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

本研究的目的在于编制评估神经系统疾病患者及其照护者家庭健康照护服务效果的多维结果量表。这项研究的参与者是442名患者和他们的护理人员：男性；239名女性；203. 对数据进行定性分析，以检验抑制家庭保健继续的因素，并制作临时量表（30个项目）。本研究采用解释因子分析和协方差结构分析的方法，构建了一个包含25个条目的5维结果量表，用于测量脑血管神经疾病患者/照顾者继续进行家庭保健的难度。我们将Promax旋转法应用于因子分析中，并通过改变因子数量的方式进行多次重复。最后，从25个条目中提取出5个因子，每个因子的负荷量均大于0.3。各因子标记如下：1)疾病和残疾焦虑指数；2)照顾者压力指数；3)运动功能障碍指数；4)症状表现指数。;5)社交网络利用干扰指数。构建的结果量表具有较高的信度，信度范围为0.784 ~ 0.908。协方差结构分析揭示了二阶因子的结构，对模型规格有很好的拟合：GFI= 0.945， AGFI= 0.913， RMR= 0.094。除指数-3外，其他5个结果量表均无性别差异，与ADL/IADL表现状态均有中等相关性。神经障碍患者与脑卒中患者5项量表得分差异有统计学意义，神经障碍患者组5项得分较高。

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.