《国际功能、残疾和健康分类·康复组合》在非急性期患者中使用的信度与效度分析

关键词：国际功能、残疾和健康分类  康复组合  信度  效度

Keywords:International Classification of Functioning, Disability and Health  rehabilitation set  reliability  validity

摘要：

      摘要 目的：检验《国际功能、残疾和健康分类?康复组合》（the International Classification of Functioning, Disability and Health Rehabilitation Set）在非急性期患者中使用的信度与效度。 方法：广东、福建、湖北省13个研究中心有515例非急性期患者参与研究，采用ICF康复组合、Barthel指数 (Barthel Index)、SF-36（Short Form-36）进行评定。分析ICF康复组合的内在一致性、评定者间信度、评定者内信度和效标关联效度。 结果：ICF康复组合的身体功能、活动和参与成分的Cronbach α系数分别是0.69和0.87；评定者间一致率和加权Kappa系数均值为68.5%和0.73；评定者内信度结果显示一致率和加权Kappa系数均值分别是81.7%和0.82；身体功能、活动、参与三个成分与Barthel指数呈中度至高度负相关（r=-0.498—-0.887，P<0.01），与SF-36中生理功能成分的相关性尚可（r=-0.524—-0.900，P<0.01），与躯体疼痛成分没有相关性或相关性较差，与SF-36的生理职能、总体健康、活力、社会功能、情感职能和精神健康成分呈现中到低度的相关性（r=-0.254—-0.547，P<0.01）。 结论：ICF康复组合具有较好的信度与效度，适合作为评定工具在临床实践中使用。

Abstract:

      Abstract Objective: To investigate the reliability and validity of International Classification of Functioning, Disability and Health Rehabilitation Set (ICF-RS) in post-acute rehabilitation patients. Method: 515 post-acute rehabilitation patients were recruited in 13 research centers in Guangdong, Fujian and Hubei provinces and they were assessed using the ICF-RS, the Barthel Index (BI), and the Mos 36-item Short Form Health Survey (SF-36). The tested psychometric properties of the ICF-RS included internal consistency, interrater reliability, intra-rater reliability and criterion-related validity. Result: The Cronbach' α coefficient of the Body Functions (BF), Activities and Participation (AP) components of the ICF-RS were 0.69 and 0.87 respectively. The weighted Kappa for the interrater and the intrarater agreement were 0.73 and 0.82, indicating good reliability. The criterion-related validity of the ICF-RS was examined based on the results of Rasch analysis which was divided into BF, A and P three components to fit the model expectation. The total scores of BF, A and P components showed moderate to high negative correlations with the BI (r=-0.498—-0.887，P<0.01)， moderate to high negative correlations with the SF-36 physical functioning (PF) domain (r=-0.524—-0.900，P<0.01), low to no correlations with the bodily pain (BP) domain, and moderate to low correlations with the role-physical (RP), general health (GH), vitality, social functioning (SF), role emotional (RE) , and mental health (HT) domains (r=-0.254—-0.547，P<0.01). Conclusion: The ICF-RS showed good reliability and validity and can be applied as a functioning assessment instrument in clinical practice.