中国版简明ICF核心要素量表在社区脑卒中康复中应用的可行性研究

Feasibility of brief ICF core sets for Chinese stroke patients in community-based rehabilitation

目的 探讨中国版脑卒中简明ICF核心要素鼍表（以下简称中国版ICF简表）在社区脑卒中康复中应用的可行性.方法 146例社区脑卒中患者,接受以本体感觉神经肌肉促进疗法（PNF）为主的康复治疗6个月.按照中国版ICF简表、美国国立卫生研究院卒中量表（NIHSS）、Barthel指数（BI）和SF-36的规则进行治疗前后评定.效度研究采用校标效度,以Spearman相关性判断中国版ICF简表与NIHSS、BI和SF-36的相关性大小.信度研究采用重测信度和内部一致性的分析方法,分别以Kpppa检验和Cronbach α表示.结果 中国版ICF简表的四个成份中,身体结构、身体功能,活动与参与的Kappa值治疗前后分别在0.782-0.935和0.787-0.965之间（P〈0.01）;环境因素的Kappa值治疗前后分别在0.578-0.931和0.608-0.969（P〈0.01）之间,有较为良好的重测信度.身体功能、活动与参与和环境因素有较好的内部一致性,α值治疗前后分别在0.774-0.926和0.786-0.953之间.治疗前后该量表与NIHSS,BI,SF-36相关系数分别为0.848,0.867,0.798（P〈0.01）及0.854,0.879,0.832（P〈0.01）,提示ICF与NIHSS,BI,SF-36有较好的共同效度.结论 在社区脑卒中康复治疗前后,中国版ICF简表具有较高的信度和效度,可以进一步推广应用.

Objective To explore the application and feasibility of brief ICF core sets for Chinese stroke patients in community-based rehabilitation. Method One hundred and forty-six community stroke patients were measured with brief ICF Core Sets for Chinese stroke patients, the NIH Stroke Scale （NIHSS） , Barthel Index （BI） and SF-36. Repetition reliability, internal consistency and face validity were analyzed with Kappa test, Conbach et index and Pearson correlation analysis respectively in the process of PNF technique for six months. Result The brief ICF Core Sets for Chinese stroke pa- tients had very good repetition reliability among components of body function, body structure, activity and participation with Kappa=0.782-0.935 and environment factor with Kappa=0.578-0.931before PNF intervention and with Ka- ppa=0.787-0.965 and Kappa =0.608-0.969 after intervention respectively. Good internal consistency existed in body func- tion, activity and participation and environment factor with tt =0.774-0.926 before PNF intervention and with ct =0.786-0.953 after PNF rehabilitation. There was concurrent validity for the ICF components with BI, NIHSS and SF-36. Correlation coefficient between ICF stroke scales and NIHSS, BI and SF-36 were 0.848,0.867,0.798 before rehabilitation intervention and 0.854,0.879,0.832 after PNF intervention respectively. Conclusion Brief ICF core sets evaluation was clinically feasible for stroke community-based rehabilitation with good reliability and validity, and could be further applied and promoted.