基于世界卫生组织残疾评定量表2.0慢性病患者整体功能的评估研究

Functioning Evaluation for Patients with Chronic Diseases Using World Health Organization Disability Assessment Schedule 2.0

目的探讨世界卫生组织残疾评定量表2.0临床应用的信度和效度,并分析慢性病患者的整体功能状态。方法受试者为2017年12月至2018年6月在华东医院-静安区康复医联体接受康复治疗的346例慢性病患者,使用中文版世界卫生组织残疾评定量表2.0评估者量表进行评价,2周后进行重测评价。根据临床康复实际使用情况,为提升功能测量的精度,评价时在领域二“活动性”中增加“搬运、移动和操纵物品”项目,在领域三“自我照护”中增加“身体护理”“如厕”项目,在领域四“与他人相处”中增加“建立正式社会人际关系”项目,整个量表共40个项目。采用内部一致性信度、重测信度和验证性因子分析检验量表(含增加4条项目)的内容信度和结构效度。结果量表内部一致性信度Cronbach α系数为0.981,重测信度Pearson系数为0.977(P<0.001)。该量表的验证性因子分析最终模型具有较好的结构效度:各项潜在变量和相应的测量指标的标准化因子载荷在0.710~0.960间,标准误介于0.023~0.066间;卡方自由度比值<5,近似误差均方根<0.1,标准化残差均方和平方根为<0.08,比较拟合指数、常规拟合指数、相对拟合指数、递增拟合指数、非范拟合指数均>0.9;各观察变量信度系数均>0.5,各潜在变量的组合信度均>0.6,各潜在变量的平均变异数萃取量均>0.5,P<0.001,标准化残差绝对值均<3,修正指标均<4,内在结构适配度较好。不同慢性病患者量表总分和各维度评分均有非常高度显著性差异(F>10.21,P<0.001)。结论世界卫生组织残疾评定量表2.0适用于慢性病患者整体功能状态评估,各测量项目(包括新增的4条项目)均具有良好的内容信度和结构效度。

Objective To test the reliability and validity of World Health Organization Disability Assessment Schedule (WHODAS 2.0) for assessment of functioning for people with chronic diseases. Methods From December,2017 to June,2018,346 patients with chronic diseases who received rehabilitation interventions in Huadong Hospital-Jing'an District Rehabilitation Medical Association were selected and evaluated with WHODAS 2.0,and re-evaluated after two weeks.According to the actual use of clinical rehabilitation,in order to improve the accuracy of functional measurement,the items had been added in the second domain Getting Around including Handling,Moving and Manipulating Objects,while added in the third domain Self Care including Caring for Body Parts and Toileting,and added in the fourth domain Getting Along with People including Establishing Formal Social Interpersonal Relationship,with a total of 40 items.The content reliability and structural validity of the scale with four items added were verified by internal consistency reliability,test-retest reliability and confirmatory factor analysis. Results The Cronbach's α coefficient of the internal consistency reliability was 0.981,the Pearson coefficient of the testretest reliability was 0.977 (P < 0.001).The final model of the scale with confirmatory factor analysis had good structural validity:the standardized factor loads between potential variables and corresponding measurement indicators were 0.710-0.960,and the standard errors were 0.023-0.066;Chi square degrees of freedom < 5,rootmean- square error of approximation < 0.1,standardized root mean square residual < 0.08,the comparatice fit index, normal of fit index,relative fit index,incremental fit index and Tucker-Lewis index all > 0.9;the reliability coefficients of the observed variables were > 0.5,the combined reliability of each potential variable > 0.6,and all the average variance extraction of each potential variable > 0.5,all P < 0.001,absolute value of the standardized residual < 3,Modification Index < 4.There was significant difference in the total score and scores of domains among the patients with different diseases (F > 10.21,P < 0.001) Conclusion WHODAS 2.0 can be used as an assessment tool for the overall health and functioning for people with chronic diseases.Each item,including four new items added,had good content reliability and structural validity.