脑卒中简明ICF核心要素信和效度检验的Rasch模型分析

The reliability and validity of the brief International Classification of Functioning, Disability and Health core sets for Chinese stroke patients

目的 运用多层面Rasch模型检验中国版脑卒中国际功能、残疾与健康分类（ICF）核心要素的信度和效度.方法 由2名评定员对38例脑卒中患者采用中国版简明ICF核心要素的＂身体功能＂成分包含的20个类目分别进行评分,运用FACETS统计软件计算个人分离指数和信度、拟合分析等检验ICF核心要素的信度和效度.结果 中国版简明ICF核心要素量表中＂身体功能＂成分类目内部一致性信度好（个人分离指数为6.02,分离信度为0.94,χ2=2158.3,P＜0.01）,评定者内信度好（未加权的均方拟合统计量为0.92～1.12）,但2位评定员评分时的严格程度有显著差异（χ2=1042.5,P=0.01）.该部分量表的结构效度较好（分离指数为1050,分离信度为0.80,χ2=467.3,P=0.01）.但是拟合分析表明,b117智力功能处于非拟合状态,而b152情感功能和b755不随意运动反应功能处于过度拟合状态.结论 中国版脑卒中简明ICF核心要素的身体功能成分具有良好的信度和结构效度.多层面 Rasch模型对于检验简明ICF核心要素的信度和效度能够提供更全面的信息,具有良好应用前景.

Objective To test the reliability and validity of the brief International Classification of Functioning, Disability and Health （ICF） core sets for Chinese stroke patients using Rasch model analysis. Methods The body functions of 38 Chinese stroke patients were measured using the brief ICF core sets. The qualifiers of the 20items were measured by two raters and analyzed using FACETS statistical software. The intra-rater reliability and validity were tested by using the separation index and separation reliability and fit analysis. Results The brief ICF core sets had good internal consistency and reliability （person separation index = 6.02, person separation reliability = 0.94 ） with these Chinese patients. The raters showed significantly different strictness in rating, but their ratings had good internal self-consistency. The construct validity was good for the body functions of the ICF component （ separation index = 10.50, separation reliability = 0.80） , but misfitting and overfitting were found in items b117, b152and b755. Conclusion The body function of the brief ICF core sets has good reliability and validity for Chinese stroke patients. A many-facet Rasch measurement model can provide comprehensive information and has good application prospects for testing the reliability and validity of ICF core sets.