만성 뇌졸중 환자들의 Elderly Mobility Scale 측정자간 신뢰도와 타당도
Inter-Rater Reliability and Validity of the Elderly Mobility Scale in Chronic Stroke Patients
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
본 연구의 목적은 만성 뇌졸중 환자들의 Elderly Mobility Scale(EMS) 평가에 대한 신뢰도와 타당도를 알아보고자 하였다. 피 실험자 33명을 대상으로 EMS의 측정자간 일치율은 측정자간 신뢰도 급간내 상관계수(Intraclass correlation coefficient ICC(2,1), 내적일치도(Cronbach’s α), 가중치 카파 계수(Weighted Kappa coefficient)를 이용하였고 EMS의 개별 항목과 총점간의 관계와 각 문항을 제거하면서 내적일치도를 표기하였다. 절대적 신뢰도 지수인 표준오차 측정(Standard Error Measurement, SEM)과 최소 감지 변화(Minimal Detectable Change, MDC)를 이용하였다. EMS의 타당도에 대한 분석은 수정된 Rivermead 이동 지수(modified Rivermead Mobility Index, mRMI), 운동 사정 척도(Motor Assessment Scale, MAS), 일어나 걸어가기 검사(Timed up & go test, TUG), 수정된 바델 지수(Modified Barthel Index, MBI), 버그 균형 척도(Berg Balance Scale, BBS)와의 상관계수를 구하였다. 본 연구 결과 EMS 측정자간 일치율은 가중치 카파계수 .62~.77(제외 50m 보행과 기능적 팔 뻗기 검사=각각 .53, .44)로 높은 수준이었다. EMS개별 항목과 총점간의 상관계수는 r=.77~.93(p<.01), EMS의 Cronbach’s α 계수는 .88, 개별 항목을 삭제한 경우 평균 .79~.88로서 높은 수준이었다. EMS총점의 측정자간 신뢰도 ICC=.90(.77~.96), SEM은 1.36점, MDC는 3.78점으로 우수하였다. EMS의 타당도는 mRMI(r=.78), MAS(r=.82), TUG(r=-.72), MBI(r=.75), BBS(r=.81, p<.01)와 높은 상관관계가 있었다. EMS척도는 측정자간 신뢰도가 우수하고 평가를 적용하기 쉬우며, mRMI, MAS, TUG, MBI, BBS와 관련성이 높은 것으로 확인되었다. 따라서 EMS는 뇌졸중 환자들의 보행과 균형 및 자세 조절을 포함한 이동성을 평가하는데 유용한 평가 도구이다.
Abstract
The purpose of this study was to examine the inter-rater reliability and validity of the Elderly Mobility Scale(EMS) of 33 chronic stroke patients. Inter-rater reliability(intraclass correlation coefficient [ICC](2,1), internal consistency and weighted kappa coefficient were used to examine the level of agreement between raters. Item-to-total correlation was determined by correlating the total score of the EMS. To examine the absolute reliability indices, we used the standard error measurement(SEM) and the minimal detectable change(MDC). Validity was tested by correlating results to modified Rivermead Mobility Index(mRMI), Motor Assessment Scale(MAS), timed up & go test(TUG), modified Barthel Index(MBI), and Berg Balance Scale(BBS). The EMS met the following requirements: (1) Inter -rater agreement was high for separate item(weight kappa=.62~.77) except for gait and functional reach(weight kappa=.53 and .44 respectively). (2) Item-to -total correlations were all significant, ranging from r=.77~.93(p<.01); EMS possessed high internal consistency(Cronbach’s α=.86) and individual items also possessed high internal consistency(α=.79~.88); the inter-rater reliability of EMS summaryl score was excellent (ICC2,1=.90[.77~.96]) as were SEM(1.36) and MDC(3.78). (3) The EMS had high concurrent validity with the mRMI(r=.78), MAS (r=.82), TUG(r=-.72), MBI(r=.75), BBS(r=.81). The EMS scale is a reliable tool and can be administered easily. It correlates well with the mRMI, MAS, TUG, MBI, and BBS. it could therefore provide a scale for assessment of mobility that considers locomotion, balance, and postural control in chronic stroke patients.
참고문헌 (28)
- Barkelius, K., "Reliabilitets-och validitetspro¨vning av modifierad Motor Assessment Scale enligt Uppsala Akademiska sjukhus -95", Nordisk Fysioterapi, 1, pp.12126~ (1997)
- Carr, J, H., "Investigation of a new motor assessment scale for stroke patients", Physical Therapy, 65(2), pp.175~180 (1985)
- Collin, C., "Assessing motor impairment after stroke: a pilot reliability study", Journal of Neurology, Neurosurgry, and Psychiatry, 53(7), pp.576~579 (1990)
- Dodds, T. A., "A validation of the functional independence measurement and its performance among rehabilitation in-patients", Archives of Physical Medicine and Rehabilitation, 74(5), pp.531~536 (1993)
- DeVellis, R. F., "Scale development: theory and applications", pp.22~88 (1991), Sage Publications
- Flansbjer, U. B., "Reliability of gait performance tests in men and women with hemiparesis after stroke", Journal of Rehabilitation Medicine, 37(2), pp.75~72 (2005)
- Granger, C. V., "Outcome of comprehensive medical rehabili tation : Measurement by PULSES profile and the Barthel Index", Archives of Physical Medicine and Rehabilitation, 60(4), pp.145~154 (1979)
- Godi, M., "Comparison of reliability, validity, and responsiveness of the mini-BESTest and Berg Balance Scale in patients with balance disorders", Physical Therapy, 93(2), pp.158~167 (2013)
- Gor-García-Fogeda., "Scales to Assess Gross Motor Function in Stroke Patients : A Systematic Review", Archives of Physical Medicine and Rehabilitation, 95(6), pp.1174~1183 (2014)
- Hsueh, I. P., "Comparison of psychometric properties of three mobility measures for patients with stroke", Stroke, 34(7), pp.1741~1745 (2003)
- Jonsson, E., "Does the functional reach test reflect stability limits in elderly people?", Journal of Rehabilitation Medicine, 35(1), pp.26~30 (2003)
- Johnson, L., "Measurement of mobility following stroke : A comparison of the Modified Rivermead Mobility Index and the Motor Assessment Scale", Physiotherapy, 90(3), pp.132~138 (2004)
- Lennon, S., "The modified Rivermead Mobility Index : Validity and reliability", Disability and Rehabilitation, 22(18), pp.833~839 (2000)
- Linder, A., "Evaluation of the Swedish version of the Modified Elderly Mobility Scale(Swe M-EMS)in patients with acute stroke", Clinical Rehabilitation, 20(7), pp.584~597 (2006)
- Lindmark, B., "Evaluation of functional capacity after stroke as a basis for active intervention. Presentation of a modified chart for motor capacity assessment and its reliability", Scandinavian Journal of Rehabilitation Medicine, 20(3), pp.103~109 (1998)
- Loewen, S. C., "Predictors of stroke outcome using objective measurement scales", Stroke, 21(1), pp.78~81 (1990)
- Lu, W. S., "The minimal detectable change of the simplified stroke rehabilitation assessment of movement measure", Journal of Rehabili tation Medicine, 40(8), pp.615~619 (2008)
- Mao, H. F., "Analysis and comparison of the psychometric properties of three balance measures for stroke patients", Stroke, 33(4), pp.1022~1027 (2002)
- Mahoney, F. I., "Functional evaluation: the Barthel Index", Maryland State Medical Journal, 14, pp.61~65 (1965)
- Persson, C. U., "A validation study using a modified version of Postural Assessment Scale for Stroke Patients : Postural Stroke Study in Gothenburg(POSTGOT)", Journal of NeuroEngineering and Rehabilitation, 8, pp.57~ (2011)
- Podsiadlo, D., "The Timed"Up & Go" : a test of basic functional mobility for frail elderly persons", Journal of the American Geriatrics Society, 39(2), pp.142~148 (1991)
- Prosser, L., "Further validation of the Elderly Mobility Scale for measurement of mobility of hospitalized elderly people", Clinical Rehabilitation, 11(4), pp.338~343 (1997)
- Smith, R., "Validation and Reliability of the Elderly Mobility Scale", Physiotherapy, 80(11), pp.744~747 (1994)
- Spilg, E. G., "A comparison of mobility assessments in a geriatric day hospital", Clinical Rehabilitation, 15(3), pp.296~300 (2001)
- Spilg, E. G., "Falls risk following discharge from a geriatric day hospital", Clinical Rehabilitation, 17(3), pp.334~340 (2003)
- Thomas, J. I., "A pilot study to explore the predictive validity of 4 measures of falls risk in frail elderly patients", Archives of Physical Medicine and Rehabilitation, 86(8), pp.1636~1640 (2005)
- Tsang, R. C., "The measurement properties of modified Rivermead mobility index and modified functional ambulation classification as outcome measures for Chinese stroke patients", Physiotherapy Theory and Practice, 30(5), pp.353~359 (2014)
- Yu, M. S., "Usefulness of the Elderly Mobility Scale for classifying residential placements", Clinical Rehabilitation, 21(12), pp.1114~1120 (2007)