简短版改良扩展Barthel指数评价脑卒中患者日常生活活动能力的信效度和一致性研究  

Reliability,Validity and Agreement of the Short Form Modified Extended Barthel Index for Assessing Activities of Daily Living of Patients with Stroke

作　　者：张文浩 孙莹 施加加 孙悦 张萍萍 王赛男 余嘉玲 沈玥怡 陈云 ZHANG Wenhao;SUN Ying;SHI Jiajia;SUN Yue;ZHANG Pingping;WANG Sainan;YU Jialing;SHEN Yueyi;CHEN Yun(Jiangsu University,Zhenjiang,Jiangsu 212001,China;Kunshan Rehabilitation Hospital,Suzhou,Jiangsu 215300,China;Shanghai Health Medical College,Shanghai University of Traditional Chinese Medicine,Shanghai 201210,China)

机构地区：[1]江苏大学,江苏镇江212001 [2]昆山市康复医院,江苏苏州215300 [3]上海中医药大学上海健康医学院,上海201210

出　　处：《康复学报》2025年第2期169-175,共7页Rehabilitation Medicine

基　　金：苏州市科技发展计划项目(SKYD2022018);昆山市重点研发计划项目(KS2367,KS2462)。

摘　　要：目的构建简短版改良扩展Barthel指数(MEBI),验证其在脑卒中患者日常生活活动能力(ADL)评价中的信效度及与MEBI的一致性。方法选择昆山市康复医院就诊的脑卒中患者267例,于患者入院3 d内,对175例患者进行MEBI、Barthel指数(BI)、改良Barthel指数(MBI)、扩展Barthel指数(EBI)和功能独立性量表(FIM)评定,其结果作为MEBI简短形式的分析集;对其余92例患者进行MEBI评定,结果作为简短版MEBI一致性分析的验证集。采用多重线性回归模型(逐步法)提取MEBI评分的重要评估项目,构建MEBI简短形式(模型1~16)。通过内部信度分析、效度分析(内容效度、校标效度和结构效度)判定具有最佳信效度的MEBI简短形式作为简短版MEBI。在验证集中,使用配对差值均值、组内相关系数(ICC)分别检验简短版MEBI与完整版MEBI的得分一致性。结果MEBI简短形式为模型5~10。在分析集中,MEBI简短形式(模型6~10)的内部信度Cronbach'sα系数、Spearman-Brown系数均>0.8,各个评估项目评分与模型得分的内容效度ρ相关系数均>0.4(P<0.001);MEBI简短形式(模型6~10)与MEBI、EBI、FIM、MBI、BI的校标效度ρ相关系数均>0.8(P<0.001);MEBI简短形式(模型7)结构效度分析,KMO值为0.837(Bartlett球形检验P<0.001),公因子累计总方差率79.3%,轮椅-床间转移、清洁四肢与躯干、清洁头面部和行走为公因子1;解决问题、理解与膀胱控制为公因子2;2个公因子的7个项目构成简短版MEBI的评估项目。在一致性验证集中,简短版MEBI与完整版MEBI的得分配对差值均值为4.13[95%CI(2.70,5.56)],ICC均值为0.969[95%C(I 0.919,0.984)]。结论简短版MEBI具有较好的可靠性、有效性,与完全版MEBI具有较高一致性,可用于评估脑卒中患者ADL。Objective To construct a short form Modified Extended Barthel Index(MEBI),and to verify its reliability and validity in assessing activities of daily living(ADL)of patients with stroke and its agreement with MEBI.Methods A total of 267 stroke patients from the Kunshan Rehabilitation Hospital were included.Within 3 days of admission,MEBI,Barthel Index(BI),Modified Barthel Index(MBI),Extended Barthel Index(EBI),and Functional Independence Measure(FIM)assessments were used to evaluate ADL of 175 patients as the analysis set for short-form development,while the remaining 92 patients completed the MEBI alone as the validation set for agreement analysis.Multiple linear regression models(stepwise method)were used to extract core MEBI items to construct short-form MEBI(model 1-16).The optimal short form MEBI was determined through internal reliability analysis and validity evaluation(content validity,criterion validity,and construct validity).In the validation set,paired mean differences and intraclass correlation coefficients(ICC)were calculated to assess agreement between short form MEBI and full MEBI scores.Results Short-form models(model 5-10)were constructed.In the analysis set,the internal reliability Cronbach'sαand Spearman-Brown coefficients of the short-form MEBI(models 6-10)were greater than 0.8,and the content validityρcorrelation coefficients between the scores of each assessment item and the total score of the model were greater than 0.4(P<0.001);criterion validityρcorrelation coefficients between short-form MEBI(models 6-10)and MEBI,EBI,FIM,MBI,BI were greater than 0.8(P<0.001).The short-form MEBI(Model 7)demonstrated optimal construct validity(KMO=0.837;Bartlett's test P<0.001),with two factors cumulatively accounting for 79.3%of the total variance:factor 1(bed-wheelchair transfer,limb-trunk hygiene,facial hygiene,ambulation),factor 2(problem-solving,comprehension,bladder control);the seven items of the two common factors constituted the evaluation items of the short form MEBI.In the agreement validatio

关 键 词：脑卒中 日常生活活动能力 改良扩展Barthel指数 信度 效度 一致性 

分 类 号：R743.3[医药卫生—神经病学与精神病学]