Evaluating the effectiveness of stroke rehabilitation: Choosing a discriminative measure
Evaluating the effectiveness of stroke rehabilitation: Choosing a discriminative measure
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DOI：
10.1053/apmr.2002.27348
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发表时间：
2002-01-01
影响因子：
4.3
通讯作者：
Greenwood, KM
中科院分区：
文献类型：
--
作者：
Brock, KA;Goldie, PA;Greenwood, KM
目的：评价用于确定脑卒中后康复结果质量的几种身体残疾指标的判别能力。设计：采用Rasch分析法对脑卒中康复患者的功能状态和活动能力进行比较研究。环境：澳大利亚墨尔本一所三级教学医院的一个有26张床位的康复病房。参与者：106例接受康复治疗的急性卒中患者的连续样本。干预措施：不适用。主要观察指标：FIM（TM）运动分量的Rasch分析。运动评估量表，功能行走分类，步态速度和步态耐力。结果：FIM运动量表中难度较大的项目在高功能患者中有充分的区分。步态速度测量进一步区分了9%的样本，他们的功能水平高于FIM运动分量表所能显示的水平。其他措施并没有增加FIM电机所提供的歧视水平。由Rasch对FIM运动量表的分析提供的能力估计比原始分数更准确地表明能力。原始分数低估了在更高水平的能力中观察到的能力变化。结论：FIM运动分量表的Rasch估计为评估脑卒中康复的结果和能力变化提供了一种判别性的测量方法。
Objective: To evaluate the discriminative ability of several measures of physical disability used to determine quality of outcome for poststroke rehabilitation.Design: A comparative study, using Rasch analysis, of the discriminative ability of functional status and mobility measures in rehabilitation patients with stroke.Setting: A 26-bed rehabilitation unit, on site of a tertiary teaching hospital in Melbourne, Australia.Participants: A consecutive sample of 106 patients with acute stroke admitted for rehabilitation.Interventions: Not applicable.Main Outcome Measures: Rasch analysis of the motor subscale of the FIM(TM). instrument, Motor Assessment Scale, Functional Ambulation Classification, gait Velocity, and gait endurance.Results: The more difficult items of the FIM motor scale adequately discriminated among higher functioning patients. The gait velocity measure further distinguished 9% of the sample, who functioned at a higher level than could be indicated by FIM motor subscale. The other measures did not add levels of discrimination to that provided by the FIM motor. Ability estimates provided by Rasch analysis of the FIM motor scale were a more accurate indication of ability than raw scores. Raw scores underestimated change in ability observed at higher levels of ability.Conclusion: Rasch estimates of the FIM motor subscale provide a discriminative measure for evaluating outcomes and change in ability achieved in stroke rehabilitation.