뇌졸중 환자들의 신체 의존성 평가에 관한 축소형 바델 지수의 타당도와 최저 실제 차이
The Validity and Smallest real difference of Short-form Barthel Index as Physical dependence for Stroke
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본 연구의 목적은 뇌졸중 환자들의 축소형 바델 지수-5개 항목(Barthel Index - 5items, BI-5)이 신체 의존성 유무를 구분할 수 있는지 그 타당도와 최저 실제 차이(Smallest Real Difference, SRD)를 알아보고자 하였다. 만성 뇌졸중 환자 54명을 대상으로 일상생활수행 BI(10개 항목)로 평가 하였고, 2일 후 축소형 BI(5개 항목)를 7일 간격으로 재평가하였다. 축소형 BI의 검사-재검사 일치율은 급간내 상관계수(Intra-class coefficient 2,1)를 이용하여 SRD를 구하였고, 뇌졸중 환자들의 신체 의존성 유무(원본 BI 항목 총점: ≤80점=자가 보고 의존, >80점=자가 보고 독립)를 구분 할 수 있는지 축소형 BI의 선별 기준값을 조사하였다. 연구 결과 축소형 BI의 SRD는 7.39점(최고 획득 점수 55점의 <20%)으로 측정 오차는 수용할만한 수준이었고, 축소형 BI의 신체 의존성 유무를 구분 할 수 있는 선별 기준값은 40.50점이었다. 곡선하 면적(Area under the curve, AUC)은 0.97, 민감도 87%, 특이도 97%, 양성 예측도 95%, 음성예측도 91%로 정확성은 93%로 매우 높은 것으로 확인되었다. 따라서 축소형 BI는 뇌졸중 환자들의 일상생활활동 평가 시 기능적인 변화를 감지할 수 있고, 신체 의존성 유무를 구분할 수 있는 평가 방법으로 사용이 가능하다.
Abstract
The purpose of this study is to investigate, whether or not the short-form Barthel Index-5items(BI-5) of stroke patients can distinguish the presence and absence of physical dependence, the validity, and the smallest real difference(SRD). For 54 chronic stroke patients, daily activity performance was assessed by BI(10 items) and two days later, reassessed by the short-form BI(5 items) at 7-day intervals. For the test-retest concordance rate of the short-form BI, SRD was calculated using the intra-class coefficient 2,1. The cutoff value of the short-form BI was investigated to identify whether or not the presence and absence of physical dependence in stroke patients(The total score of the original BI items ≤80 points represents the dependence on self-report; the total score >80 points represents the independence of self-report) could be distinguished. According to the result of the study, the SRD of the short-form BI was 7.39(<20% of the maximum acquisition point 55 points), so the measurement error was acceptable. The cutoff value to distinguish the physical dependence of the short-form BI was 40.50 points. The Area under the curve(AUC) was 0.97; the sensitivity 87%; the specificity 97%; the positive predictive value 95%; the negative predictive value 91%. The accuracy was found to be very high at 93%. So, the short-form BI can detect a functional change in the assessment of activities of daily living of stroke patients and can be used as an evaluation method to distinguish the presence and absence of physical dependence.
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