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題 名 | 短版巴氏量表應用於中風患者之最小可偵測變化值及反應性=Minimal Detectable Change and Responsiveness of the 5-item Barthel Index in Patients with Stroke |
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作 者 | 呂文賢; 李雅珍; 凃富籌; 謝清麟; | 書刊名 | 臺灣復健醫學雜誌 |
卷 期 | 41:2 2013.06[民102.06] |
頁 次 | 頁113-119 |
分類號 | 415.922 |
關鍵詞 | 短版巴氏量表; 中風; 最小可偵測變化值; 反應性; 5-item Barthel index; Stroke; Minimal detectable change; Responsiveness; |
語 文 | 中文(Chinese) |
中文摘要 | 背景與目的:精簡的評估工具較受臨床人員接受,短版巴氏量表(5-item Barthel index)僅有5題,因此具備臨床常態使用之潛力。然而短版巴氏量表之最小可偵測變化值(minimal detectable change,MDC)及反應性驗證有限,影響使用者對短版巴氏量表評量結果之解釋。因此本研究之目的為:驗證短版巴氏量表應用於中風病人之最小可偵測變化值及反應性,並與原版10題巴氏量表比較。方法:本研究為次級資料分析,研究者使用昔日以原版巴氏量表二次施測(間隔二週)於56位慢性中風病人(發病超過半年且病情穩定)之資料估算短版巴氏量表及原版巴氏量表之最小可偵測變化值。以原版巴氏量表施測於226位亞急性中風病人(發病14天以及發病90天)之資料估算短版巴氏量表及原版巴氏量表之反應性,包含團體層級反應性:效應值d(effect size d)、標準化反應平均值(standardized response mean)及配對t檢定;個別層級反應性:二量表偵測個案於發病14~90天期間總分數改變超過最小可偵測變化值之人數差異以及最小可偵測變化值比值差異。結果:原版巴氏量表及短版巴氏量表之最小可偵測變化值(MDC%)值分別為4.3(28.8%)及3.1(41.1%)。原版巴氏量表及短版巴氏量表團體層級反應性皆大且相似(效應值d及標準化反應平均值皆大於0.8),二量表總分於前後二次測量之平均分數具備統計顯著差異(P<0.001)。個別層級反應性指標中,雖然原版巴氏量表比短版巴氏量表可反應較多個案(155 vs 141)之進步量超過最小可偵測變化值,但此差異未達統計顯著水準。然而在最小可偵測變化值比值上,原版巴氏量表顯著比短版巴氏量表高(P=0.008)。結論:短版巴氏量表之團體層級反應性良好,然而短版巴氏量表之隨機測量誤差比原版巴氏量表相對較大且其個別層級之反應性略遜於原版巴氏量表。我們建議臨床及研究人員,如果評估時間充裕,宜使用原版巴氏量表以便能充分呈現個案之日常生活功能改變。本研究結果有助於臨床及研究人員合理解讀個案前後測分數的變化,以及選擇適當的評估工具。 |
英文摘要 | Background and Purpose: A concise measurement tool can be easily accepted by clinicians. The 5-item Barthel Index (BI-5) has only 5 items and thus the potential to be used routinely in clinical settings. However, the minimal detectable change (MDC) and responsiveness of the BI-5 have not been verified sufficiently, limiting the interpretability of the change scores of the BI-5. The purposes of this study were to investigate the MDC and responsiveness of the BI-5 in patients with stroke and to compare the MDC and responsiveness of the BI-5 to those of the original BI.Methods: This study used secondary data analysis. A prior data set (with 56 stroke patients administered the BI twice, 14 days apart) was used to calculate the MDCs of the BI and the BI-5. Another data set (with 226 stroke patients administered the BI on the 14th day and the 90th day post onset) was used to calculate the responsiveness of the BI and that of the BI-5. Responsiveness indices included group-level responsiveness (i.e., effect size d, standardized response mean, SRM and paired t test) and individual-level responsiveness (i.e., the difference in number of patients whose change scores on the BI and BI-5 exceeded the respective MDC, and the difference in value of MDC ratio).Results: The MDCs (MDC%) of the BI and BI-5 were 4.3 (28.8%) and 3.1 (41.1%), respectively. The group-level responsiveness of the BI and that of the BI-5 were both large (both d and SRM were more than 0.8). The mean differences of the BI and the BI-5 between two measurements were significant. In individual-level responsiveness, the number of patients administered the BI having change scores exceeding the MDC was greater than that of those administered the BI-5 (155 vs. 141). However, the difference was not statistically significant. The value of the MDC Ratio of the BI was also significantly higher than that of the BI-5.Conclusion: The group-level responsiveness of the BI-5 was good. However, the random measurement error of the BI-5 was larger than that of the original BI, and the individual-level responsiveness of the BI-5 was slightly less than that of the BI. Thus, we recommend that given sufficient time for assessment, clinicians and researchers should use the original BI rather than the BI-5 to sufficiently show the change of ADL function in stroke patients. The results of this study can help clinicians and researchers interpret patients' change scores and select an appropriate ADL measure. |
本系統中英文摘要資訊取自各篇刊載內容。