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아급성기 뇌졸중 환자들의 낙상 예측을 위한 modified Postural Assessment Scale for Stroke와 Berg Balance Scale의 타당도

The Validity of the Modified Postural Assessment Scale for Stroke and Berg Balance Scale in Predicting Fall of Subacute Stroke Patients

박창식
특수교육재활과학연구소 (The Research Institute for Special Education & Rehabilitation Science)|2014.09|특수교육재활과학연구|제53권 제3호|pp. 1-18|DOI http://dx.doi.org/10.15870/jsers.2014.09.53.3.1

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참고문헌

키워드

뇌졸중Stroke낙상Postural Control자세 조절Berg Balance Scale버그 균형 척도수정된 뇌졸중 자세 평가 척도Fall downmodified Postural Assessment Scale for Stroke
주제분류기타사회과학

초록

본 연구의 목적은 아급성기 뇌졸중 환자를 대상으로 자세 조절을 평가하는 수정된 뇌졸중 자세 평가 척도(modified Postural Assessment Scale for Stroke, mPASS)와 버그 균형 척도(Berg Balance Scale, BBS)를 이용하여 낙상의 위험성을 예측하거나 변별력이 있는지 그 타당도를 검증하고자 하였다. 본 연구는 후향적 연구(Retrospective study)로서 연구에 참여한 아급성기 뇌졸중 환자 62명을 대상으로 뇌졸중 발병 후 연구 시점을 기준으로 낙상 횟수에 대한 기록을 하였다. 낙상 경험 예측 변별력은 mPASS와 BBS를 사용하였고 기능 수행 평가로 수정된 바델 지수(Modified Barthel Index, MBI), 퓨글 마이어 상ㆍ하지ㆍ총합(Fugl Meyer-Upper/Lower extremity motor function, FM-UㆍL/Eㆍtotal)을 이용하였다. mPASS 와 BBS의 낙상 경험 예측에 관한 선별 기준값(cutoff value)과 양ㆍ음성 예측도(PositiveㆍNegative predictive value, PPVㆍNPV)를 구하였고, mPASS와 BBS의 낙상 경험 예측 선별 기준값은 낙상군과 비낙상군의 위험정도를 예측하기 위하여 교차비(Odd ratio)를 구하였다. mPASS의 낙상 위험선별 기준값은 24.5점(AUC=.74, 민감도=63%, 특이도=71%), BBS는 40.5점(AUC=.71, 민감도=74%, 특이도=63%)으로 수용할 만 하였다. 낙상 경험 예측의 선별 기준값인 mPASS≤24.5점, BBS≤40.5점에 해당하는 피실험자들은 각각 낙상의 위험성이 4.25배, 4.84배 증가하는 것으로 확인이 되었다. 낙상을 일으킬 수 있는 요소 중 자세 조절을 평가하는 mPASS와 BBS 모두 아급성기 뇌졸중 환자들의 낙상 위험성을 규명하는데 충분한 타당성이 있었으나 mPASS는 심리측정학적인 분석을 BBS는 외적인 타당도를 고려한 포괄적인 연구를 통한 타당도 검증이 이루어져야 할 것이다.

Abstract

The purpose of this study is to verify the validity of predicting the risk of falls or whether it has the distinction by using the modified Postural Assessment Scale for Stroke(mPASS) and Berg Balance Scale(BBS) that assesses the postural control targeting the subacute stroke patients. This is a retrospective study targeting 63 subacute stroke patients where the records on the number of falls were based within 6 months after the onset of stroke. mPASS and BBS were used for the predicted distinction on the experience of falls and Modified Barthel Index(MBI), Fugl Meyer-Upper/Lower extremity motor function were used for evaluation of functional performance. The Cutoff Value and PositiveㆍNegative predictive value(PPVㆍNPV) on the prediction of falls of mPASS and BBS were obtained. For the selection standard value of prediction of falls of mPASS and BBS, Odd ratio was obtained in order to predict the degree of risk for falls and non-falls. The selection standard value for risk of falls of mPASS was 24.5 points(AUC =.74, sensitivity=63%, specificity=71%) and BBS was 40.5 points(AUC=.71, sensitivity =74%, specificity=63%) which were in the acceptable range. Subjects corresponding to the selection standard value of mPASS ≤24.5 points, BBS ≤40.5 points for prediction of falls have shown that the risk of falls was increased by 4.25 times and 4.84 times respectively. Although both mPASS and BBS that assess the postural control among the factors that can cause falls had sufficient validity for identifying the risk of falls of subacute stroke patients, a comprehensive study should be made considering the psychometrics analysis of mPASS and the external validity of BBS.

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