뇌졸중 환자들의 한국어판 Modified Version of Postural Assessment Scale for Stroke의 신뢰도와 타당도
The Reliability and Validity of the Modified Postural Assessment Scale for Stroke(Korean Version) in Stroke Patients
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초록
본 연구의 목적은 수정된 뇌졸중 자세 평가 척도(modified Postural Assessment Scale for Stroke, mPASS)의 한국어판을 만들고 신뢰도와 동시(Concurrent)ㆍ집중타당도(Convergent Validity)를 조사하는 것이었다. 본 연구에는 만성 뇌졸중 환자 32명이 참여하였다. 한국어판 mPASS의 개별 항목에 대한 신뢰도 분석은 측정자간 관찰 일치비율(%)과 카파 계수(Kappa coefficient)로 표기하였고, mPASS의 개개 항목과 전체 점수는 스피어만 계수(Spearman coefficient)로 나타내었다. mPASS 총점의 측정자간 신뢰도(Inter-rater reliability)는 급간내상관계수(Intra class coefficient, ICC2,1)와 문항 내적 일치도인 Cronbach’s α 계수로 표기하였고, 절대적 신뢰도(측정 오차 신뢰도)는 표준오차 측정(Standard Error Measurement, SEM)과 최소 감지 변화(Minimal Detectable Change, MDC)를 이용하였다. mPASS의 동시 타당도 검증은 축소형 뇌졸중 자세평가 척도(Short Form-Postural Assessment Scale for Stroke, SF-PASS), 버그균형척도(Berg Balance Scale, BBS)와의 상관관계로 알아보았고, 집중타당도는 수정된 바델 지수(Modified Barthel Index, MBI), 푸글-마이어 평가(Fugl Meyer-Upper/lower Extremity, FM-UE/LE)와의 관계를 스피어만 계수로 나타내었다. 본 연구의 결과 한국어판 mPASS의 12개 항목에 대한 측정자간 관찰된 일치율은 81%~97%였고, 개별 항목과 총점과의 상관계수는 높은 양의 상관관계(r=.81~.92)를 보였다. 한국어판 mPASS의 측정자간 신뢰도 K 계수는 평균 .83(.71~.90), ICC2,1= .97(.94~.96), 크론바 알파(Cronbach’s α)는 .93으로 매우 신뢰할만하였고, SEM과 MDC는 각각 .83, 2.30점으로 수용할만하였다. 한국어판 mPASS의 동시 타당도에서 SF-PASS(r=.89), BBS(r=.74)와는 높은 양의 상관관계가 있었고, 집중 타당도에서 MBI(r=.81), FM (r=.71~.76) 평가와는 높은 양의 상관관계가 있었다. 본 연구에서 만성 뇌졸중 환자들을 위한 한국어판 mPASS는 높은 신뢰도와 만족할만한 동시ㆍ집중타당도가 있음을 확인 할 수 있었고, 무작위 측정 오차 수준을 반영할 수 있는 SEM과 MDC 모두 수용할만하였다. 따라서 mPASS는 임상에서 뇌졸중 환자들의 자세조절을 평가하는데 유용하다고 할 수 있다.
Abstract
The purpose of this study was to investigate the inter-rater reliability as well as the concurrent and convergent validity of the modified Postural Assessment Scale(mPASS) for stroke that translated into Korean in chronic stroke patients. The subjects participated in this study were thirty-two stroke patients with hemiparesis being able to walk independently. The mPASS scale was administered in 2 testing sessions 3 days apart. Inter-rater reliability(intraclass correlation coefficient ICC2,1), Internal consistency, and Kappa coefficient was used to examine the level of agreement between raters. Absolute reliability indices, including the Bland and Altman method, the standard error of measurement(SEM), and the Minimal Detectable Change(MDC). Concurrent validity was examined by correlating the total score of mPASS to the Short Form-Postural Assessment Scale for Stroke(SF- PASS), Berg Balance Scale(BBS), Convergent validity was examined by correlating the total score of mPASS to the Modified Barthel Index(MBI), Fugl-Meyer assessment (FM-UE/LE/total). The mPASS meets the following requirements: (1) The percentage agreement of these items ranged from 81%~97%, item- to -total correlations were all significant, ranging from r=.81~.92(p<.01). (2) The Kappa coefficient of the individual items of mPASS ranged from average K= .83(.71~.90)(substantial ~good), the overall inter-rater reliability of the mPASS total score was high ICC(2,1) =.97(.94~.96)(very reliable), and high internal consistency(Cronbach’s α-coefficient =.93) (3) The SEM and MDC of the mPASS representing were .83 and 2.30, respectively, indicating acceptable levels of measurement error (4) good concurrent validity: high correlation with SF-PASS(r=.89), BBS(r=.74) (5) convergent validity: high correlation between mPASS score on the MBI(r=.81), FM-UE/LE/total score(r=.71~.76)(p<.01). The mPASS is a reliable and valid for assessing the postural control for individuals with stroke. This result support implication for using the mPASS on the chronic stroke patients in clinical settings.
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