肌萎缩侧索硬化患者电话功能量表的评价

Functional evaluation by phone call interview in patients with amyotrophic lateral sclerosis

目的设计一种电话随访量表，与现行临床常用的Appel肌萎缩侧索硬化量表（AALSS）进行比较分析，测定效度和信度。方法选择年龄及性别匹配的肌萎缩侧索硬化患者31例及正常对照30例，全部患者均符合国际神经病学联盟诊断标准。采用新设计的肌萎缩侧索硬化电话功能量表（PIALSS），共13个问题，分别测定延髓、颈段、胸段、腰段脊髓功能。所有分值相加范围30～181分，分值越高表明功能障碍程度越重，总分超过30分定义为运动功能障碍。结果肌萎缩侧索硬化患者组和正常对照组的性别构成比、年龄差异均无统计学意义，AALSS和PIALSS评分的差异有统计学意义。两次电话访问的重测信度和不同评定员之间的重测信度相关系数分别为0．985和0．984（P〈0．01）。对13个子项目进行内部信度一致性检验显示内在一致性良好（K值=O．938）。将所有项目和因素做相关分析，每个因素的内部一致性系数均大于该因素与其他因素的相关系数。将PIALSS与AALSS总分做ROC曲线显示，AALSS对运动障碍的区分效度略优于PIALSS（P〈0．01）。PIALSS与面访有较好的相关一致性。除延髓及胸段脊髓功能外，各部分功能评价的相关系数均〉0．9。PIALSS还显示了较好的重测信度，其中时间重测信度和评定员重测信度都达到了实地应用要求。结论PIALSS作为知情者量表，即便患者因功能丧失导致不能使用电话也不受到影响。因此，可以作为随访评判ALS患者病情及疗效的重要工具。

Objective To design a phone call interview with amyotrophic lateral sclerosis scale （PIALSS）. Meth- ods PIALSS and AALSS were conformed to evaluate 31 patients with amyotrophic lateral sclerosis and 30 healthy controls from Sep 2004 to June 2005. The distinctive results were assessed in terms of the reliability and validity by comparing with the data obtained from 13 questions for functional score of bulbar, cervical, thoracic and lumbar spinal cord. Total score more than 30 meaned functional disturbance and higher score meaned more severe functional disturbance. Results There was no significant difference in gender constituent ratio and age between ALS patients and healthy control subjects. P value of time test-retest reliability and visitor test-retest reliability correlation coefficient was less than 0.01. Correlation of telephone interview and face-to-face interview showed satisfactory concordance except bulbar and thoracic factor. Internal consistency checking showed satisfactory K value. The assessment of construct validity revealed that the intra-consistency coefficient of each factor was more than that with others. ROC curve showed the AALSS difference validity was bet- ter than PIALSS（P 〈 0.01）. Test-retest reliability of cervical and lumbar factor and total score was higher. Conclusion PI- ALSS, with high reliability and validity, shows satisfactory concordance with AALSS. PIALSS can be conformed even patient loss function of call. Therefore it could be recommended as an important instrument for follow-up of illness state and therapy efficacy evaluation.