扩展Barthel指数在脑卒中患者中的信度与效度

doi:10.3969/j.issn.1006-9771.2021.03.003

摘要/Abstract

摘要： 目的

研究扩展Barthel指数(EBI)在脑卒中患者日常生活活动(ADL)评估中的信度与效度。

方法

2018年1月至2019年10月，方便抽取苏州大学附属第一医院住院的脑卒中患者136例，采用EBI进行评定，评定者A于患者入院48 h内完成EBI评定2次，间隔> 12 h；评定者B在患者入院24 h内完成EBI评估1次；评定者C于患者入院48 h内完成改良Barthel指数(MBI)、功能独立性测量(FIM)评定。计算EBI的重测组间相关系数(ICC)、评定者间ICC；计算EBI内部一致性Cronbach α系数。各项目分与总分行Spearman相关分析；MBI、FIM各项目分与EBI相关项目行Spearman相关分析；因子分析法分析EBI的结构效度。

结果

EBI各项评分重测ICC = 0.766~0.953，运动项和认知项总分重测ICC分别为0.938和0.845，总分重测ICC = 0.891；EBI各项评分评定者间ICC = 0.728~0.976，运动项和认知项总分评定者间ICC分别为0.948和0.717，总分评定者间ICC = 0.866；内部一致性分析Cronbach α = 0.885；除视觉项外(r = 0.215, P < 0.05)，其余各项与总分的相关系数均> 0.4 (P < 0.001)。EBI各项与MBI相应项目明显相关(r = 0.648~0.958, P < 0.01)，EBI各项与FIM相应项目明显相关(r = 0.722~0.976, P < 0.01)。主成分分析提取4个主成分，累计贡献率72.19%；剔除视觉项后，提取3个主成分，累计贡献率69.09%；主成分1主要代表括约肌控制和部分高级脑功能(交流和社会认知)，主成分2主要代表下肢功能相关的ADL，主成分3主要代表上肢功能相关的ADL。

结论

EBI在脑卒中患者ADL评定中具备良好的信度和效度。

关键词: 脑卒中, 扩展Barthel指数, 信度, 效度

Abstract: Objective

To study the reliability and validity of extended Barthel Index (EBI) in the assessment of activities of daily living (ADL) for stroke patients.

Methods

From January, 2018 to October 2019, 136 stroke inpatients from the First Affiliated Hospital of Soochow University were conveniently sampled. They were assessed with EBI by rater A twice within 48 hours after admission, with interval above twelve hours; and by rater B within 24 hours. They were also assessed with modified Barthel Index (MBI) and Function Independence Measure (FIM) within 48 hours after admission by rater C. The intraclass correlation coefficient (ICC) of retest and inter-rater of EBI were calculated, as well as the Cronbach's α coefficient, Spearman correlation coefficient between scores of items and total, and Spearman correlation coefficient of EBI to MBI or FIM. The construct validity of EBI was tested with factor analysis.

Results

The retest ICC of items was 0.766 to 0.953; the retest ICC of motor and cognitive items was 0.938 and 0.845, respectively; the retest ICC of total was 0.891. The inter-rater ICC of items was 0.728 to 0.976, the inter-rater ICC of motor and cognitive items was 0.948 and 0.717, respectively; the inter-rater ICC of total was 0.866. The Cronbach's α coefficient of EBI was 0.885. The correlation coefficients were above 0.4 in all the items (P < 0.001) to the total, except the item of vision (r = 0.215, P < 0.05). The correlation of items of EBI to MBI was significant (r = 0.648 to 0.958, P < 0.01), as well as those of EBI to FIM (r = 0.722 to 0.976, P < 0.01). Four components were extracted with principal component analysis, accumulated to 72.19% of the variable; after the vision item was removed, three principal components were extracted, accumulated to 69.09% of the variable. The component 1 was mainly about sphincter control and some advanced brain functions (communication and social cognition), component 2 mainly about ADL related to lower extremities, and component 3 mainly about ADL related to upper extremities.

Conclusion

EBI is reliable and valid in the assessment of ADL for stroke patients.

Key words: stroke, extended Barthel Index, reliability, validity

中图分类号:

R743.3

吴炜,倪波业,施加加. 扩展Barthel指数在脑卒中患者中的信度与效度[J]. 《中国康复理论与实践》, 2021, 27(3): 261-268.

Wei WU,Bo-ye NI,Jia-jia SHI. Reliability and Validity of Extended Barthel Index for Stroke Patients[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2021, 27(3): 261-268.

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评定项目	第1次	第2次	ICC (95%CI)
饮食	3 (2, 4)	3 (2, 4)	0.863 (0.789~0.913)
梳理	2 (2, 2)	2 (1, 3)	0.912 (0.862~0.945)
穿/脱	1 (1, 2)	1 (0, 2)	0.911 (0.861~0.944)
洗澡	0 (0, 1)	0 (0, 1)	0.934 (0.896~0.959)
如厕	1 (0, 2)	1 (0, 2)	0.950 (0.920~0.969)
肠道控制	4 (4, 4)	4 (4, 4)	0.766 (0.647~0.849)
膀胱控制	4 (4, 4)	4 (3, 4)	0.843 (0.758~0.900)
轮椅/床间转移	2 (1, 3)	1 (1, 2)	0.919 (0.872~0.949)
行走	1 (0, 2)	1 (0, 2)	0.894 (0.835~0.933)
上下楼梯	0 (0, 0)	0 (0, 0)	0.953 (0.925~0.971)
理解	4 (3, 4)	4 (3, 4)	0.914 (0.864~0.946)
表达	4 (4, 4)	4 (3, 4)	0.785 (0.674~0.861)
社交互动	4 (4, 4)	4 (3, 4)	0.873 (0.803~0.920)
解决问题	4 (4, 4)	4 (3, 4)	0.901 (0.844~0.937)
记忆/学习/定位	3 (2, 3)	3 (2, 3)	0.886 (0.822~0.928)
视觉	4 (4, 4)	4 (3, 4)	0.871 (0.799~0.918)
运动项总分	19.5 (15, 24)	18 (14, 23)	0.938 (0.902~0.961)
认知项总分	19 (16.25, 19)	17 (14, 19)	0.845 (0.761~0.901)
EBI总分	42 (36, 46.75)	40.5 (32.25, 46)	0.894 (0.834~0.933)

评定项目	评定者A首次	评定者B	ICC (95%CI)
饮食	3 (2, 4)	3 (2, 4)	0.753 (0.620~0.843)
梳理	2 (2, 2)	2 (1, 3)	0.821 (0.725~0.885)
穿/脱	1 (1, 2)	1 (1, 2)	0.895 (0.836~0.934)
洗澡	0 (0, 1)	0 (0.25, 1)	0.976 (0.961~0.985)
如厕	1 (0, 2)	1 (0, 2)	0.963 (0.935~0.978)
肠道控制	4 (4, 4)	4 (4, 4)	0.933 (0.894~0.958)
膀胱控制	4 (4, 4)	4 (4, 4)	0.760 (0.636~0.845)
轮椅/床间转移	2 (1, 3)	2 (1, 2)	0.922 (0.877~0.951)
行走	1 (0, 2)	1 (0, 2)	0.955 (0.927~0.972)
上下楼梯	0 (0, 0)	0 (0, 0)	0.959 (0.934~0.974)
理解	4 (3, 4)	4 (3, 4)	0.744 (0.616~0.834)
表达	4 (4, 4)	4 (3, 4)	0.871 (0.799~0.918)
社交互动	4 (4, 4)	4 (4, 4)	0.728 (0.593~0.823)
解决问题	4 (4, 4)	4 (4, 4)	0.794 (0.682~0.869)
记忆/学习/定位	3 (2, 3)	3 (2, 3)	0.729 (0.594~0.824)
视觉	4 (4, 4)	4 (4, 4)	0.799 (0.693~0.871)
运动项总分	19.5 (15, 24)	18.5 (14, 24.75)	0.948 (0.918~0.968)
认知项总分	19 (16.25, 19)	19 (14, 19)	0.717 (0.577~0.816)
EBI总分	42 (36, 46.75)	40.5 (33, 47)	0.866 (0.790~0.915)

项目	删除项后		校正的项总计相关性	删除项的Cronbach α
项目	刻度均值	刻度方差	校正的项总计相关性	删除项的Cronbach α
饮食	37.59	80.634	0.406	0.883
梳理	38.62	80.150	0.343	0.887
穿/脱	39.53	80.372	0.429	0.882
洗澡	40.21	77.688	0.565	0.877
如厕	39.32	72.371	0.660	0.873
肠道控制	36.82	82.715	0.479	0.881
膀胱控制	36.90	80.840	0.508	0.880
轮椅/床间转移	38.82	71.909	0.657	0.873
行走	39.31	71.470	0.698	0.871
上下楼梯	40.21	75.778	0.546	0.878
理解	37.35	75.187	0.630	0.874
表达	37.00	80.776	0.601	0.878
社交互动	37.03	79.342	0.542	0.878
解决问题	37.03	76.954	0.601	0.875
记忆/学习/定位	37.88	76.016	0.709	0.872
视觉	36.97	83.551	0.279	0.886

项目	r	项目	r	项目	r	项目	r
饮食	0.429^a	如厕	0.798^a	行走	0.842^a	社交互动	0.514^a
梳理	0.469^a	肠道控制	0.407^a	上下楼梯	0.657^a	解决问题	0.538^a
穿/脱	0.548^a	膀胱控制	0.436^a	理解	0.757^a	记忆/学习/定位	0.735^a
洗澡	0.668^a	轮椅/床间转移	0.798^a	表达	0.536^a	视觉	0.215^b

EBI	MBI		FIM
EBI	项目	r	项目	r
饮食	进食	0.958^a	进食	0.919^a
梳理	修饰	0.812^a	梳洗	0.873^a
穿/脱	穿衣	0.856^a	穿上衣+穿下衣	0.916^a
洗澡	洗澡	0.648^a	洗澡	0.800^a
如厕	如厕	0.686^a	如厕	0.919^a
肠道控制	大便控制	0.894^a	大便管理	0.773^a
膀胱控制	小便控制	0.823^a	小便管理	0.778^a
轮椅/床间转移	床椅转移	0.947^a	床/椅/轮椅+如厕+盆浴/淋浴转移	0.930^a
行走	行走	0.891^a	步行	0.947^a
上下楼梯	上下楼梯	0.899^a	上下楼梯	0.733^a
理解	－	－	理解	0.931^a
表达	－	－	表达	0.772^a
社交互动	－	－	社交交往	0.722^a
解决问题	－	－	解决问题	0.708^a
记忆/学习/定位	－	－	记忆	0.899^a
视觉	－	－	－	－
运动项总分	总分	0.958^a	运动项总分	0.957^a
认知项总分	－	－	认知项总分	0.930^a
总分	总分	0.946^a	总分	0.976^a