뇌졸중 환자들을 위한 한국어판 Modified Rivermead Mobility Index의 측정자간 신뢰도와 동시 타당도
The Inter-rater Reliability and Concurrent Validity of the Modified Rivermead Mobility Index for Stroke Survivors
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본 연구의 목적은 뇌졸중 환자의 Modified Rivermead Mobility Index(MRMI)의 측정자간 신뢰도와 동시 타당도를 알아보는 것이다. 본 연구에서는 뇌졸중 환자 42명을 대상으로 하였다. MRMI의 측정자간 신뢰도(Inter-rater reliability)를 알아보기 위해 대상자들은 MRMI를 이용한 검사에 2회 참여하였다. 또한, MRMI의 동시 타당도를 알아보기 위하여 수정된 기능적 보행 지수(Modified Functional Ambulation Category, MFAC), 수정된 5m 보행 속도 검사, 일어나 걸어가기 검사(Timed Up & Go test, TUG), 버그 균형 척도(Berg Balance Scale, BBS), 수정된 바델 지수(Modified Barthel Index, MBI), 그리고 퓨글 마이어 평가(Fugl Meyer Assessment, FMA)에 참여하였다. MRMI의 측정자간 일치율은 급간내 상관계수(Intraclass correlation coefficient; ICC), 내적일치도(Cronbach’s α), 가중치 카파 계수(Weighted Kappa coefficient)를 이용하였고, MRMI의 개별 항목과 총점 간의 관계는 스피어만 상관 계수(Spearman Correlation Coefficient)를 이용하였다. 또한 MRMI의 표준오차 측정(Standard Error Measurement, SEM)과 최소 감지 변화(Minimal Detectable Change, MDC)를 구하였다. MRMI의 동시 타당도는 MFAC, 수정된 5m 보행 속도 검사, TUG, BBS, MBI, FMA와의 관계를 알아보았다. 본 연구의 결과, MRMI의 측정자간 일치율은 가중치 카파계수 .64∼.84, MRMI 개별 항목과 총점 간의 상관계수는 r=.89∼.96, MRMI의 Cronbach's α 계수는 .97, 개별 항목을 삭제한 경우에도 평균 .96∼.97로 높은 수준으로 나타났다. 또한, MRMI 총점의 ICC는 .97 (.94∼.98), SEM은 1.32점, MDC는 3.66점으로 매우 신뢰할 만 수준으로 나타났다. MRMI의 동시 타당도에서 MFAC(r=.64), 수정된 5m 보행 속도 검사(r=.73), TUG(r=-.76), BBS(r=.83), MBI(r=.83), FMA(r=.56∼.59) 등과 높은 상관관계가 있었다. 게다가, 대상자들의 이동성은 실제 3.6점 이상 변화될 수 있는 것으로 확인되었다. 본 연구를 통해 MRMI는 높은 측정자간 신뢰도와 동시 타당도가 있는 것으로 확인되었고, 만성 뇌졸중 환자의 이동성을 평가하는데 있어 유용하게 사용될 수 있을 것으로 사료된다.
Abstract
The purpose of this study was to investigate the inter-rater reliability and concurrent validity of the Modified Rivermead Mobility Index(MRMI) for stroke survivors. 42 stroke patients were participated in the study. The MRMI was administered in 2 testing sessions. Inter-rater reliability (Intraclass Correlation Coefficient; ICC), Internal consistency, and Weighted Kappa coefficient were used to examine the level of agreement between raters. For scale the item-total correlation and alpha if each item was deleted were calculated. Also we used to the Absolute reliability indices, including the Bland and Altman method, the standard error of measurement(SEM), and the Minimal Detectable Change(MDC). The concurrent validity was examined by correlating results to Modified Functional Ambulation Category(MFAC), 5m Walking Test(5mWT), Timed Up & Go test(TUG), Berg Balance Scale(BBS), Modified Barthel Index(MBI), Fugl Meyer Assessment(FMA). The mRMI meets the following requirements; 1) Inter-rater exact agreement for separate items was between Weighted Kappa=.64–.84. 2) The item-to-total correlations were all significant, ranging from r=.89∼.96(p<.01). MRMI showed good internal consistency(Cronbach’s α=.97). Individual items also possessed high internal consistency .96∼.97. Inter-rater reliability was excellent for ICC2,1=.97(.94~.98) for mRMI summary score and excellent SEM and MDC were 1.32, 3.66 respectively. 3) The mRMI were demonstrated high concurrent validity with the FAC(r=.84), the 5m WT(r=.73), TUG(r=-.76), BBS(r=.83), MBI(r=.83), and FMA(r=.56~.59 p<.01). In addition, there needs to be a difference of more than 3.6 points(MDC score) in the overall score to detect true change in the subjects level of mobility. The MRMI makes it feasible to measure changes in mobility in routine clinical practice with high inter-rater reliability and concurrent validity.
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