脊髓独立性评定的信效度分析及其在社区脊髓损伤患者中的应用

Reliability and Validity Analysis of the Chinese Version of Spinal Cord Independence Measure-Ⅲ and Application Study among Individuals with Spinal Cord Injury from Chinese Communities

目的:对脊髓独立性评定(SCIM-Ⅲ)中文版量表开展应用性评估研究,分析社区患者专业机构康复训练后的独立性状况及其影响因素。方法:研究对象为2017~2019年在上海市养志康复医院(上海市阳光康复中心)参加康复训练的256例社区脊髓损伤者,收集个人和受伤的基本情况、SCIM-Ⅲ和FIM评估结果,应用描述性统计、相关分析、因子分析和多元线性回归等方法。结果:SCIM-Ⅲ的克朗巴哈系数为0.884,四个主成分累计可解释方差80.5%。SCIM-Ⅲ敏感度指标略低于FIM。经过康复训练,独立性总分提高10.5%;各指标得分提高2.9%~50.0%(P<0.01);转移和自我照顾维度存在明显天花板效应,移动维度和地面-轮椅转移存在地板效应。回归分析发现:与颈段损伤相比,胸段自我照顾分数也提高更多(β=0.12,P<0.01);受伤时间越久,自我照顾得分提升越少(β=-0.10,P<0.01),另外年龄越大,自我照顾得分提高越多(β=0.07,P=0.03)。在移动方面,受伤时间越长,移动能力提高的越少(β=-0.04,P=0.01);学历越高,移动能力进步越大。在转移方面,与颈段损伤相比,胸段及以下损伤的患者转移得分提高均更多;女性患者在括约肌管理方面提高比男性更多(β=0.06,P=0.02)。结论:SCIM-Ⅲ的信效度良好,但也有一定局限性。样本脊髓损伤人群在康复训练后,功能独立性水平明显提高。建议脊髓损伤新受伤患者尽早接受系统康复训练,社区患者重点加强转移类项目训练,同时应加强无障碍环境建设和管理。

Objective:To make the application study on the Chinese version of Spinal Cord Independence Measure-Ⅲ(SCIM-Ⅲ),and to evaluate the effects of functional independence and its relevant factors of individuals with spinal cord injury(SCI) in communities by specialized,institution-based rehabilitation training in China's Mainland.Methods:The participants were 256 individuals with S CI who were admitted into Shanghai Yangzhi Rehabilitation Hospital(Shanghai Sunshine Rehabilitation Center) to participant rehabilitation training from 2017 to 2019.Data on personal and injury characteristics,and evaluation results of SCIM-Ⅲ and FIM were collected.The descriptive analysis,correlational analyses,factor analysis,sensitivity analysis,and multiple linear regression analysis were conducted.Results:The Cronbach’s alpha of SCIM-Ⅲ was 0.884.Four factors(self-care,mobility,transfer and sphincter management) were recognized by factor analysis,and the cumulative sum of squared loadings was 80.5%.The sensitivity of the SCIM-Ⅲ was slightly lower than that of the FIM.The mean SCIM-Ⅲ total score on admission increased by 10.5%.The mean score increasing of every item of SCIM-Ⅲ ranged from 2.9% to 50.0%(P<0.01).However,mobility and ground-wheelchair transfer showed floor effects,and transfer and self-care had ceiling effects.Compared with individuals with cervical cord injury,the cases with thoracic cord injury had higher score improvement(β=0.12,P<0.01),the time since injury was a negative factor to functional independence of individuals with SCI(β=-0.10,P<0.01),however,higher age was associated with higher self-care scores(β=0.07,P=0.03).In terms of mobility,the longer time since injury was related with the lower scores(β=-0.04,P=0.01),in addition,the SCI people with higher education background could acquire greater progress in mobility.Compared with cervical cord injury,the scores of people with thoracic injury or lower increased more in transfer domain.Women could be observed more score increase than men in sphincter management(β=0.06,P=0.02).Conclusion:The SCIM-Ⅲ in had good reliability and validity with some limitations among individuals with SCI in communities.The functional independence of individuals with SCI could increase by rehabilitation training.It was suggested to:1) refer injured people with SCI to the specialized institutions to receive specialized and systematic rehabilitation training as soon as possible;2) focus on the transfer domain with the possibilities to increase for people with SCI in communities;3) construct barrier-free environment and housing to promote functional independence for people with SCI in China's Mainland.