Development of the multi-dimensional outcome scale that judges the effect of home health care service for the patients with neurological disorders and their caregivers

本研究的目的是开发多维结果量表，用于评估神经疾病患者及其照顾者的家庭保健服务效果。这项研究的参与者是442名患者和他们的照顾者：男性；239，女性；203。通过对数据进行定性分析，考察制约家庭健康护理持续的因素，编制了临时量表条目(30个条目)，运用解释因子分析和协方差结构分析进行模型说明，构建了包含25个条目的5维结果量表，用于测量脑血管疾病和神经疾病患者/照顾者持续家庭健康护理的难度。我们将Promax旋转法应用于因子分析，并通过改变因子数来重复多次。最后，从这25个条目中提取了5个因子，每个条目的因子负载量都在0.3以上。每个因素被标记为：1)疾病和残疾焦虑指数；2)照顾者紧张指数；3)运动功能障碍指数；4)症状表现指数。(5)社会网络利用的干扰指数。构建的结果量表显示出较高的信度，范围在0.784到0.908之间。协方差结构分析揭示了二阶因子的结构，并提供了较好的模型描述：GFI=.945，AGFI=.913，RMR=.094。除Index-3外，其余5个结果量表均无性别差异，且与ADL/IADL表现状态呈中等相关。神经功能障碍患者与卒中患者5项结局量表评分差异有统计学意义，神经功能障碍患者组5项评分较高。

The purpose of the research is to develop the multi-dimensional outcome scale that judges the effect of home health care service for the patients with neurological disorders and their caregivers. The participants of this research were 442 patients and their caregivers : male ; 239, female ; 203. Data was analyzed qualitatively in order to examine the factors that inhibit the continuation of home health care, and provisional scale items (30 items) were made.We constructed a 25-item and 5-dimensional outcome scale which measures the difficulty of the continuation of home health care for the patients/caregivers with cerebral-vascular and neurological disorders by means of use of explanatory factor analysis and covariance structure analysis for model specification. We applied the Promax rotation method in factor analysis and repeated it several times by changing the number of factors. Finally, 5 factors were extracted from the 25 item, in each of which the all items having more than 0.3 factor loadings. Each of factors were labeled as following : 1) Index of anxiety for disease and disability ; 2) Index of caregiver strain ; 3) Index of motor dysfunction ; 4) Index of expression of symptom. ; 5) Index of interference of the social-network utilization. The constructed outcome scale demonstrated high reliabilities ranging from 0.784 to 0.908. Covariance structure analysis revealed the structure of second-order factor and provided a good fit for model specification : GFI=.945, AGFI=.913, RMR=.094. Five outcome scales showed no sex differences excepted Index-3, and middle correlation to the performance status of ADL/IADL. Score of 5-outcome scales were significantly different between the patients with neurological disorders and stroke patients, with high score of 5-scales in the patients group of neurological disorders.