失禁相关性皮炎风险评估量表的构建与评价

Construction and evaluation of risk assessment scale for incontinence-associated dermatitis

目的：编制适合我国成年失禁患者失禁相关性皮炎（ IAD）的风险评估量表,并进行信效度检验,为临床评估失禁患者发生IAD风险提供评估工具。方法采取结构化的决策方法从多维度拟定量表条目,经过Delphi 专家咨询对条目进行筛选,用综合评分法确定条目的权重,形成初量表；对408例患者进行测试,用克朗巴赫系数法、评定者一致性、重测信度、结构效度、内容效度、敏感度、特异度、和量表的ROC曲线下面积对量表进行考评。结果构建的量表包括组织耐受性、会阴部环境、自理能力3个维度共7个条目。 Cronbach′s α系数为0.53；评定者一致性信度为0.904；因子分析提取特征根值＆gt;1得到3个公因子,其累计方差贡献率为59.13％,经方差最大正交旋转后得到7个条目的因子负荷值,根据负荷值对3个公因子进行归因,各项目所述因子上的负荷值均在0.4以上；条目的内容效度均＆gt;0.78,量表的内容效度S-CVI/UA为0.857,S-CVI/Ave为0.975；AUC为0.8,P〈0.01,95％可信区间0.77~0.91,取界值46.5时特异度76.9％,灵敏度88.9％。结论 IADRAS构建过程科学并具有较好的信度和效度,可用于评估成年失禁患者发生IAD的风险。

Objective To develop the risk assessment scale for adult patients with incontinence-associated dermatitis （ IAD） and to test the validity and reliability. To provide a tool to assess the risk of IAD in clinical practice. Methods The items of the scale were confirmed using the structured method from multi-dimensions. Delphi expert consultation was performed to select the items. The initial scale was formed after confirming the weight of items by comprehensive scored method. 408 patients were tested. The scale was analyzed by means of Cronbach′s α coefficient, rater consistency, test-retest reliability, construct validity, content validity, sensitivity, specificity and the area under ROC curve. Results The scale included seven items and three dimensions, which were tissue tolerance, perineal environment and self-care ability. The Cronbach′s αcoefficient was 0.53. The rater consistency reliability was 0.904. Factor analysis extracted 3 common factors that the characteristic roots value was ＆gt;1. The accumulative variance contribution explained 59.13% of the variance for the total scale. The load values of seven items were obtained by varimax orthogonal rotation. Three common factors were attributed according to the load value. And the factor load value on each item mentioned was higher than 0.4. The content validity of items was all greater than 0.78. The content validity of scale （ S-CVI/UA） was 0.857, and S-CVI/AVE was 0.975. Area under ROC curve was 0.84 （ P〈0. 01, 95% CI：0.77-0.91） . When the boundary of the diagnostic cut-off level of high-risk people was set at 46.5 points, the sensitivity was 88.9% and the specificity was 76.9%.Conclusions The construction of the scale which has a good reliability and validity is scientific. The instrument can be used to assess the risk of the occurrence of IAD in adult patients.