脑损伤患者应用洛文斯顿作业疗法认知评定量表的结构效度检测

Constructive validity of Loewenstein Occupational Therapy Cognitive Assessment in Chinese patients with brain injury

目的:检测国内脑损伤患者中洛文斯顿作业疗法认知评定量表(中文版)的结构效度。方法:以2004-05/2005-01在南方医院康复医学科住院的脑损伤患者34例作为病例组,以无中枢神经系统疾病的其他患者和患者家属、陪护人员64例为对照组。运用证实性因子分析的方法对洛文斯顿作业疗法认知评定量表的结构效度进行考察。中文洛文斯顿作业疗法认知评定量表包括6个方面26项条目:①地点定向;②时间定向;③物品识别;④几何图形识别;⑤图形重叠识别;⑥物品一致性辨别;⑦身体方向;⑧与周围物体的空间关系;⑨图片之中的空间关系;⑩运动模仿;紒矠紜物品使用;紝紒矠象征性动作;紞矠紒临摹几何图形;紟矠紒复绘二维图形;紡矠紒插孔拼图;紣矠紒彩色方块拼图;紒矠紤无色方块拼图;紒紥矠碎图复原;紦矠紒画钟面;紓紛矠物品分类;紜矠紓Riska无组织图形分类;紓矠紝Riska有组织图形分类;紞矠紓图片排序A;紟矠紓图片排序B;紡矠紓几何图形排序推理;紓紣矠逻辑问题。其中①～②为定向;③～⑥为视知觉;⑦～⑨为空间知觉,⑩～紒紝矠为动作运用。紞紒矠～紦矠紒为视运动组织,紛紓矠～紓矠紣为思维运作。除了①、②记分为1～8分,紛矠紓～紝矠紓记分为1～5分外,其余记分为1～4分。总分为115分。结果:两组观察对象均完成测试,进入结果分析。洛文斯顿作业疗法认知评定量表在病例组中有较高的结构效度,病例组6个公因子累积方差贡献率为88.4%,每个条目在其中一个公因子有较高的负荷,地点定向、时间定向负荷于因子5,几何图形识别、图形重叠识别、物品一致性辨别负荷于因子1,临摹几何图形、复绘二维图形、插孔拼图、彩色方块拼图、无色方块拼图、碎图复原负荷于因子1,图片顺序B、图片顺序A、几何图形排序推理、逻辑问题负荷于因子2,与量表设计的6个方面相近。对照组6个公因子累积方差贡献率为68.1%,各条目在6个公因子的负荷分布与洛文斯顿作业疗法认知评定量表设计的6个方面差异大,部分条目因子负荷为负数,说明该量表在对照组结构效度一般。结论:对于国内脑损伤患者,洛文斯顿作业疗法认知评定量表具有较好的结构效度,适宜在国内临床工作中运用。

AIM：To detect the constructive validity of the Chinese Edition of Loewenstein Occupational Therapy Cognitive Assessment in Chinese patients with brain injury. METHODS： Thirty-four inpatients with brain injury in the Department of Rehabilitation Medicine of Nanfang Hospital between May 2004 and January 2005 were selected as the patient group, and other patients, relatives and accompanying persons without disease of central nerve system （n=64） were selected as controls, both of which were assessed by a professional assessor with Loewenstein Occupational Therapy Cognitive Assessment. The. constructive validity was tested through confirmed factor analysis. There were 26 items in 6 aspects of Loewenstein Occupational Therapy Cognitive Assessment： （1）orientation for place; （2） orientation for time; （3） object identification; （4） shape identification; （5）overlapping figures; （6） object constancy; （7） directions of body; （8） Spatial relations between his/her body and objects in the near space; （9） spatial relations： represented in a picture; （10）motor imitation;（11） utilization of objects; （12） symbolic actions; （13）copy geometric forms; Reproduction of a two-dimensional model; （14）pigboard construction; （15）colored block-design; （16） plain block-design; （16） reproduction of a puzzle; （18） drawing a clock; （19） categorization; （20） Risks unstructured object classification; （21）Risks structured object classification; （22）pictorial sequencc A; （23） pictorial sequence; （24）geometrical sequence; logic questions. （1）-（2） items belonged to orientation; （3）-（6） were visual perception; （7）-（9） were spatial perception; （10）-（12） were motor praxis; （13）- （19）were visuomotor organization; （20）-（26） were thinking operations. Except that （1）-（2） items scored from 1 to 8 and （20）-（22） from 1 to 5, all the items scored from 1 to 4, and the total score was 115. RESULTS： Both groups of subjects had finished the assessment. Factor analysis showed that Loewenstein Occupational Therapy Cognitive Assessment had good constructive validity in the patient group, the dedication rate of the 6 factors accumulative variance was 88.4%, each item had higher loading in every factor, fact 5 was loaded by orientation for place and orientation tor time; tactor 1 by shape identification, over.lapping figures and object constancy; factor 1 by copy geometric forms, Reproduction of a two-dimensional model, pigboard construction, colored block-design, plain block-design and reproduction of a puzzle,; and factor 2 by pictorial sequence A, pictorial scqucncc, geometrical sequence and logic questions, which were similar to the 6 aspects designed in the assessment. In the control group, the dedication rate of the 6 factors accumulative variance was 68.1%, the loaded distribution of each item in the 6 factors was greatly different those designed in Loewenstein Oceupational Therapy Cognitive Assessment, and the factor loads of part items were negative, indicating that this assessment had common constructive validity in the cuotrol roup. CONCLUSION： Since it has better constructive validity in Chinese patients with brain injury, Loewenstein Occupational Therapy Cognitive Assessrnent is worth being used in clinic in China.