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

本研究旨在发展一个多维的结果量表，以判断家庭健康照护服务对神经系统疾病患者及其照顾者的效果。本研究的参与者为442名患者及其照顾者：男性; 239名，女性; 203名。对数据进行了定性分析，以检查抑制家庭保健持续的因素，临时比额表项目我们编制了一个25个项目和5个维度的结果量表，用于测量脑卒中患者/照顾者继续家庭健康护理的困难程度。血管和神经系统疾病，通过使用解释因子分析和协方差结构分析的模型规格。我们将Promax旋转法应用于因子分析中，并通过改变因子的数量重复多次。最后，从25个项目中提取出5个因子，每个因子中所有项目的因子负荷都大于0.3。每个因素标记如下：1）疾病和残疾的焦虑指数; 2）照顾者紧张指数; 3）运动功能障碍指数; 4）症状表达指数。（5）社会网络利用干扰指数。构建的结果量表显示出较高的信度，范围从0.784到0.908。协方差结构分析揭示了二阶因子的结构，并为模型规格提供了良好的拟合：GFI=.945，AGFI=.913，RMR=.094。除指数3外，5个结局量表均无性别差异，与ADL/IADL的表现状态呈中等相关。神经系统疾病组与脑卒中组5项结局量表评分差异有统计学意义，神经系统疾病组5项结局量表评分较高。

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.