뇌졸중 환자들의 발가락 두드림 검사(Toe Tap Test)의 상대적⋅절대적 신뢰도와 타당도
The Relative⋅Absolute Reliability and Validity of the Toe Tap Test in Stroke Patients
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초록
본 연구의 목적은 만성 뇌졸중 환자의 Toe Tap Test(TTT)의 상대적⋅절대적 신뢰도와 타당도를 알아보고자 하였다. 본 연구에 참여한 만성 뇌졸중 환자 32명을 대상으로 TTT 횟수의 상대적 신뢰도 지수(급간내상관계수: Intra Class Coefficient, ICC)를 이용하였다. 또한 절대적 신뢰도 지수인 표준 측정 오차(Standard Error Measurement, SEM)와 극소 식별변화(Minimal Detectable Change, MDC) 및 Bland and Altman(일치 한계) 분석이 포함되었다. TTT의 타당도는 버그 균형 척도(Berg Balance Scale, BBS), 푸글마이어 하지 운동기능(Fugl Meyer Assessment-Lower/extremity, FMA-L/E), 일어나 걸어가기 검사(Timed Up & Go Test, TUG)간의 스피어만 상관 계수(Spearman Correlation Coefficient)를 이용하였다. 마비측과 비마비측의 TTT 횟수는 ICC=0.952∼0.959(0.901∼0.980), SEM은 각각 0.90, 0.88(평균 점수 <20%), MDC는 각각 2.48, 2.43(최고 획득 가능 점수 <20%)으로 신뢰할 수 있는 수준인 것으로 확인되었다. 마비측 TTT횟수는 BBS(r=.51), FM-L/E(r=.56)와는 양의 상관관계가 있었고, TUG(r=-.57)와는 음의 상관관계가 있었다. 만성 뇌졸중 환자의 TTT는 높은 상대적⋅ 절대적 신뢰도가 있었고, 마비측 TTT횟수는 마비측 하지 운동 기능(FM-L/E)과 동적 균형 능력(BBS) 및 일어나 걸어 가기 검사(TUG)와 유의한 관련성이 있었다. 따라서 마비측 TTT 횟수는 임상에서 만성 뇌졸중 환자의 발목관절 조절 능력을 평가하기 위한 간단하고 신뢰할 수 있는 평가 도구가 될 수 있을 것이다.
Abstract
The aim of this study is to examine the relative absolute reliability and validity of the Toe Tap Test(TTT) counts in subjects with chronic stroke. A total of 32 subjects with chronic stroke participated in this study. A relative reliability index (intraclass correlation coefficient, ICC) was used to examine the level of agreement of reliability for TTT counts. Furthermore, absolute reliability indices—including the standard error of measurement (SEM), the minimal detectable change (MDC), and limits of agreement by Bland and Altman analysis—are also utilized. The validity was demonstrated by spearman correlation of TTT counts with Berg Balance Scale(BBS). Fugl Meyer Assessment-Lower/Extremity (FMA-L/E) and Timed Up & Go Test(TUG)- an excellent relative reliability in TTT counts was found (paretic, ICC=0.952; non-paretic, ICC=0.959). It all showed acceptable SEM of the TTT counts, as paretic and nonparetic were 0.90 and 0.88 respectively (average score <20%), and the MDC of the paretic and non-paretic were 2.48 and 2.43 respectively(with the possible highest score being <20 %). This indicates that the measures had a small and acceptable measurement error. The TTT counts of paretic side were significantly correlated with BBS(r=.51), FM-L/E(r=.56), and TUG(r=-.57). Furthermore, the TTT counts is a reliable measurement tool. TTT counts of paretic side were significantly associated with dynamic standing balance (BBS), motor function of affected lower extremity (FMA-L/E), and timed up & go test (TUG). The results show that TTT counts on the affected side is a simple and reliable tool for assessing ankle control in people with stroke.
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