三种平衡量表在脑卒中患者评测中的天花板效应研究及相关分析

The ceiling effects and correlation of three balance scales in stroke patients

目的:探讨Berg平衡量表(BBS)、Brunel平衡量表(BBA)、简易平衡评定系统测试(mini-BESTest)应用于不同患病程度脑卒中患者时出现地板或天花板效应以及与日常生活活动能力(ADL)和肢体运动功能的相关性,为临床选择适宜的平衡量表提供客观依据。方法:对308例脑卒中患者进行BBS、BBA、mini-BESTest、ADL功能和肢体运动功能评测,分析BBS、BBA、miniBESTest在不同患病程度的脑卒中患者中是否存在地板或天花板效应;用Spearman相关系数分析BBS、BBA、miniBESTest之间的相关性以及三者与肢体运动功能和ADL功能间的相关性。结果:BBS、BBA在轻度脑卒中患者中出现天花板效应,以BBA最为明显。轻度、中度和重度脑卒中患者BBS、BBA、mini-BESTest之间的相关系数分别为0.611—0.810(P<0.01)、0.314—0.568(P<0.01)、0.489—0.691(P<0.01)。在轻度脑卒中患者中仅BBA与ADL相关系数为0.175(P<0.05),BBS、BBA、mini-BESTest与ADL能力和肢体活动能力相关系数为-0.093—0.083(P>0.05),在中重度脑卒中患者中BBS、BBA、mini-BESTest与ADL能力和肢体活动能力相关系数为-0.551—0.554(P<0.05)。结论:三个平衡量表之间具有较好的相关性。但BBA在轻度脑卒中患者应用时具有较高的天花板效应;miniBESTest要优于BBS,更适宜在临床上应用;BBA适宜中重度脑卒中患者在临床进行快速评估使用。

Objective： To explore the floor or ceiling effects and correlation of Berg balance scale（BBS）,Brunel balance as- sessment （BBA） and mini-balance evaluation systems test（mini-BESTest） used for patients with stroke in differ- ent severity of illness, so as to provide the objective basis for choosing the appropriate balance scale in clini- cal patients. Method： Evaluations were administed with BBS,BBA and mini-BEStest, modified Barthel index（MBI） and neu- rological impairment rating scale（NIS） in 308 patients with stroke. The data were examined with descriptive sta- tistical analysis to make sure whether having floor or ceiling effects of BBS,BBA and mini-BEStest in patients with stroke in different severity of illness.The level of association between mini-BEStest, BBS and BBA were examined with Spearman＇s correlation coefficients. Spearman correlation analysis were conducted to relationship between three balance scales and MBI,NIS. Result： BBS and BBA had ceiling effects in patients with mild stroke, especially in BBA. The significant cor-relation was shown between three balance scales in different severity of illness, the correlation coefficients were 0.611-0.810（P〈0.01 ）,0.314-0.568（P〈0.01 ） and 0.489-0.691 （P〈0.01）.The correlation coefficients of bal- ance scales with MBI and NIS were -0.093-0.083（P〉0.05）, only BBA with MBI was 0.175 （P〈0.05） in pa- tients with mild stroke. The correlation coefficients of balance scales with MBI and NIS were -0.551-0.554（P〈 0.05） in patients with moderate to severe stroke. Conclusion： There are good correlations in three balance scales.But BBA has high ceiling effects in patients with mild stroke, mini-BEStest is better than BBS in clinical. BBA is suitable for rapid assessment in clinical patients with moderate to severe stroke.