目的以《国际功能、残疾和健康分类(儿童及青少年版)》(ICF-CY)为框架,明确三种常用脑瘫儿童上肢功能评估量表的内容和临床使用价值。方法选择脑瘫儿童精细运动功能测试量表(FMFM)、墨尔本单侧上肢功能评估量表2 (MA2)和上肢技巧质量测试量表(QUEST),由2名从事脑瘫儿童上肢功能评估3年以上的康复医生和治疗师独立确定每个条目所包含的概念,按相关联系法则将提取的概念ICF-CY类目建立关联,分析各量表提取的概念数、涉及ICF-CY类目数以及与之发生关联数的分布状况。结果三个量表共计提取62个概念,发生403次关联。FMFM关联的ICF-CY类目最多,“活动和参与”类目占关联总数近2/3 (134/204)。QUEST主要与身体功能的下级类目“关节活动和手臂的支撑功能”发生关联。MA2与反映运动准确性的知觉功能类目关联7次,涉及运动流畅性的类目关联9次,合计占总关联数50%以上。结论FMFM更多地评价脑瘫儿童上肢功能的活动和参与能力,也更为适合年幼脑瘫儿童;MA2更多地关注上肢运动的准确度和流畅性;而QUEST主要关注身体功能,尤其是上肢的关节活动和支撑功能。
ObjectiveTo review the concepts of three common scales assessing upper limbs function of children with cerebral palsy, namely Fine Motor Function Measure (FMFM), Melbourne Assessment 2 of Unilateral Upperlimb Function (MA2) and Quality of Upper Extremity Skills Test (QUEST), from the framework of Chinese version of International Classification of Functioning, Disability and Health-Child and Youth Version (ICF-CY). MethodsConcepts of each item from FMFM, MA2 and QUEST were extracted independently by a rehabilitation doctor and a therapist with professional experience more than three years, and then linked with ICF-CY category according to the linking rules. The distribution of concepts of each scale linking to ICF-CY categories was investigated. ResultsA total of 62 concepts were extracted from these three scales, and 403 linkages to various ICF-CY categories. Concepts from FMFM were the most linked with ICF-CY category among them, in which nearly two-thirds (134/204) concepts linked with the categories of Activity And Participation. Concepts from QUEST principally linked with the category of joint and arm-supporting in Body Function. Concepts from MA2 linked to category of cognition function which reflected motor accuracy 7 times and motor fluency 9 times (more than 50% of the total amount of linkages). ConclusionFMFM mainly evaluates the activity and participation associated with upper limb function in children with cerebral palsy, and may be more applicable for younger children. MA2 mainly evaluates the accuracy and fluency of upperlimb movement. QUEST mainly evaluates body function especially the joint and supporting function of upper limbs.
[1] 史惟,杨红,施炳培,等. 国内外脑性瘫痪定义、临床分型及功能分级新进展[J]. 中国康复理论与实践, 2009, 15(9): 801-803.
[2] 史惟,丁俊杰,杨红,等. 痉挛型偏瘫儿童上肢精细运动功能发育进程研究[J]. 中国循证儿科杂志, 2013, 8(4): 247-251.
[3] 史惟,李惠,苏怡,等. 中文版脑瘫患儿手功能分级系统的信度和效度研究[J]. 中国循证儿科杂志, 2009, 4(3): 263-269.
[4] 邱卓英,李沁燚,陈迪,等. ICF-CY理论架构、方法、分类体系及其应用[J]. 中国康复理论与实践, 2014, 20(1): 1-5.
[5] 世界卫生组织. 国际功能、残疾和健康分类(儿童和青少年版)[M]. 邱卓英,译. 日内瓦:世界卫生组织, 2013.
[6] 史惟,李惠,杨红,等. 脑瘫患儿精细运动功能测试量表的单维性和信度研究[J]. 中国循证儿科杂志, 2008, 3(2): 110-118.
[7] 付海城,姜志梅,孙晓燕,等. 中文版墨尔本单侧上肢功能评估量表2的信度和效度研究[J]. 中国康复医学杂志, 2014, 31(12): 1134-1137.
[8] Randall M, Imms C, Carey LM, et al. Rasch analysis of the Melbourne Assessment of Unilateral Upper Limb Function [J]. Dev Med Child Neurol, 2014, 56(7): 665-672.
[9] 王军,陈静,朱登纳,等. 中文版上肢技巧质量量表在脑性瘫痪患儿上肢功能评定中的信度和效度[J]. 中国康复医学杂志, 2016, 33(1): 41-44.
[10] 刘鹏,姜志梅,汤敬华,等. 中文版上肢技巧质量测试量表信度和效度的初步研究[J]. 中国康复, 2013, 28(6): 424-426.
[11] World Health Organization. International Classification of Functioning, Disability, and Health: Children & Youth Version: ICF-CY[M]. Geneva: World Health Organization, 2007.
[12] Cieza A, Geyh S, Chatterji S, et al. ICF linking rules: an update based on lessons learned [J]. J Rehabil Med, 2005, 37(2): 212-218.
[13] 邱卓英,陈迪,祝捷. 构建基于ICF的功能和残疾评定的理论和方法[J]. 中国康复理论与实践, 2010, 16(7): 675-677.
[14] 邱卓英,荀芳. 基于ICF的康复评定工具开发与标准化研究[J]. 中国康复理论与实践, 2011, 17(2): 101-105.
[15] 史惟,杨红,王素娟,等. 脑性瘫痪患儿运动障碍的系统康复管理(一)[J]. 中国循证儿科杂志, 2007, 2(3): 220-227.
