Barthel指数量表在小儿生活自理能力评估应用中年龄截断值的研究

Age cut-off value of the Barthel Index in the assessment of children's activities of daily living

目的基于不同年龄段患儿生活自理能力的评分、专家共识法,明确Barthel指数量表在小儿自理能力评估的最佳年龄截断值。方法采用便利抽样法,选取于2019年12月5日—2020年3月31日安徽省儿童医院口腔科收治的186例慢诊择期手术患儿为研究对象,采用一般资料调查表、Barthel指数量表对患儿进行自理能力评估,按照患儿年龄分为幼儿组1(12~17个月)(n=25)、幼儿组2(18~35个月)(n=49)、学龄前组(36~71个月)(n=54)、学龄组(≥6岁)(n=54),比较不同年龄组患儿生活自理能力的差异。本研究共发放问卷186份,回收有效问卷182份,有效回收率为97.85%(182/186)。采用目的抽样法,于2020年1月7—14日选取8名护理专家及2名医疗专家,经过2轮面对面专家会议,依据儿童神经精神发育进程表,就小儿自理能力评估的最佳年龄截断值达成共识。结果幼儿组1患儿中,重度依赖占96.00%(24/25)、中度依赖占4.00%(1/25);幼儿组2患儿中,重度依赖占61.22%(30/49)、中度依赖占36.73%(18/49)、轻度依赖占2.04%(1/49);学龄前组患儿中,中度依赖占20.37%(11/54)、轻度依赖占77.78%(42/54)、完全自理占1.85%(1/54);学龄组患儿中,轻度依赖占27.78%(15/54)、完全自理占72.22%(39/54),各年龄段生活自理能力评分比较差异均有统计学意义(P<0.01)。通过面对面专家会议法,确定小儿自理能力评估的最佳年龄截断值为≥3岁。结论基于不同年龄段患儿的评分、专家共识法,推荐≥3岁的儿童使用Barthel指数量表评估自理能力等级,作为确立护理级别的依据之一。

Objective To determine the best age cutoff value of Barthel Index in the assessment of children's activities of daily living based on the scores of children's activities of daily living at different ages and the expert consensus.Methods From December 5,2019 to March 31,2020,186 children with elective surgery who were admitted to the Stomatology Department of Anhui Provincial Children's Hospital were selected as the study subject by convenience sampling.The General Information Questionnaire and Barthel Index were used to evaluate the activities of daily living of children.According to children's age,children were divided into infant group 1(12-17 months)(n=25),infant group 2(18-35 months)(n=49),preschool group(36-71 months)(n=54),and school age group(≥6 years)(n=54).The differences of children's activities of daily living in different age groups were compared.A total of 186 questionnaires were distributed,and 182 valid questionnaires were recovered,with avalid recovery rate of 97.85%(182/186).From January 7 to 14,2020,8 nursing experts and 2 medical experts were selected by purposive sampling.After two rounds of face-to-face expert meetings,consensus was reached on the best age cutoff value for children's activities of daily living evaluation according to the children's neuropsychiatric development progress.Results Among children in infant group 1,96.00%(24/25)were severely dependent and 4.00%(1/25)were moderately dependent.Among children in infant group 2,61.22%(30/49)were severely dependent,36.73%(18/49)were moderately dependent,and 2.04%(1/49)were lightly dependent.Among children in preschool group,20.37%(11/54)were moderately dependent,77.78%(42/54)were lightly dependent,and 1.85%(1/54)were completely self-care.In the school age group,27.78%(15/54)of the children were lightly dependent and 72.22%(39/54)were completely self-care.The scores of activities of daily living in different age groups were statistically significant(P<0.01).Through face-to-face expert meeting,the best age cutoff value for children's activities of daily living assessment was determined to be≥3 years old.Conclusions Based on the scores of children of different ages and the expert consensus,it is recommended that children≥3 years old use the Barthel Index to evaluate their activities of daily living as one of the bases for establishing the nursing grade.