3D扫描容积法评定上肢远端体积的信度和效度

Feasibility,reliability and validity of a 3D scanning volume measurement for distal upper limb volume

目的明确3D扫描容积法测量上肢远端体积的可行性,分析其评定者间信度和效标关联效度。方法2022年1月至3月,由1名未接触过3D扫描容积法和排水法的康复治疗师(操作者A)经过培训后,分别使用手持式3D激光扫描仪和溢水杯,对PVC材质上肢远端模型进行体积测量。分别记录两种方法各操作30次的时间,采用累积和分析法(CUSUM)绘制两种操作方法的学习曲线,以曲线顶点为界,划分为学习提高阶段和熟练掌握阶段,记录两种方法达到熟练掌握阶段所需次数以及熟练掌握阶段的操作时间。从复旦大学附属华山医院招募20例健康受试者,由2名康复治疗师(操作者A、操作者B)经过培训后,分别使用手持式3D激光扫描仪测量双侧上肢远端体积,由操作者A使用溢水杯测量双侧上肢远端体积。结果3D扫描容积法学习曲线的拟合曲线(R²=0.984)在操作8次时到达顶点;排水法学习曲线的拟合曲线(R²=0.494)在操作5次时到达顶点。熟练掌握阶段,3D扫描容积法操作时间较排水法短(P<0.05)。2名操作者使用3D扫描容积法2次测量双上肢的组内相关系数均为0.979(P<0.001)。3D扫描容积法测得体积与排水法测得体积呈高度相关(r>0.979,P<0.001)。结论3D扫描容积法在操作8次后可熟练掌握;熟练掌握后,操作时间较排水法缩短,更为简单实用。3D扫描容积法有良好的评定者间信度和效标关联效度。3D扫描容积法可以替代排水法作为上肢远端体积测量的一种新方法。

Objective To clarify the feasibility of the 3D scanning volume method for distal upper limb volume measurement,and to analyze its scorer reliability and criterion-related validity.Methods From January to March,2022,a therapist(operator A)who had not been exposed to 3D scanning volume method and water displacement method was trained to use a handheld 3D laser scanner and a spilt cup to measure the volume of a PVC distal upper limb model.The operation time of 30 operations of each method was recorded.The learning curves of the two methods were plotted using cumulative sum(CUSUM)analysis.The curve was cut into the learning stage and the mastery stage by the vertex of peak.The times required to reach the mastery stage and the operation time of the mastery stage for the two methods were recorded.A total of 20 healthy subjects were recruited from Huashan Hospital of Fudan University.Two trained therapists(operator A and operator B)measured the bilateral distal upper limb volume using a handheld 3D laser scanner,and operator A measured the bilateral distal upper limb volume using a spilt cup.Results The fitting learning curve of the 3D scanning volume method(R²=0.984)reached its peak after eight times of operation;while that of the water displacement method(R²=0.494)reached its peak after five times of operation.At mastery stage,the operator spent less time using 3D scanning volume method than using water displacement method(P<0.05).The intraclass correlation coefficient between the two operators were both 0.979 for bilateral distal upper limb volume measure(P<0.001).The Pearson coefficients was above 0.979 between 3D scanning volume method and water displacement method(P<0.001).Conclusion A therapist can master the use of the 3D scanning volume method after eight times of operation,and the operation time of 3D scanning volume method is shorter than that of water displacement method at mastery stage.The 3D scanning volume method is well reliable and valid,that can be used as an alternative to the water displacement method for distal upper limb volumetric measurement.