慢性心力衰竭患者运动康复依从性量表的编制及信效度检验

Development of Exercise Rehabilitation Adherence Scale for Patients with Chronic Heart Failure and Test on Its Reliability and Validity

背景慢性心力衰竭患者运动康复效果的维持有赖于良好的运动康复依从行为,有效及科学地评估其运动康复依从性具有重要的实践意义,但目前国内外尚缺乏公认的慢性心力衰竭患者运动康复依从性评价工具。目的编制慢性心力衰竭患者运动康复依从性量表,为快速便捷地评估慢性心力衰竭患者运动康复依从性提供科学、适宜的工具。方法在前期慢性心力衰竭患者运动康复最佳证据总结和质性研究的基础上,通过文献回顾、结合课题组意见,形成初始条目池;根据小样本预调查、德尔菲专家函询形成临床测试版量表。便利抽样法选取2020年11月—2021年2月在江苏省3所三级甲等医院心血管内科就诊的稳定期慢性心力衰竭患者作为研究对象。第一阶段发放有效量表274份,结合项目反应理论和经典测量理论对量表的条目进行筛选并进行探索性因子分析,形成正式版量表;第二阶段发放有效量表282份,对正式版量表进行验证性因子分析和信效度分析,形成最终版量表。结果正式量表包括2个维度11个条目。各条目的难度合理,且均未出现逆反阈值,条目区分度、项目信息量及项目特征曲线均较优。量表总的Cronbach’sα系数为0.905,其中“处方依从”维度Cronbach’sα系数为0.895,“监测依从”维度Cronbach’sα系数为0.910。总折半信度为0.724、重测信度为0.902。探索性因子分析结果显示2个因子能解释总变异的70.231%,进一步验证性因子分析的结果显示模型各参数较优,拟合较好。结论本研究构建的慢性心力衰竭患者运动康复依从性量表的条目难度、区分度合理,项目信息量较好,同时具有较高的信度和效度,可作为慢性心力衰竭患者运动康复依从性的评估工具。

Background The maintenance of exercise rehabilitation effect in patients with chronic heart failure depends on good adherence to exercise rehabilitation.It is of great practical significance to evaluate the adherence to exercise rehabilitation effectively and scientifically,however,there is still a lack of accepted tools to evaluate the adherence to exercise rehabilitation in patients with chronic heart failure at home and abroad.Objective To develop an exercise rehabilitation adherence scale for patients with chronic heart failure,and provide a scientific and appropriate tool for the rapid and convenient evaluation of adherence to exercise rehabilitation in patients with chronic heart failure.Methods Based on the previous summary of the best evidence and qualitative research on exercise rehabilitation of patients with chronic heart failure,the initial pool of entries was formed through literature review,combining the opinions of the research group;the clinical test version of the scale was formed based on a small sample pre-survey and Delphi expert correspondence.Patients with stable chronic heart failure who were treated in the cardiovascular department from three tertiary-level hospitals in Jiangsu Province from November 2020 to January 2021 were selected as the study subjects using a convenience sampling method.In the first phase,274 valid scales were recovered,aiming to screen the items of the scale and conduct exploratory factor analysis by combining item response theory and classical test theory to form the official version of the scale;in the second phase,282 valid scales were recovered,aiming to perform confirmatory factor analysis and test on reliability and validity of the official version of the scale to form the final version of the scale.Results The formal scale consisted of 11 items in 2 dimensions.The difficulty of each item was reasonable without no inverse threshold,and the item differentiation,item information content,and item characteristic curve were all superior.The total Cronbach's α coefficient of the exercise rehabilitation adherence scale for patients with chronic heart failure was 0.905,of which the dimension of "prescription adherence" was 0.895,the dimension of "monitoring adherence" was 0.910.The total Spearman-Brown split reliability coefficient of the scale was 0.724,and the retest reliability was 0.902.The results of exploratory factor analysis showed that the two factors could explain 70.231% of the total variation.The results of further confirmatory factor analysis showed that the model was better fitted with each parameter.Conclusion The exercise rehabilitation adherence scale for patients with chronic heart failure developed in the study is reasonable in terms of item difficulty,differentiation,the information content of the items is good with high reliability and validity,which can be used as an evaluation tool for adherence to exercise rehabilitation in patients with chronic heart failure.