基于ICF的老年肌少症功能测量工具的内容和心理测量特性比较

doi:10.3969/j.issn.1006-9771.2024.03.004

Abstract

Abstract:

Objective To explore the content and psychometric properties of sarcopenia measurements for older adults.

Methods Using the International Classification of Functioning, Disability and Health (ICF) linking and coding rules, a content analysis were conducted on the seven types of measurement tools for geriatric sarcopenia, including Strength, Assistance with walking, Rising from a chair, Climbing stairs, and Falls (SARC-F); Ishii Test; Mini Sarcopenia Risk Assessment-7 (MSRA-7); 6-minute walk test (6MWT); Barthel Index (BI); Short Physical Performance Battery (SPPB); and World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0), and psychometric property was explored.

Results The seven measurement tools can be categorized into body functions and structures, activities and participation, and comprehensive categories. ICF coding for SARC-F involved muscle power functions (b730), walking (d450), changing basic body position (d410), etc. Ishii Test involved muscle power functions (b730) and weight maintenance functions (b530). MSRA-7 involved walking (d450), involuntary movement reaction functions (b755), muscle endurance functions (b740), etc. ICF coding for 6MWT involved walking (d450). SPPB involved changing basic body position (d410), control voluntary movement functions (b760), and walking (d450). BI involved eating (d550), drinking (d560), washing oneself (d510), caring for body parts (d520), etc. WHODAS 2.0 involved attention functions (b140), acquiring skills (d155), communication-receiving-verbal messages (d310), community life (d910), etc. SARC-F was low to medium in sensitivity, and medium to excellent in specificity. Ishii Test was medium to good in sensitivity, average to good in specificity, and good in diagnostic performance. MSRA-7 was medium to good in sensitivity, average in specificity, and average to medium in diagnostic performance, while MSRA-5 was average to good in sensitivity, average in specificity, and medium in diagnostic performance. 6MWT was average to medium in sensitivity, and average in specificity. SPPB was average in sensitivity, average to medium in specificity, and average to excellent in diagnostic performance. BI was good in reliability, and WHODAS 2.0 was excellent in reliability.

Conclusion The measurement tools for sarcopenia can be categorized into body functions and structures, activities and participation, and comprehensive assessment tools combining the above. The psychometric properties of the seven measurement tools are low to excellent in sensitivity and average to excellent in specificity.

Key words: older adults, sarcopenia, screening, measurement, assessment

CLC Number:

R685

LIU Hui, YIN Hang, HU Chenghong, JIA Shaohui, FENG Yewenzhe, HU Qingkui. Content and psychometric properties of functional measurements in patients with sarcopenia based on ICF[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(3): 273-280.

Figures/Tables 2

Table 1

Content analysis of functioning measurements in sarcopenia based on ICF"

测量工具	测量项目	ICF编码
SARC-F	1.力量	肌肉力量功能(b730)
	2.行走辅助	步行(d450)
	3.从椅子起立	改变身体的基本姿势(d410)
	4.爬楼梯	攀登(d4551)
	5.跌倒	不随意运动反应功能(b755)
Ishii测试	1.握力	肌肉力量功能(b730)
Ishii测试	2.小腿围	体重维持功能(b530)
MSRA-7	1.握力测试	独立肌肉和肌群的力量(b7300)
	2.下肢力量测试	下半身肌肉的力量(b7303)
	3.平衡测试	随意运动控制功能(b760)
	4.功能性移动测试	步行(d450)；到处移动(d455)
	5.行走速度测试	步行(d450)
	6.反应时间测试	不随意运动反应功能(b755 )
	7.耐力测试	肌肉耐力功能(b740)
6MWT	6 min内可以在平坦、坚硬的表面上快速行走的距离	步行(d450)
SPPB	1.椅子站立测试(不使用手臂的五次重复椅子站立)	改变身体的基本姿势(d410)
	2.站立平衡(站立平衡的渐进式测试)	随意运动控制功能(b760)
	3.步行速度(4 m的常规步伐步行)	步行(d450)
BI	1.进食	吃(d550)；喝(d560)
	2.洗澡	盥洗自身(d510)
	3.修饰	护理身体各部(d520)
	4.穿衣	穿着(d540)
	5.控制大便	控制大便(d5301)
	6.控制小便	控制小便(d5300)
	7.如厕	如厕(d530)
	8.床椅转移	坐姿移动自身(d4200)
	9.平地行走	步行(d450)
	10.上下楼梯	攀登(d4551)
WHODAS 2.0	1.1集中注意力	注意力功能(b140)
	1.2记得做重要的事	记忆功能(b144)
	1.3分析并解决日常生活问题	解决问题(d175)
	1.4学习一项新任务	掌握技能(d155)
	1.5理解别人的言语	交流-接收-口头讯息(d310)
	1.6发起并维持谈话	交谈(d350)
	2.1长时间站立	保持一种身体姿势(d415)
	2.2坐下后站立	改变身体的基本姿势(d410)
	2.3家中来回走动	在不同地点到处移动(d460)
	2.4从家中外出	在不同地点到处移动(d460)
	2.5长距离行走	步行(d450)
	3.1洗澡	盥洗自身(d510)
	3.2穿衣服	穿着(d540)
	3.3进食	吃(d550)
	3.4独立生活数日	进行日常事务(d230)
	4.1与陌生人相处	与陌生人的联系(d730)
	4.2维持一段友情	非正式社会关系(d750)
	4.3同他人密切相处	家庭人际关系(d760)
	4.4结交新朋友	非正式社会关系(d750)
	4.5性活动	亲密关系(d770)
	5.1承担家务劳动责任	照管居家物品(d650)
	5.2完成家务劳动	做家务(d640)
	5.3完成所有家务劳动
	5.4尽快完成家务劳动
	5.5日常工作或学习	学龄前教育(d815)；学校教育(d820)；职业训练(d825)；高等教育(d830)；有报酬的就业(d850)
	5.6很好地完成大多数重要工作或学习
	5.7完成份内所有工作
	5.8尽可能完成工作
	6.1像他人一样参与社区活动	社区生活(d910)
	6.2“有尊严的活着”的困难	人权(d940)
	6.3健康问题及影响上花费时间	照顾个人的健康(d570)
	6.4健康问题对家庭带来的经济损失	经济自给(d870)
	6.5自我放松或娱乐方面的困难	娱乐和休闲(d920)

Table 1

Table 2

Psychometric properties of functioning measurements of sarcopenia"

测量工具	适应人群	心理测量特性	心理测量特性指标
SARC-F	初步筛查患有肌少症的老年人群	敏感性较低，特异性优秀	敏感性29.5% (95%CI 18.5%~42.6%) 特异性98.1% (95%CI 96.0%~99.3%)
SARC-F	初步筛查患有肌少症的老年人群	敏感性较低~中等，特异性中等~良好	敏感性28.9%~55.3% (95%CI 11.8%~61.6%) 特异性68.9%~88.9% (95%CI 76.0~98.8%) Youden指数0.00~0.64
Ishii测试	需评估肌肉质量的老年人群	敏感性中等~良好，特异性一般~良好与女性群体相比，在男性群体中的敏感性、差异性、诊断效果更好	男性：敏感性88.9%；特异性70.6% AUC：0.87 女性：敏感性77.8%；特异性68.6% AUC：0.78
Ishii测试	需评估肌肉质量的老年人群	敏感性优秀，特异性较低，诊断效果中等，分类模型性能中等	敏感性90.1%；特异性36.0% AUC：0.78；Youden指数0.5
MSRA	有肌肉减少风险的老年人群	MSRA-7敏感性良好，特异性一般，诊断效果中等 MSRA-5敏感性良好，特异性一般，诊断效果中等	MSRA-7 敏感性80.4%；特异性50.5% AUC：0.786 (95%CI 0.725~0.847) MSRA-5 敏感性80.4%；特异性60.4% AUC：0.789 (95%CI 0.728~0.851)
MSRA	有肌肉减少风险的老年人群	MSRA-7敏感性中等，特异性一般，诊断效果一般 MSRA-5敏感性一般，特异性一般，诊断效果中等	MSRA-7 敏感性75.7%；特异性65.1% AUC:0.666 (95%CI 0.542~0.789) MSRA-5 敏感性68.8%；特异性67.9% AUC: 0.710 (95%CI 0.593~0.827)
6MWT	心肺功能障碍群体老年患者	敏感性一般~中等，特异性一般，诊断效果一般~中等与女性群体相比，在男性群体中的敏感性、特异性、诊断效果更好	男性：敏感性71%；特异性63% AUC：0.720 (95%CI 0.628~0.690) 女性：敏感性69%；特异性58% AUC：0.692 (95%CI 0.623~0.755)
SPPB	老年患者	敏感性一般，特异性一般~中等，诊断效果一般~优秀	敏感性42%~58%；特异性69%~71% AUC：0.69~0.98
BI	脑卒中患者肌少症患者肿瘤患者	信度良好	信度(Cronbach α) > 0.85
WHODAS 2.0	所有患病人群一般人群	信度优秀	信度(Cronbach α) > 0.90

Table 2

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Content and psychometric properties of functional measurements in patients with sarcopenia based on ICF

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