《脊髓损伤护理相关ICF组合》中的身体功能限定值反应选项的Rasch分析

Rasch analysis of the qualifier response options of the ICF set for spinal cord injury nursing

目的采用Rasch分析检验《脊髓损伤护理相关ICF组合》（ICF-SCIN）中的“身体功能”成份的限定值反应选项。方法2013年12月至2014年3月，采用ICF-SCIN的“身体功能”成份对4个研究中心140例脊髓损伤患者进行评定。采用RUMM2030版软件对评定结果进行Rasch分析，统计指标包括Rasch模型拟合度、阈值估计值和个人分离指数。结果Rasch分析发现，ICF-SCIN“身体功能”成份78．8％类目的阈值顺序发生逆反，顺序逆反的ICF类目等级多发生在1、2、3之间。将ICF限定值（0、1、2、3、4）重新计分为0、1、1、1、2后，每个类目的阈值顺序表现为逐级递升的趋势，该成份与Rasch模型相拟合（x^2=93．96，P=0．0155），项目拟合与个人拟合残差均值（标准差）分别为-0．14（0．94）和-0．35（0．98），个人分离指数（PSI）为0．82。结论ICF-SCIN“身体功能”成份中的类目在经过重新计分后，与Rasch模型的拟合度得到了明显改善，类目的阈值顺序也呈现出递升趋势。在今后的研究中，对ICF限定值的量化应更加明确和细致。

Objective To test the suitability of the qualifier response options of the Body Functions （BF） component of the ICF Set for Spinal Cord Injury Nursing （ICF-SCIN） using Rasch analysis. Methods A total of 140 spinal cord injury patients were recruited between December 2013 and March 2014 from four research centers. Nurses used the BF component of the ICF-SCIN to rate their functioning. Rasch analysis was performed using RUMM 2030 software. Rasch model fit, threshold estimates, and person separation index （PSI） were quantified. Results Twenty-six categories （78.8%） displayed disordered thresholds among the level 1, 2 and 3 qualifiers. After rescoring the qualifiers from 0, 1, 2, 3 and 4 to 0, 1, 1, 1 and 2, the threshold estimates of the ICF categories showed a gradually increasing tendency and the BF component demonstrated good fit to the Rasch model （X2= 93.96, P ≤ 0.05）. The mean fit residuals （ standard deviations） for items and persons were - 0.14 （0.94） and - 0.35 （ 0.98 ）. The PSI was 0.82. Conclusions The categories in the BF component of the ICF-SCIN showed increased Rasch model fit and an increasing tendency of threshold ordering. The overall model of the component was also improved. The standards for quantifying the ICF qualifiers should be more explicit in future studies.