康复分级诊疗评定量表在脑卒中患者中的信效度检验及应用价值研究

薛凯文; 吕星; 王玉龙

doi:10.16766/j.cnki.issn.1674-4152.003087

康复分级诊疗评定量表在脑卒中患者中的信效度检验及应用价值研究

doi: 10.16766/j.cnki.issn.1674-4152.003087

深圳市第二人民医院(深圳大学第一附属医院)康复医学科，广东深圳 518035

基金项目:

国家重点研发计划“主动健康和老龄化科技应对”重点专项项目 2020YFC2008700

深圳市医疗卫生“三名工程”项目 SZSM202111010

详细信息

通讯作者:
王玉龙，E-mail：ylwang668@163.com

中图分类号: R743.3 R49
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- 被引次数: 0
出版历程
- 收稿日期: 2022-08-05
- 网络出版日期: 2023-08-28

Reliability and validity test and application value of hierarchical diagnosis and treatment rating scale in rehabilitation medicine in stroke patients

Department of Rehabilitation Medicine, the Second People's Hospital of Shenzhen (The First Affiliated Hospital of Shenzhen University), Shenzhen, Guangdong 518035, China

摘要

摘要: 目的检验康复分级诊疗评定量表A、B版的信效度及截断值，并确定更适用的版本。方法 2022年4月在深圳市四家康复机构开展研究，使用Cronbach′s α系数、组内相关系数(ICC)、Kaiser-Meyer-Olkin(KMO)、Bartlett球形检验、Spearman相关系数和ROC曲线对量表进行检验。结果 A、B版量表的Cronbach′s α系数分别为0.740和0.694，ICC>0.75。A、B版量表的KMO值分别为0.659和0.660，Bartlett球形检验P＜0.01。A、B版量表与美国国立卫生院卒中量表(NIHSS)相关性>0.75，而与改良Rankin量表(mRS)相关性为-0.101和-0.063。NIHSS＞20分对应A、B版量表疾病项得分为2.5分和7.5分，AUC分别为0.775(95% CI：0.677~0.855)和0.840(95% CI：0.750~0.908)。A版量表功能项对应龙氏日常生活能力评定量表(LS)床上人和社会人得分为7.5分和5分，AUC分别为0.541(95% CI：0.435~0.645)和0.575(95% CI：0.469~0.677)；B版功能项对应LS量表床上人和社会人得分为10分和5分，AUC分别为0.500(95% CI：0.395~0.606)和0.555(95% CI：0.448~0.658)。结论康复分级诊疗评定量表A、B用于脑卒中患者均具有良好的信度和效度，但功能项评定内容仍需调整。分级诊疗评定量表B更适用于评定脑卒中患者转诊需求。
- 康复分级诊疗评定量表 /
- 分级诊疗 /
- 脑卒中 /
- 信度 /
- 效度
Abstract: Objective To evaluate the reliability, validity and cut-off points of version A and B of the hierarchical diagnosis and treatment rating scale, and to determine a more applicable version. Methods The study was conducted in four rehabilitation facilities in Shenzhen in April 2022, and the scales were tested using Cronbach′s α coefficient, interclass correlotion coefficient (ICC), Kaiser-Meyer-Olkin (KMO) and Bartlett's spherical test, Spearman correlation coefficient and ROC curves. Results The Cronbach's α coefficients for version A and B were 0.740 and 0.694, respectively, with ICC greater than 0.75. The KMO values for version A and B were 0.659 and 0.660, respectively, with Bartlett spherical test P < 0.01. The correlation between the scale (version A and B) and the National Institute of Health Stroke Scale (NIHSS) was greater than 0.75, while the correlation between the scale (version A and B) and modified Rankin scale (mRS) were -0.101 and -0.063 respectively. NIHSS>20 points corresponded to disease item scores of 2.5 and 7.5 points in the A and B version of the scale, with AUCs=0.775 (95% CI: 0.677-0.855) and 0.840 (95% CI: 0.750 -0.908). The functional items of version A corresponded to the scores of 7.5 and 5 for bedridden group and community group of Longshi scale (LS), with AUC=0.541 (95% CI: 0.435-0.645) and 0.575 (95% CI: 0.469-0.677); The functional items in version B corresponded to the scores of 10 and 5 for bedridden group and community group of LS, with AUCs=0.500 (95% CI: 0.395-0.606) and 0.555 (95% CI: 0.448-0.658). Conclusion Both hierarchical diagnosis and treatment rating scale A and B have good reliability and validity for application with stroke patients. However, the functional components of the scale need further adjustment. Items in version B are more appropriate for assessing patients' rehabilitation needs and referral directions.
- Hierarchical diagnosis and treatment rating scale in rehabilitation medicine /
- Hierarchical diagnosis and treatment /
- Stroke /
- Reliability /
- Validity

HTML全文

图 1 A、B版康复分级诊疗评定量表

Figure 1. version A and version B of hierarchical diagnosis and treatment rating scale in rehabilitation medicine

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图 2 康复分级诊疗评定量表A和B版的疾病项得分对应的NIHSS得分20分的ROC曲线

注：A为康复分级诊疗评定量表A疾病项总分对应的NIHSS得分20分的ROC曲线；B为康复分级诊疗评定量表B疾病项总分对应的NIHSS得分20分的ROC曲线。

Figure 2. ROC curves of the NIHSS score 20 corresponding to hierarchical diagnosis and treatment rating scale in rehabilitation medicine version A and B

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图 3 康复分级诊疗评定量表A版和B版的功能项得分对应的龙氏日常生活能力评定量表床上人和社会人的ROC曲线

注：A、B分别为康复分级诊疗评定量表A功能项得分对应的龙氏日常生活能力评定量表床上人和社会人的ROC曲线；C、D分别为康复分级诊疗评定量表B功能项得分对应的龙氏日常生活能力评定量表床上人和社会人的ROC曲线。

Figure 3. ROC curves of Long's Activity of daily Living Scale in bedridden and community group corresponding to hierarchical diagnosis and treatment rating scale in rehabilitation medicine version A and B

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表 1 A版和B版康复分级诊疗评定量表的信度和效度

Table 1. Reliability and validity of A and B version of hierarchical diagnosis and treatment rating scale in rehabilitation medicine

量表版本	信度检验		效度检验
	内部一致性(Cronbach’s α)	重测信度(ICC)	结构效度		校标效度
	内部一致性(Cronbach’s α)	重测信度(ICC)	KMO	Bartlett球形检验P值	r₁值	r₂值
康复分级诊疗评定量表(A版)	0.740	0.851	0.659	＜0.01	0.798	-0.101
康复分级诊疗评定量表(B版)	0.694	0.783	0.660	＜0.01	0.875	-0.063
注：ICC为基于双向随机效应的组内相关系数；KMO为Kaiser-Meyer-Olkin检验；r₁为与NIHSS量表得分的相关性；r₂为与mRS量表得分的相关性。

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参考文献(19)

[1]	张亚琳, 廖晓阳, 赵茜, 等. 基层整合型医疗服务的国际经验和中国实践[J]. 中华全科医学, 2021, 19(6): 887-891. doi: 10.16766/j.cnki.issn.1674-4152.001942 ZHANG Y L, LIAO X Y, ZHAO Q, et al. International experience and practice of integrated primary care in China[J]. Chinese Journal of General Practice, 2021, 19(6): 887-891. doi: 10.16766/j.cnki.issn.1674-4152.001942
[2]	燕铁斌. 分级诊疗中的脑卒中康复[J]. 中国康复, 2016, 31(3): 163-164. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLKF201603034.htm YAN T B. Stroke rehabilitation in hierarchical diagnosis and treatment[J]. Chinese Journal of Rehabilitation, 2016, 31(3): 163-164. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLKF201603034.htm
[3]	陶磊, 梁海伦. 我国分级诊疗政策的推广路径与动因: 基于政策扩散理论的分析[J]. 中国卫生政策研究, 2019, 12(6): 9-14. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWZ201906002.htm TAO L, LIANG H L. Study on the path and impetus of China's hierarchical healthcare system reform: an analysis based on the policy diffusion theory[J]. Chinese Journal of Health Policy, 2019, 12(6): 9-14. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGWZ201906002.htm
[4]	王述寒, 田庆丰, 刘贝贝, 等. 分级诊疗视角下中老年人基层首诊影响因素分析[J]. 中国医疗保险, 2022(7): 62-67. https://www.cnki.com.cn/Article/CJFDTOTAL-YLBX202207010.htm WANG S H, TIAN Q F, LIU B B, et al. Analysis of influencing factors of first diagnosis at primary medical institutions for middle-aged and elderly people from the perspective of hierarchical diagnosis and treatment[J]. China Health Insurance, 2022(7): 62-67. https://www.cnki.com.cn/Article/CJFDTOTAL-YLBX202207010.htm
[5]	吴毅, 杨佩君, 郑洁皎, 等. 分层级、分阶段构建上海地区康复医疗服务体系[J]. 上海医药, 2017, 38(13): 3-8, 30. https://www.cnki.com.cn/Article/CJFDTOTAL-SYIY201713002.htm WU Y, YANG P J, ZHENG J J, et al. Construction of the rehabilitation medical service system in Shanghai by differentiating levels and phases[J]. Shanghai Medical & Pharmaceutical Journal, 2017, 38(13): 3-8, 30. https://www.cnki.com.cn/Article/CJFDTOTAL-SYIY201713002.htm
[6]	王亚平, 郑洁皎, 林万隆, 等. 《医联体脑卒中防治一体化康复管理指南》解读[J]. 中国标准化, 2021(12): 109-113. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGBZ202112021.htm WANG Y P, ZHENG J J, LIN W L, et al. Interpretation of "integrated rehabilitation management guide for stroke prevention and treatment in medical association"[J]. China Standardization, 2021(12): 109-113. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGBZ202112021.htm
[7]	ESPIN A, GARCÍA-GARCÍA J, LATORRE EREZUMA U, et al. Videoconference-based physical performance tests: reliability and feasibility study[J]. Int J Environ Res Public Health, 2022, 19(12): 7109.
[8]	NUNES A F, MONTEIRO P L, NUNES A S. Factor structure of the convergence insufficiency symptom survey questionnaire[J]. PLoS One, 2020, 15(2): e0229511. DOI: 10.1371/journal.pone.0229511.
[9]	MARTÍNEZ-CAMBLOR P, PÉREZ-FERNÁNDEZ S, DÍAZ-COTO S. The area under the generalized receiver-operating characteristic curve[J]. Int J Biostat, 2021, 18(1): 293-306.
[10]	MANI S, SHARMA S, OMAR B, et al. Validity and reliability of Internet-based physiotherapy assessment for musculoskeletal disorders: a systematic review[J]. J Telemed Telecare, 2017, 23(3): 379-391.
[11]	KONTOS A P, ELBIN R J, TRBOVICH A, et al. Concussion clinical profiles screening (CP screen) tool: preliminary evidence to inform a multidisciplinary approach[J]. Neurosurgery, 2020, 87(2): 348-356.
[12]	CLARK L A, WATSON D. Constructing validity: new developments in creating objective measuring instruments[J]. Psychol Asses, 2019, 31(12): 1412-1427.
[13]	MISTRY E A, YEATTS S, DE HAVENON A, et al. Predicting 90-day outcome after thrombectomy: baseline-adjusted 24-hour NIHSS is more powerful than NIHSS score change[J]. Stroke, 2021, 52(8): 2547-2553.
[14]	SAVER J L, CHAISINANUNKUL N, CAMPBELL B C V, et al. Standardized nomenclature for modified Rankin scale global disability outcomes: consensus recommendations from stroke therapy academic industry roundtable XI[J]. Stroke, 2021, 52(9): 3054-3062.
[15]	SCHOBER P, BOER C, SCHWARTE L A. Correlation coefficients: appropriate use and interpretation[J]. Anesth Analg, 2018, 126(5): 1763-1768.
[16]	屠建莹, 任筱舒, 陆博逊. 急性脑卒中患者出院后去向及转诊的影响因素[J]. 中国康复理论与实践, 2017, 23(1): 106-109. https://www.cnki.com.cn/Article/CJFDTOTAL-ZKLS201701026.htm TU J Y, REN X S, LU B X. Factors impacting whereabouts and referral in patients with acute stroke after discharge[J]. Chinese Journal of Rehabilitation Theory and Practice, 2017, 23(1): 106-109. https://www.cnki.com.cn/Article/CJFDTOTAL-ZKLS201701026.htm
[17]	KONG W L, YUAN J J, HUANG J C, et al. Outcomes of endovascular therapy in acute basilar artery occlusion with severe symptoms[J]. JAMA Network Open, 2021, 4(12): e2139550. DOI: 10.1001/jamanetworkopen.2021.39550.
[18]	GEERARS M, WONDERGEM R, PISTERS M F. Decision-making on referral to primary care physiotherapy after inpatient stroke rehabilitation[J]. J Stroke Cerebrovasc Dis, 2021, 30(5): 105667. DOI: 10.1016/j.jstrokecerebrovasdis.2021.105667.
[19]	CHEN Y C, CHEN T L, CHENG C C, et al. High-intensity post-stroke rehabilitation is associated with lower risk of pressure ulcer development in patients with stroke: real-world evidence from a nationwide, population-based cohort study[J]. Medicina(Kaunas), 2022, 58(3): 402.