北极星移动评价量表在Duchenne型肌营养不良患儿中的信度研究

Reliability study on North Star Ambulatory Assessment for the children with Duchenne muscular dystrophy

目的了解北极星移动评价量表(North Star Ambulatory Assessment,NSAA)应用在Duchenne型肌营养不良(Duchenne muscular dystrophy,DMD)患儿中的组间信度及组内信度,并探讨通过录像法评测运动功能的可行性。方法分析2017年7月至2017年11月北京大学第一医院使用NSAA对40例DMD患儿进行运动功能评估的资料。40例DMD患儿年龄4.3~13.4岁,均为男性;分为3个年龄亚组,<5岁的10例,5~9岁的18例,>9岁的12例。由3名治疗师A、B、C进行评估。在组间信度的研究中,评估者A应用NSAA对DMD患儿进行现场运动评估并摄像,评估者B、C分别通过录像进行独立评分,通过三者对同一患儿的评分计算组间信度。在组内信度的研究中,与第1次评估至少间隔1个月以上,评估者分别根据录像对每个患儿进行第2次评估,根据评估者B、C对同一患儿两次评估的评分计算组内信度。根据评估者A对同一患儿两次评估的评分,计算录像评分与现场评分的一致性。通过计算相关系数检测信度。结果在组间信度的研究中,总体相关系数为0.990,各年龄亚组相关系数为0.971~0.992;在组内信度的研究中,总体相关系数为0.987~0.988;录像评分与现场评分一致性相关系数为0.980。结论 NSAA在评估DMD患儿运动功能水平时具有较高的信度,且现场评分和对录像评分一致性好,可能适用于远程康复评估。

Objective To evaluate the interrater and intrarater reliability of North Star Ambulatory Assessment(NSAA)used in the children with Duchenne muscular dystrophy(DMD)and explore the feasibility of evaluating motor function by videos. Methods The assessment data of 40 cases of DMD admitted from July 2017 to November 2017 to Peking University First Hospital were analyzed. Forty DMD boys aged 4.3 to 13.4 years were admitted. They were divided into three groups based on their age. Ten boys were younger than 5 years. Eighteen boys were aged 5 to 9 years. Twelve boys were older than 9 years.Three evaluators,A,B,and C,joined the study. In the interrater reliability study,evaluator A performed the evaluation with NSAA on the boys and video-taped their performance,then evaluators B and C scored the performance in the videos independently to examine interrater reliability. After one month,three evaluators rescored the performance according to the videos again to examine the intrarater reliability. The intra-group reliability was calculated according to the NSAA scores evaluated by the evaluators B and C twice for the same child. The consistency of the video score with the on-site score was calculated according to the NSAA score of the two assessments of the same child by evaluator A. Intraclass correlation coefficient(ICC)was calculated to examine the reliability. Results In the interrater reliability study,total ICC was 0.990,subgroups ICC was from 0.971 to 0.992. In the intrarater reliability study,total ICC was from 0.987 to 0.988. The video score and the on-site score wereconsistent withICCbeing 0.980. Conclusion NSAA is a reliable and practical method to evaluate the motor development of children with DMD. The consistency between on-site scoring and video scores is high.