Oswestry功能障碍指数的改良及信度和效度检验

Improvement of Oswestry disability index and its test of reliability and validity

目的 :改良Oswestry功能障碍指数(Oswestry disability index,ODI)量表评价体系,评估其临床信度和效度。方法:采用包含多种评价指标的随访表对100例手术患者进行术前及术后3个月随访,根据随访结果,剔除依从性差的评价项目,筛选出适合国人的、能反映术后短期腰部功能改善情况的指标,将"生活自理"、"提重物"、"性生活"、"社会生活"、"旅游"5个评定项目换为"下肢麻木程度"、"卧位翻身"、"坐位站起"、"家务劳动"、"工作情况"5个评定项目,建立改良版ODI量表。采用JOA腰痛评分(Japanese Orthopaedic Association low back pain score)、ODI及改良版ODI量表对41例行手术治疗的患者进行随访评定,其中22例行微创椎间盘手术,19例行开放椎间盘手术。评定时间点为术前及术后1周、2周、4周、8周、12周、24周,以内部一致性、分半信度为指标评估量表的信度,以因子分析、Pearson相关系数评价量表的结构效度和内容效度。结果:改良版ODI量表总的Cronbach′sα系数为0.849,各项目的 Cronbach′sα系数均在0.813~0.861之间,分半信度系数为0.894;因子分析的检验结果显示,KMO值为0.857,Bartlett球形检验P<0.001。主成分分析提取全部10个因子,累计方差贡献率为67.2%;内容效度的检验结果显示,改良ODI与JOA、ODI分值显著相关,相关系数分别为-0.695(P<0.001)、0.819(P<0.001)。结论:改良版ODI量表具有良好的信度和效度,适合国人进行腰椎功能评定及手术后短期的疗效评定,中长期的评定效果有待进一步验证。

Objectives： To make improvement to the Oswestry disability index（ODI） to make it suitable and applicable for short-term outcomes evaluation after surgical treatment of low back pain in China. Methods： The follow-ups for low back pain were proceeded in 100 patients before therapy and 3 months after operation, and the items with poor compliance were removed. The items fit for short-term efficacy evaluation were selected to construct the modified ODI in China. Five items in ODI （＂personal care＂, ＂lifting＂, ＂sex life＂, ＂social life＂ and ＂traveling＂） were replaced with five items in modified ODI（＂lower limb numbness＂, ＂turn over in bed＂, ＂stand up when sitting＂, ＂homemaking＂ and ＂employment＂）. 41 low back pain patients undergoing minimally invasive（n=22） and open（n=19） disc surgery were evaluated by Japanese Orthopaedic Association（JOA） low back pain score, ODI and modified ODI. The time points were before therapy and after operations（1 week, 2 weeks, 4 weeks, 8 weeks, 12 weeks and 24 weeks after operation）. The reliability of modified ODI was evaluated by internal consistency and Split-half reliability. The construct validity and content validity of scale were evaluated by factor analysis and Pearson correlation coefficient. Results： The Cronbach′s α coefficient of modified ODI was 0.849, the Cronbach′s α coefficient of items in the scale was between 0.813 and 0.861. The split-half reliability coefficient was 0.894. The factor analysis showed KMO value was 0.857（P〈0.001）. The principal component analysis showed that all the 10 factors were extracted, and the common factor cumulative variance contribution rate was 67.2%. The content validity test showed modified ODI was significantly correlated with JOA score（r=-0.695, P〈0.001） and ODI score（r=0.819, P〈0.001）. Conclusions： With good reliability and validity, modified ODI can be used to make the assessment for low back pain in China and to evaluate short-term outcomes of surgery for low back pain.