脑卒中患者偏瘫侧肌力测定的信度和效度——手持式测力仪测定规则

The validity and reliability of a hand-held dynamometer in testing the muscle strength of the affected side in stroke patients

目的研究手持式测力仪（HHD）测定脑卒中患者偏瘫侧股四头肌肌力的信度和效度。方法效度判定：使用HHD分别测定2个已知砝码，将测定结果与砝码的标准重量进行相关性比较；并且将HHD与KIN-COM（肌力测定金标准）同时测定的结果进行相关性比较。信度判定：首先分析影响测定结果的因素，用HHD测量l例脑卒中患者取坐位、偏瘫侧膝关节分别屈曲90°和60°时，分别在偏瘫侧踝关节正前方和踝上7cm处以及分别坐在有靠背和无靠背座椅时偏瘫侧股四头肌肌力，然后进行t检验比较各自差异，根据以上影响测定因素结果，制定测定规则；进而根据测定规则，由3名不同检查者对21例脑卒中偏瘫患者进行连续4d、每日1次、共4次测定，分析影响测定结果的因素。结果效度判定结果：2个砝码标准重量是8．972kg和18．666kg，利用HHD测量的结果分别是（8．98±0．00）kg和（18．57±0．00）kg；HHD与KIN-COM的测定结果完全一致。可信度的分析结果：偏瘫侧膝关节不同屈曲角度时测定结果之间差异无统计学意义；而不同测定部位测定结果之间和不同座椅的测定结果之间差异均有统计学意义。因此，规定患者取坐位于有靠背的坐椅上、膝关节屈曲90°、以踝关节正前方为测定点进行测量，发现患者间肌力差异有统计学意义，但3名检查者对相同患者测定的结果差异无统计学意义，同一患者4次测定结果差异无统计学意义。结论用HHD测定脑卒中偏瘫患者偏瘫侧股四头肌肌力时，只要遵从一定测定规则可以保证其信度及效度。

Objective To investigate the validity and reliability of a hand-held dynamometer （HHD） in measuring the strength of the quadriceps femoris muscle on the affected side in stroke patients. Methods The validity test was done by comparing HHD measurements with two known weights and KIN-COM results. Reliability was tested by examining the differences in quadriceps femoris muscle strength measured on the affected side in a stroke patient with the knee flexed between 90° and 60°, the differences between measurements just anterior to the face of the ankle and 7 cm proximal to the ankle, the differences on a chair with or without a backrest, as well as the differences among 3 examiners in their determinations of quadriceps femoris muscle strength on the affected side in stroke patients. Results The measurements of the known weights （8. 972 and 18. 665 kg） with HHD were 8.98±0 kg and 18.57±0 kg, respectively. These values were almost consistent with those determined with KIN-COM, as shown by a Pearson＇s product-moment correlation coefficient of 0.99. Significant differences were observed among measuremeats of quadriceps femoris strength on the affected side in a stroke patients between just anterior to the face of the ankle and 7 cm proximal to the ankle, and on a chair with or without a backrest, but the differences between the 90° and 60° flexed position of the knee were not significant. There were also no significant differences in muscle strength values determined by the 3 different examiners or in 4 trials on 4 successive days, but significant differences were found among the patients. Conclusion Using HHD with the standardized procedure reliably measures quadriceps femoris muscle strength on the affected side in stroke patients.