上肢动作研究测试量表评定亚急性期缺血性卒中患者偏瘫侧上肢及手功能的信效度和敏感性研究

Study on the Reliability,Validity,and Sensitivity of Action Research Arm Test Scale in Evaluating the Function of Hemiplegic Upper Limb and Hand in Subacute Stage Ischemic Stroke Patients

目的探讨上肢动作研究测试(action research arm test,ARAT)量表应用于亚急性期缺血性卒中患者上肢及手功能障碍评定的效度、信度和敏感性。方法本研究招募2020年1月—2022年5月于首都医科大学附属北京天坛医院等17家医院住院的300例缺血性卒中患者,并由两名评定者分别对受试者进行ARAT量表评估。同时以Fugl-Meyer运动功能评定量表上肢部分(Fugl-Meyer assessment-upper extremity,FMA-UE)作为效标。分别采用Spearman相关分析及验证性因子分析评价ARAT量表的效标效度及结构效度;采用Cronbach’sα系数及组内相关系数评价ARAT量表的内部信度、敏感性及外部信度。结果以FMA-UE为效标,ARAT量表总分与其总分呈正相关(r=0.946,P<0.001)。结构效度检验中,验证性因子分析结果表明:因子间相关系数范围为0.79~0.92,模型整体拟合指标为χ^(2)/df=7.011,P=0.001,比较拟合指数=0.906,增值拟合指数=0.907,规范拟合指数=0.895,近似误差均方根=0.055。各因子的组合信度值在0.964~0.983,各因子的平均变异抽取量在0.940~0.952。内部一致性检验中,评分等级的Cronbach’sα系数为0.987,敏感性分析中,Cronbach’sα系数在0.986~0.987。外部一致性检验中,两名评定者间的组内相关系数最高为0.999,95%CI集中于0.961~0.999。结论ARAT量表具有良好的效标效度、结构效度、信度和敏感性,适用于亚急性期缺血性卒中患者偏瘫侧上肢及手功能的评估。

Objective To evaluate the validity,reliability,and sensitivity of the action research arm test(ARAT)scale in evaluating the function of hemiplegic upper limb and hand in subacute stage ischemic stroke patients.Methods In this study,300 patients with ischemic stroke admitted to 17 hospitals including Beijing Tiantan Hospital,Capital Medical University from January 2020 to May 2022 were recruited.The ARAT scale was used to assess all the patients by two evaluators,independently.The Fugl-Meyer assessment-upper extremity(FMA-UE)scale was taken as the criterion.The Spearman correlation analysis and the confirmatory factor analysis were used to evaluate the criterion validity and construct validity of the ARAT scale,respectively.The Cronbach’sαcoefficient and intraclass correlation coefficient analysis were used to evaluate the internal reliability,sensitivity,and external reliability of the ARAT scale.Results With FMA-UE as the criterion,the FMA-UE total score was positively correlated with the ARAT total score(r=0.946,P<0.001).To evaluate the construct validity,the confirmatory factor analysis showed that the correlation coefficient between the factors ranged from 0.79 to 0.92,the overall fitting index of the model wasχ^(2)/df=7.011,P=0.001,the comparative fit index=0.906,the incremental fix index=0.907,the normed fit index=0.895,and the root mean square error of approximation=0.055.The combined reliability values of each factor ranged from 0.964 to 0.983,and the average amount of variation of each factor ranged from 0.940 to 0.952.In the internal consistency test,the Cronbach’sαcoefficient of grade score was 0.987,and the Cronbach’sαcoefficient ranged from 0.986 to 0.987 in the sensitivity analysis.In the external consistency test,the highest intraclass correlation coefficient between the two evaluators was 0.999,and the 95%CI was concentrated between 0.961 and 0.999.Conclusions ARAT scale has good criterion validity,construct validity,reliability,and sensitivity,which is suitable for evaluating the function of hemiplegic upper limb and hand in subacute stage ischemic stroke patients.