脑卒中患者步行功能恢复的客观依据:自由和最大步行速度测量的信度和同时效度研究

Objective evidence of walking functional recovery:reliability and concurrent validity of comfortable and maximal gait speed test

目的:步行速度是反映脑卒中患者功能恢复的重要指标。研究采用自由和最大步行速度测量法进行脑卒中患者步行能力评定时的信度和同时效度,为临床评定提供客观依据。方法:解放军总医院康复医学科收治脑卒中偏瘫患者55例,符合第四届全国脑血管病会议通过的诊断标准,意识清晰,可接受动作行指令,患者可独立或在监视下步行20m以上,排除下肢全关节置换术后、严重关节炎而影响步行者,以及存在其他限制下肢活动的并发症者。有5位医师参与,其中2位医师评估55例脑卒中偏瘫患者的10m自由和最大步行速度,作为评测者间信度研究,患者在同一时间段内被同一医师再评估1次,以作为评测者内信度研究。由另3位医师共同利用下肢Fugl-Meyer评价、Berg平衡量表和功能独立性测量作效标尺度进行同时效度的研究。结果:在信度方面,10m自由和最大步行速度的测量在同一评定者的两次评定结果之间高度相关(ICC=0.912～0.937),不同评定者的同一次评定结果之间也高度相关(ICC=0.961～0.972),在同时效度方面,自由和最大步行速度与Fugl-Meyer评价,Berg平衡量表和功能独立性测量有较好的相关性(r=0.595～0.693,P<0.001)结论:自由和最大步行速度测量法评定具有良好的信度与同时效度,推荐在临床结局评价中使用。

AIM:The gait speed is the important index for reflecting the functional recovery in patients after stroke.This study is to assess the reliability and concurrent validity of comfortable and maximal gait speed test in evaluating the walking ability of stroke patients, so as to provide objective evidence for clinical evaluation. METHODS:Fifty-five hemiplegic stroke patients after stroke were selected from the Department of Rehabilitation Medicine, General Hospital of Chinese PLA.All the patients were in accordance with the diagnostic criteria of the Fourth National Academic Meeting for Cerebrovascular Disease, had consciousness,could act as the instruction,and could walk over 20 m by themselves or under monitoring.The patients,who had received total joint replacement of whole lower limbs,walking disturbance induced by severe arthritis and other complications that confined the activities of lower limbs,were excluded.All subjects were randomly examined by two of the five independent evaluators within one day to assess inter-rater reliability,and were reexamined for intra-rater reliability by the same evaluator.The patients were measured with Fugl-Meyer assessment(FMA),Berg balance scale(BBS) and measurement of functional independence taken as the validity scale for the study of concurrent validity. RESULTS:In the aspect of reliability,the results of 10-meter comfortable and maximal gait speed tests showed good intrarater and interrater reliability in the two evaluation by the same evaluator(ICC=0.912 to 0.937) and the same evaluation by different evaluator(ICC=0.961 to 0.972).In the aspect of concurrent validity,the comfortable and maximal gait speed tests were well correlated with the FMA,BBS and measurement of functional independence(r=0.595 to 0.693,P< 0.001). CONCLUSION:The comfortable and maximal gait speed tests have good reliability and concurrent validity,and should be used in evaluating the clinical outcomes.