功能独立性测量的信度与效度研究

Reliability and validity of Functional Independence Measure

目的：探讨功能独立性测量（ＦＩＭ）在残疾评测中的信度与效度。方法：检测２９例住院康复患者，中风９例，脊髓损伤１３例，外伤性脑损伤７例。其中１６例作了评测者内部、评测者间的信度分析；ＦＩＭ内部一致性用Ｃｒｏｎｂａｃｈα计算。对ＦＩＭ总分、ＦＩＭ运动分、ＦＩＭ认知分及Ｂａｒｔｈｅｌ指数、简易智力状态速测法（ＭＭＳＥ）得分作相关分析。结果：ＦＩＭ评测者内部及评测者间信度佳（Ｐｅａｒｓｏｎｒ＝０．９９９８，Ｐ＜０．００１，ｒ＝０．９９３３，Ｐ＜０００１），ＦＩＭ内部一致性良好（入院ＦＩＭα＝０．８３，出院ＦＩＭα＝０８２）；ＦＩＭ总分与Ｂａｒｔｈｅｌ指数及ＭＭＳＥ得分显著相关（ｒ＝０．９１７４，Ｐ＜０．００１，ｒ＝０．３１６２，Ｐ＜００５），ＦＩＭ运动分与Ｂａｒｔｈｅｌ指数显著相关（ｒ＝０．９５４６，Ｐ＜０．００１），ＦＩＭ认知分与ＭＭＳＥ得分显著相关（ｒ＝０．８５６７，Ｐ＜０．００１）。结论：ＦＩＭ具有很高的重测信度，内部一致性良好，与Ｂａｒｔｈｅｌ指数及ＭＭＳＥ有良好的平行效度，是整体功能残疾一项可信、有效的评测工具。

Objective:To investigate the reliability and validity of the Functional Independence Measure(FIM) among rehabilitation inpatients.Methods:29 patients(stroke:9 cases;spinal cord injury:13 cases;traumatic brain injury:7 cases) were measured.19 male,10 female.For reliability purposes,intrarater and interrater agreement were analyzed using Pearson correlation in 16 of 29 patients. Internal consistency of the FIM was calculated using Cronbach α in all patients.Differences between admission and discharge FIM scores for analysis of FIM temporal responsiveness were examined.Interrelationships among FIM,Barthel index(BI),Minimental State Examination(MMSE),FIM moter subscale and FIM cognitive subscale were investigated.Results: FIM has a good intrarater and interrater reliability ( r>0 99,P <0.01) and good overall internal consistency (admission FIMα=0.83, discharge FIMα=0.82).As to FIM validity FIM demonstrated some responsiveness(45%FIM score improvement, P <0.05);FIM had positive relationships with BI and MMSE( r=0.9174,P<0 001;r=0.3162,P<0.05) .FIM motor subscore was positively correlated to BI( r=0 9546,P<0 001) FIM cognitive subscore was also positively correlated to MMSE( r=0.8567,P<0.001 ) Conclusion:FIM has good retest reliability,good internal consistency and good validity in functional evaluation among inpatients with commonly encountered disabilities. Author′s address Dept. of Rehabilitation Medicine,Zhejiang Provincial People′s Hospital,Hangzhou,310014