脑瘫精细运动功能测试量表在偏瘫型患儿中需要重新建立评估标准与程序

doi:10.3969/j.issn.1673-5501.2019.04.003

摘要/Abstract

摘要： 目的分析脑瘫精细运动功能测试量表(FMFM)在偏瘫和非偏瘫型脑瘫间的项目功能差异(DIF)。方法收集2001至2018年复旦大学附属儿科医院康复中心及其医联体儿童康复协作网诊断为脑瘫并行FMFM评估的患儿,从FMFM评估数据中提取偏瘫患儿对侧数据,随机选择30%样本作为DIF的焦点组样本;根据整体样本中非偏瘫型与偏瘫型的比例确定采用随机分层匹配对照组样本。采用Conquest软件把两组合并数据样本分别与FMFM中B~E区的全部56个项目以及经项目内容分析后划分出的30个单手项目和26个双手项目进行Rasch分析,以内聚拟合度(Infit)的均方来确定FMFM的单维性,标准为MnSq在0.6～1.4,并对全部56项、单双手项目组进行项目功能差异分析。结果 1 556例脑瘫患儿的3 442次FMFM评估作为整体样本和数据,焦点组198个和对照组792个FMFM评估数据进入本文分析,单独样本配对检验显示两组FMFM分值[112(96,146) vs 113(95,145)]差异无统计学意义。经过3轮项目内容分析,30个归入单手项目,26个归为双手项目。全部56个项目的难度尺度对数值之差的绝对值>0.5分别有41个(73.2%),30个单手和26个双手项目的难度尺度对数值之差的绝对值>0.5分别有23个(76.7%)和9个(34.6%)。结论 FMFM全部56个操作项目在偏瘫和非偏瘫型脑瘫间存在DIF,在单手项目中尤其显著,为了更为精准地评价偏瘫儿童的精细运动功能,需要重新建立评估标准与程序。

关键词: 功能, 精细运动, 脑瘫, 评估, 项目功能差异

Abstract: Objective To analyze the differential item functioning (DIF) of Fine Motor Function Measure (FMFM) between hemiplegic and non-hemiplegic cerebral palsy.Methods Data of children with cerebral palsy diagnosed by Rehabilitation Center of Children's Hospital of Fudan University and Children Rehabilitation Collaboration Network of Children's Hospital from 2001 to 2018 were collected and assessed by FMFM as well. The contralateral data of hemiplegic children were extracted from FMFM evaluation data, and 30% samples were randomly selected as focus group samples of DIF. According to the proportion of non-hemiplegic type and hemiplegic type in the whole sample, randomized stratified matching was used to match the control group sample. Conquest software was used to make Rasch analysis of the two groups of merged data samples and all 56 items in B to E area of FMFM, and single-handed items and double-handed items were separated by analysis item functioning. The single dimensionality of the scale was determined by the mean square of cohesive fit (Infit), the standard was MnSq 0.6-1.4, and differential item functioning of all 56 items and both single and double-handed items were analyzed.Results Tetally 3,442 times of FMFM assessments of 1,556 children with cerebral palsy were taken as whole samples and data. One hundred and ninety-eight FMFM assessments of focus group and 792 FMFM assessments of control group were included in this study. Single sample pairing test showed that there was no significant difference in FMFM scores between the two groups [112 (96, 146) vs 113 (95, 145)]. After three turns of item functioning analysis, 30 were classified as single-handed items and 26 as double-handed items. The absolute value >0.5 of the difference between the numerical of difficulty scale pair of total 56 items is 41. The absolute value >0.5 of the difference between the numerical of difficulty scale pair of 30 single-handed and 26 double-handed items are 23 (76.7%) and 9 (34.6%) respectively.Conclusion There exists DIF between hemiplegic and non-hemiplegic cerebral palsy in all 56 items of FMFM scale, especially in single-handed items. In order to accurately evaluate the fine motor function of hemiplegic children, it is necessary to re-establish the evaluation criteria and procedures.

Key words: Cerebral palsy, Difference of item functioning, Fine motor, Function assessment

李惠, 史惟. 脑瘫精细运动功能测试量表在偏瘫型患儿中需要重新建立评估标准与程序[J]. 中国循证儿科杂志, 2019, 14(4): 254-259.

LI Hui, SHI Wei. The evaluation criteria and procedures of fine motor function measure scale need to be re-established in children with hemiplegia[J]. Chinese Journal of Evidence -Based Pediatric, 2019, 14(4): 254-259.

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