基于ICF的儿童运动功能和活动能力测量工具的内容和心理测量特性研究

doi:10.3969/j.issn.1006-9771.2024.03.003

Abstract

Abstract:

Objective To analyze the content and psychometric properties of measurement tools for children's gross motor function and activity.

Methods Six measurement tools for children's gross motor function and activity were selected, including Gross Motor Function Measure (GMFM), Bruininks-Oseretsky Test of Motor Proficiency-Second Edition (BOT-2), Peabody Developmental Motor Scales-Second Edition (PDMS-2), Movement Assessment Battery for Children-Second Edition (MABC-2), Test of Gross Motor Development-Third Edition (TGMD-3) and Functional Movement Screen (FMS). International Classification of Functioning, Disability, and Health (ICF) linking rules, categories and coding were used to analyze the content of measurement dimensions and items of these six tools, and their psychometric properties were explored.

Results For the body function, the content of these six tools primarily addressed neuromusculoskeletal and movement-related functions (b7), such as mobility of joint functions (b710), stability of joint functions (b715), muscle power functions (b730), motor reflexes functions (b750), control of voluntary movement functions (b760), supportive functions of arm or leg (b7603) and gait patterns functions (b770). For the activities and participation, the content primarily addressed mobility (d4), such as changing and maintaining body positions (d410, d415), transferring oneself (d420), walking (d450), running (d4552), and jumping (d4553). GMFM was good in inter-rater and test-retest reliability; BOT-2 was good in inter-rater reliability, test-retest reliability and internal consistency; PDMS-2 was good in inter-rater and test-retest reliability; MABC-2 was good in test-retest reliability and internal consistency with an excellent model fit; TGMD-3 was good in internal consistency and test-retest reliability; and FMS was good in internal consistency and test-retest reliability.

Conclusion The six tools for motor and activity function measurement primarily concern neuro-musculoskeletal and movement-related functions (b7) for ICF body function, and mobility (d4) for activities and participation. PDMS-2 is suggested for a comprehensive evaluation of children's motor functions and activities; TGMD-3 and GMFM for gross motor functions; and BOT-2, MABC-2 and FMS for motor development, coordination and functional movement patterns. BOT-2, PDMS-2, MABC-2 and TGMD-3 are norm-referenced measures, whereas GMFM and FMS are criterion-referenced. Norm-referenced tools, due to their established norms tailored for various objectives, boast superior psychometric properties and wider applications. All the six tools exhibit good to excellent reliability, and internal consistency coefficients ranging from moderate to excellent. Their validity also spans from moderate to excellent.

Key words: children, motor, activity, measurement, psychometric property, International Classification of Functioning, Disability, and Health

CLC Number:

R493

WANG Xinting, YANG Jian. Content and psychometric properties of children's motor function and activity measurements using ICF[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 265-272.

Figures/Tables 3

Table 1

Table 2

Content analysis of the measurement tools based on ICF"

工具	项目	ICF编码
GMFM	A部分：卧位与翻身	躺姿移动自身(d4201)
	B部分：坐位	坐下(d4103)；保持坐姿(d4153)
	C部分：爬与跪	跪下(d4102)；保持跪姿(d4152)
	D部分：站立	站起(d4104)；保持站姿(d4154)
	E部分：行走与跑跳	步态功能(b770)；移动自身(d420)；步行(d450)；奔跑(d4552)；跳跃(d4553)；在不同地点到处移动(d460)；利用设备到处移动(d465)；其他特指或未特指的步行和移动(d469)
BOT-2	精细的手控：精确性和完整性	精巧手的使用(d440)
	手的协调：上肢、手技能和协调性	手和手臂的使用(d445)
	身体的协调性：双侧的协调性和平衡性	不随意运动反应功能(b755)；改变身体的基本姿势(d410)；保持一种身体姿势(d415)；移动自身(d420)；其他特指或未特指的改变和保持身体姿势(d429)；到处移动(d455)
	力量与敏捷性	肌肉力量功能(b730)
PDMS-2	反射	运动反射功能(b750)；改变身体的基本姿势(d410)
	静止	保持一种身体姿势(d415)；其他特指或未特指的改变和保持身体姿势(d429)
	移动	移动自身(d420)；步行(d450)；到处移动(d455)；在不同地点到处移动(d460)；利用设备到处移动(d465)；其他特指或未特指的步行和移动(d469)
	实物操作	关节活动功能(b710)；手和手臂的使用(d445)
	抓握	精巧手的使用(d440)
	视觉运动整合	随意运动控制功能(b760)
MABC-2	手部精细操作	随意运动控制功能(b760)；不随意运动反应功能(b755)；精巧手的使用(d440)
	手眼协调能力	随意运动控制功能(b760)
	静态以及动态平衡能力	肌肉力量功能(b730)；改变身体的基本姿势(d410)；保持一种身体姿势(d415)
TGMD-3	A部分：跑；马步跳；单脚连续跳；跨步跳；立定跳；侧滑步	奔跑(d4552)；跳跃(d4553)；移动自身(d420)；到处移动(d455)；步态功能(b770)；关节稳定功能(b715)；肌肉力量功能(b730)；随意运动控制功能(b760)
TGMD-3	B部分：双手持棒击定位球；单手持拍击反弹球；单手原地拍球；双手接球；踢定位球；过肩投球；下手抛球	肌肉力量功能(b730)；随意运动控制功能(b760)；精巧手的使用(d440)；手和手臂的使用(d445)；运动反射功能(b750)
FMS	深蹲；弯腰；直立旋转	关节活动功能(b710)；关节稳定功能(b715)；肌肉力量功能(b730)
	踢腿	关节稳定功能(b715)；肌肉力量功能(b730)；手臂或腿的支撑功能(b7603)
	下肢卷曲	关节活动功能(b710)；肌肉力量功能(b730)
	背部挺身	关节活动功能(b710)；肌肉力量功能(b730)
	步行	步态功能(b770)；肌肉力量功能(b730)；步行(d450)

Table 2

Table 3

References 32

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项目	内容	评定标准
结构和内容	结构	测量工具的维度和项目
结构和内容	内容	测量工具的项目与ICF类目进行匹配
心理测量特性	信度	内部一致性系数：较低，0.11~0.40；一般，0.41~0.60；中等，0.61~0.80；良好，0.81~0.90；优秀，0.91~1.00 Cronbach α系数：一般，0.60~0.70；中等，0.71~0.80；良好，0.81~0.90；优秀，0.91~1.00 重测信度/评定者间信度：中等，0.70~0.80；优秀，> 0.80
	效度内容效度构建效度	卡方/自由度：可以接受，2.0~5.0；非常理想，< 2.0 比较拟合指数(Comparative Fit Index, CFI)、非标准化拟合指数(Non-Normed Fit Index, NNFI)、塔克-刘易斯指数(Tucker-Lewis Index, TLI)、调整的拟合度指数(Adjusted Goodness-of-Fit Index, AGFI)：可以接受，0.80~< 0.9；很好，≥ 0.90 逼近误差均方根(Root Mean Square Error of Approximation, RMSEA)：较好，0.05~< 0.10；很好，0.01~< 0.05；非常好，<0.01
	适用性	工具对不同年龄、类型和文化背景的适用性

工具	适应人群	测量性质	心理测量指标
GMFM	脑瘫儿童；唐氏综合症儿童和后天性脑损伤儿童；非常年幼的儿童或粗大运动功能分类系统第五级的儿童	标准参照	GMFM-88：总体信度ICC = 1.00 (95%CI 0.99~1.00)；维度信度ICC = 0.99 (95%CI 0.99~1.00)^[8] GMFM-66：评定者间信度ICC = 0.97 (95%CI 0.94~0.99)；重测信度ICC = 0.94 (95%CI 0.88~0.97)^[9]
BOT-2	2~21岁11个月的儿童和青少年；特定精神障碍儿童	常模参照	Cronbach α = 0.93；重测信度ICC = 0.80~0.99^[13] Cronbach α = 0.89；评定者间信度ICC = 0.99 (95%CI 0.89~1.00)；重测信度ICC = 0.99 (95%CI 0.87~1.00)^[14]
PDMS-2	0~6岁11个月早期发育迟缓或障碍的儿童，如脑瘫、孤独症、唐氏综合征	常模参照	评定者间信度：ICC = 0.90 (95%CI 0.81~0.99)；重测信度：ICC = 0.93 (95%CI 0.62~0.96)^[17] Cronbach α = 0.85；重测信度ICC = 0.98~0.99^[18]
MABC-2	3~16岁儿童和青少年	常模参照	Cronbach α = 0.72~0.87；重测信度ICC = 0.80~0.91^[21] 评定者间信度ICC = 0.79 (95%CI 0.80~0.83)；RMSEA = 0.028；NNFI = 0.98；AGFI = 0.97^[22]
TGMD-3	3~10岁患有粗大运动障碍的儿童	常模参照	Cronbach α = 0.92；效度优秀^[24] Cronbach α = 0.93；重测信度ICC = 0.99 (95%CI 0.96~0.99)^[25]
FMS	有功能性力量相关运动问题的儿童；神经系统疾病儿童	标准参照	Cronbach α = 0.74；重测信度ICC = 0.91~0.94^[27] 评定者间信度ICC = 0.72~0.87^[28]

Content and psychometric properties of children's motor function and activity measurements using ICF

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