建立脑卒中康复运动功能评定量表的最小可测变化值

Establishing the minimal detectable change of stroke rehabilitation assessment of movement

目的确定脑卒中康复运动功能评定量表(stroke rehabilitation assessment of movement,STREAM)及其分量表(上肢部分、下肢部分和生活活动部分)的最小可测变化值(minimal detectable change,MDC)。方法由同一评定员使用STREAM对60名脑卒中偏瘫患者进行前后两次评定,记录评定结果,使用等级间相关分析(intraclass correlation coefficient,ICC)来检验STREAM的组内(评定者内部)重测信度,使用SPSS软件计算出组内信度系数r,再进一步根据公式计算出90%置信度下的MDC值(MDC(90%CI))。结果脑卒中康复运动功能量表及其分量表(上肢部分、下肢部分、生活活动部分)的组内重测信度分别为:0.973、0.935、0.982和0.961,进一步根据公式计算出四者的MDC(90%CI)分别为6.8、3.4、1.7和3.6,分别占总分值的百分比为9.7%、17%、8.7%和11.9%。结论汉化版STREAM的组内信度优良,其MDC的确立有助于临床和科研工作人员识别个体变化值是否是真实,是否有统计学意义。

Objective To determine the MDC （minimal detectable change） of the stroke rehabilitation assessment of movement and its three subscales （ including upper extremity,lower extremity, and mobility subscales）. Methods Sixty patients with stroke were evaluated twice through the stroke rehabilitation assessment of movement by a good training rater. The intraclass correlation coefficient was used to examine the intra-rater reliability of STREAM scale and 3 subscales. The minimal detectable change of 90% confidence interval （ MDC90%CI） ） was calculated on basis of the formulae. Results The intraclass correlation of the intra-rater agreement of the stroke reha- bilitation assessment of movement scale and its 3 subseales （ including upper extremity, lower extremity, and mobility subseales） was 0. 973,0.935,0.982 and 0. 961, respectively. And the value of MDC （ 90% CI） of the four scales was 6.8,3.4,1.7 and 3.6, correspondingly. They accounted for the percentage of the total score of 9.7%, 17%, 8.7% and 11.9%. Conclusion The minimal detectable changes of the stroke rehabilitation assessment of movement measure are useful for both clinicians and researchers to determine whether the change score of an individual patient is real and statistically significant. Meanwhile ,we know that its Chinese version also has a good intra-rater reliability.