基于ICF-CY的脑性瘫痪上肢功能评估量表内容效度分析

Content Validity of Upper Limb Functional Assessments for Children with Cerebral Palsy: Based on ICF-CY

目的以《国际功能、残疾和健康分类(儿童及青少年版)》(ICF-CY)为框架,明确三种常用脑瘫儿童上肢功能评估量表的内容和临床使用价值。方法选择脑瘫儿童精细运动功能测试量表(FMFM)、墨尔本单侧上肢功能评估量表2(MA2)和上肢技巧质量测试量表(QUEST),由2名从事脑瘫儿童上肢功能评估3年以上的康复医生和治疗师独立确定每个条目所包含的概念,按相关联系法则将提取的概念ICF-CY类目建立关联,分析各量表提取的概念数、涉及ICF-CY类目数以及与之发生关联数的分布状况。结果三个量表共计提取62个概念,发生403次关联。FMFM关联的ICF-CY类目最多,"活动和参与"类目占关联总数近2/3(134/204)。QUEST主要与身体功能的下级类目"关节活动和手臂的支撑功能"发生关联。MA2与反映运动准确性的知觉功能类目关联7次,涉及运动流畅性的类目关联9次,合计占总关联数50%以上。结论 FMFM更多地评价脑瘫儿童上肢功能的活动和参与能力,也更为适合年幼脑瘫儿童;MA2更多地关注上肢运动的准确度和流畅性;而QUEST主要关注身体功能,尤其是上肢的关节活动和支撑功能。

Objective To review the concepts of three common scales assessing upper limbs function of children with cerebral palsy, namely Fine Motor Function Measure （FMFM）, Melbourne Assessment 2 of Unilateral Upperlimb Function （MA2） and Quality of Upper Extremity Skills Test （QUEST）, from the framework of Chinese version of International Classification of Functioning, Disability and Health-Child and Youth Version （ICF-CY）. Methods Concepts of each item from FMFM, MA2 and QUEST were extracted independently by a rehabilitation doctor and a therapist with professional experience more than three years, and then linked with ICF-CY category accord-ing to the linking rules. The distribution of concepts of each scale linking to ICF-CY categories was investigated. Results A total of 62 con-cepts were extracted from these three scales, and 403 linkages to various ICF-CY categories. Concepts from FMFM were the most linked with ICF-CY category among them, in which nearly two-thirds （134/204） concepts linked with the categories of Activity And Participation. Concepts from QUEST principally linked with the category of joint and arm-supporting in Body Function. Concepts from MA2 linked to category of cognition function which reflected motor accuracy 7 times and motor fluency 9 times （more than 50%of the total amount of link-ages）. Conclusion FMFM mainly evaluates the activity and participation associated with upper limb function in children with cerebral palsy, and may be more applicable for younger children. MA2 mainly evaluates the accuracy and fluency of upperlimb movement. QUEST mainly evaluates body function especially the joint and supporting function of upper limbs.