脑卒中患者日常生活活动能力量表的信度与效度研究

Study on reliability and validity of ADL Scale in patients with stroke

目的探讨陶氏日常生活活动能力(ADL)量表的信度与效度。方法采用陶氏ADL量表和Barthel指数对222例急性脑卒中患者入院时、发病后14 d和发病后90 d的日常生活活动能力进行评价。重测信度、评价者之间信度及不同评价方法之间信度以Kappa值表示,分半信度及内部一致性信度以Cronbach α值表示,同时效度行Spearman相关分析,结构效度采用因子分析。结果陶氏ADL量表中点用钞票重测信度为0.594,一般家务评价者之间信度为0.598,分半信度为0.901,内部一致性信度为0.966,电话评价与现场评价之间具有较高的相关性(均P<0.01),陶氏ADL量表评分与Barthel指数在脑卒中急性期和恢复期均有较好的相关性(均P=0.000),陶氏ADL量表有两项公因子,反映患者的运动功能和认知功能。结论陶氏ADL量表内部一致性信度极高,适宜电话随访,但某些评价项目重复或不必要,部分评价项目定义模糊、涉及内容不具体。陶氏ADL量表与Barthel指数具有同时效度,包括两项公因子,反映患者的运动功能和认知功能,可以更为全面地评价脑卒中患者日常生活活动能力。推荐应用修订后的陶氏ADL量表。

Objective To study the reliability and validity of a kind of Activities of Daily Living （ADL） Scales in patients with stroke. Methods Two hundred and twenty-two inpatients with acute stroke were included in this study. The patients were assessed at admission, 14 d and 90 d of hospitalization by Tao ADL Scale and Barthel Index （BI）. Intrarater reliability, interrater reliability and test-retest reliability were determined by Kappa coefficient. The split-half reliability and internal consistency reliability were evaluated by Cronbach α coefficient. Concurrent validity of Tao ADL Scale and BI was determined by Spearman rank correlation. Construct validity was assessed by factor analysis. Results By using Tao ADL Scale, the score of intrarater reliability in the item ＂paying cash, cash counting＂ was 0.594. the score of interrater reliability in the item ＂household duties＂ was 0.598, the split-half reliability and the internal consistency reliability were demonstrated by the score of 0.901 and 0.966, respectively. The high correlation between telephone assessment and direct evaluation （P 〈0.01. for all）, except for the score in the item ＂household duties＂ was 0.478. Concurrent validity analysis of Tao ADL Scale demonstrated a high correlation with BI in both acute and convalescence stage of stroke （P = 0.000, for all）. Factor analysis displayed 2 factors in Tao ADL Scale reflecting motor and cognition functions of stroke patients. Conclusion Tao ADL Scale has an extremely high internal consistency reliability, but some might be redundant or unnecessary. It is suitable for telephone assessment. Due to ambiguity, confusion and nonspecificity of some items, further revision is suggested. Concurrent validity exists between Tao ADI_ Scale and BI. Factor analysis of Tao ADL Scale reveals 2 factors, which reflect the motor and cognition functions of stroke patients. It can thoroughly evaluate the activities of daily living, therefore, the Tao ADL Scale is recommended for use after revision.