽样法,选取2021年3—12月收住于上海市某三级甲等医院综合ICU的患者共114例,分别在患者首次康复治疗前和末次康复后(出ICU前24h)使用中文版CPAx、Perme Score、IMS量表对患者进行身体功能测评,并于末次康复后使用Likert 5分级量表进行患者健康状况总体变化自评。反应度包括内部反应度和外部反应度。内部反应度的评价应用配对t检验、效应大小(effect size,ES)和标准化反应均数(standardized response mean,SRM)来比较;外部反应度应用Spearman相关分析来检验3个量表与患者总体变化自评的相关性。MCID计算综合分布法和效标法的估计值。结果:内部反应度结果显示:患者康复前后的CPAx、Perme Score和IMS总分比较,两者间差异均有显著性意义(P<0.05);其效应值ES分别为:1.03、1.09、1.14,SRM分别为:1.75、1.52、1.73。表明以上量表具有良好的内部反应度,可敏感地反映患者的病情变化。外部反应度结果显示:CPAx、Perme Score和IMS量表康复前后差值与患者总体变化自评的Spearman相关系数分别为:0.67、0.50、0.30,P<0.01。表明除IMS外部反应度较为欠缺外,其余量表均具有良好的外部反应度,能够反映出患者在康复疗程中自我感觉的变化。MCID结果显示:CPAx量表以ES为中介指标的MCID为5.66,以SEM为中介指标的MCID为5.48,以患者总体变化自评为主观锚的MCID值为8.73;Perme Score量表以ES为中介指标的MCID为2.43,以SEM为中介指标的MCID为3.64,以患者总体变Objective:To explore the responsiveness and minimal clinical significance difference(MCID)of the Chinese version of the Chelsea critical care physical assessment tool(CPAx),the Perme Score intensive care unit mobility score(Perme Score),and the intensive care unit(ICU)mobility scale(IMS)for patients in ICU during the early-stage rehabilitation,providing more comprehensive evidence support for clinical application of these scales.Method:It is a prospective observational study.The convenience sampling method was used to select 114 patients in a ICU of a Tertiary Hospital in Shanghai from March 2021 to December 2021.Patients were assessed by Chinese version of CPAx,Perme Score,and IMS before the first rehabilitation treatment and within 24 hours before discharge from ICU.Likert five-scale was used to evaluate the overall changes in health status of the patients after the last rehabilitation.Responsiveness includes both internal responsiveness and external responsiveness.Internal responsiveness was determined by pair t-test,effect size(ES)and standardized response mean(SRM);external responsiveness was assessed by using Spearman correlation coefficient.MCID was calculated by integrating the estimates from the distribution-based methods and the anchor-based methods.Result:Internal responsiveness outcomes indicated that there was significant difference between the score of CPAx,Perme Score and IMS before and after rehabilitation(P<0.05),with ES of 1.03,1.09 and 1.14,and SRM of 1.75,1.52 and 1.73,respectively.The results showed that the scale had good internal responsiveness and could sensitively reflect the changes of patients'condition.External responsiveness outcoms showed that Spearman correlation coefficients of CPAx,Perme Score and IMS with global rating of change(GRC)were 0.67,0.50 and 0.30,respectively(P<0.01),indicating that apart from IMS,the other scales had good external reactivity,and could reflect the changes of patients'self-perception during the rehabilitation process.The MCID of CPAx scale with ES as the

关 键 词：危重患者 早期康复 测评工具 反应度 最小临床重要差值 

分 类 号：R493[医药卫生—康复医学] R563.9[医药卫生—临床医学]