基于国际功能残疾和健康分类的手外伤康复疗效评价简表的研制

Development of a short form for evaluation of rehabilitation efficacy of hand injury based on international classification of functioning,disability and health

目的对《手外伤康复疗效评价量表》开展临床实验,结合专家咨询法,综合筛选条目,形成简化版量表,并考核简表的信效度。方法选取300例手外伤患者开展临床调查,同时采用专家咨询法向22位专家函询,分别对《手外伤康复疗效评价量表》中4个领域48个条目进行信度、效度、条目对总分的贡献(回归分析)以及重要性、建议保留比例等多维度分析评价,综合筛选标准,筛选条目,形成简表,并考核简表的信效度。结果筛选各领域内被保留次数≥5的条目,精简形成了15个条目的《简表》。简表的克朗巴赫系数为0.875,简表内部一致性信度较好;各条目与领域总分的相关系数在0.608~0.988之间,简表内容效度较好;提取因子累计贡献率为71.4%,各条目在各自领域上的因子负荷均较高,简表结构效度较好;与DASH总分相关系数为0.687,简表效标效度较好;DASH、简表总分及各领域评分治疗前后的比较差异均有统计学意义(P<0.001),简表用以评估疗效的有效性良好。结论基于ICF的简化版《手外伤康复疗效评价量表》具有较好的信度和效度,是手外伤患者手功能评估和康复疗效评价研究中简单易行、可靠有效的测量工具。

Objective To carry out clinical experiments on the evaluation scale for rehabilitation efficacy of hand injury,to develop a simplified version of the scale based on the screened items through expert consultation method,and to assess the reliability and validity of the short form.Methods 300 patients with hand injury were selected for clinical investigation.At the same time,the consultation from 22 experts was addressed by letter;the reliability,validity,the contribution of items to overall evaluation(regression analysis)and significance,and recommended reserved ratio etc.of 48 items in 4 fields in the evaluation scale for rehabilitation efficacy of hand injury were evaluated;the criteria and entries were comprehensively screened to form a short form,and the reliability and validity were assessed.Results The entries with reserved times≥5 in each field were screened,and the brief scale including 15 items was condensed.The Kronbach coefficient of the short form was 0.875,and the internal consistency reliability was good;the correlation coefficient between each item and the total score of the field ranged 0.608 to 0.988,and the validity was good;the cumulative contribution rate of the extraction factor was 71.4%,each item had a higher factor loading in its field,and the validity of the structure was good;the correlation coefficient with the total score of disability of arm shoulder and hand(DASH)was 0.687,and the standard validity was good;there were statistical differences in total score of DASH,form and each field before and after treatment(P<0.001),the short form was effective to evaluate the treatment efficacy.Conclusion The simplified version of the international classification of functioning,disability and health(ICF)-based evaluation scale for rehabilitation efficacy of hand injury has good reliability and validity,and it is a simple,reliable,and effective measurement tool for hand function evaluation and rehabilitation efficacy evaluation of patients with hand injury.