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中国循证儿科杂志

中国循证儿科杂志 ›› 2017, Vol. 12 ›› Issue (6): 410-415.

• 论著 • 上一篇    下一篇

复旦中文版脑瘫幼儿手功能分级系统的信度和效度研究

陆恺,史惟,翟淳,王燕娜   

  1. 复旦大学附属儿科医院康复中心上海，201102
  • 收稿日期:2017-12-12 修回日期:2017-12-22 出版日期:2017-12-25 发布日期:2017-12-25
  • 通讯作者: 史惟，E-mail:shiweixiyi@163.com

Reliability and validity of Chinese version of Mini Manual Ability Classification System for Cerebral Palsy(Fudan)

LU Kai, SHI Wei, ZHAI Chun, WANG Yan-na   

  1. Rehabilitation Center of Children's Hospital of Fudan University, Shanghai 201102,China
  • Received:2017-12-12 Revised:2017-12-22 Online:2017-12-25 Published:2017-12-25
  • Contact: SHI Wei, E-mail: shiweixiyi@163.com

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摘要： 摘要 目的：建立复旦中文版脑瘫幼儿手功能分级系统（Mini-MACS)的信度和效度。方法：以2017年10月至2017年11月在复旦大学附属儿科医院（我院）康复中心以及上海儿童康复合作群（8家单位）接受康复干预的1~4岁的脑瘫（CP）儿童为研究对象，排除有严重视觉和听觉障碍的CP儿童。通过分析现场操作评价和录像评价结果之间的关系确定Mini-MACS的重测信度；分析不同评估者间［主要照顾者、作业治疗师（OT师）、物理治疗师（PT师）］的评价结果确定Mini-MACS的评估者间信度；以脑瘫儿童精细运动能力测试（FMFM）的精细运动能力分值为效标确定Mini-MACS的平行效度。结果：76例CP儿童进入本文分析，其中我院康复中心18例，上海儿童康复合作群单位共58例；男46例，女30例；平均年龄（2.5±0.9）个月，1~2岁组25例，~3岁组23例，~4岁组28例；痉挛型四肢瘫29例，双瘫11例，偏瘫27例，手足徐动型2例，共济失调型2例，无法分类5例；粗大运动功能分级（GMFCS）Ⅰ级7例，Ⅱ级27例，Ⅲ级16例，Ⅳ级16例，Ⅴ级10例。OT师现场评价与录像评价结果间重测信度ICC值为0.96（95%CI：0.94~0.98）；OT师与PT师间的ICC值为0.97（95%CI：0.94~0.98），OT师与主要照顾者ICC值为0.92（95%CI：0.86~0.95）；1~2岁组、~3岁组和~4岁组重测信度ICC值0.95~1.00，~4岁组评价者间信度低于1~2岁组和~3岁组，尤其是OT师与主要照顾者间的信度明显低于其他两组（ICC=0.64）。Mini-MACS与精细运动能力分值之间平行效度Spearman相关系数为-0.76。结论：中文版Mini-MACS具有良好的评价者间信度和平行效度，适用于对国内脑瘫幼儿进行手功能分级。

Abstract: AbstractObjective: To determine the reliability and validity of Chinese version of Mini Manual Ability Classification System(Mini-MACS) for Cerebral Palsy. Methods: Inclusion criteria: Children diagnosed as cerebral palsy aged from 1 to <4 in Children's Hospital of Fudan University and Shanghai cooperation hospitals of children's rehabilitation cooperation group from October to November 2017. Exclusion criteria: Children with severe hearing and visual impairments. The test retest reliability of Mini-MACS was determined by analyzing the relationship between site operation evaluation and video evaluation results. The Mini-MACS inter rater reliability was determined by analyzing different inter rater (caregivers, occupational therapists and physical therapist). By analyzing the correlation of the fine motor ability scores of Fine Motor Function Measure scale(FMFM), the validity of Mini-MACS was determined.Results: 76 children with CP were included, of them 18 cases were from Children's Hospital of Fudan University, 58 cases were from Shanghai children's rehabilitation group cooperation units; 46 male, 30 female; average age was（2.5±0.9） months, 25 cases aged 1 to 2 years, 23 cases aged~<3 years, 28 cases aged ~4 years; 29 spastic quadriplegia, 11 double paralysis, 27 hemiplegia, 2 athetosis, 2 ataxia type, and 5 could not be classified; 7 of them Gross Motor Function Classification System(GMFCS) grade Ⅰ, 27 grade Ⅱ, 16 grade Ⅲ, 16 grade Ⅳ, 10 grade Ⅴ. The results of OT's site evaluation and video evaluation showed that the Mini-MACS had a good retest reliability, and the ICC value was 0.96 (95% CI: 0.94-0.98). At the same time, the mini-MACS had a good inter rater reliability. The ICC value between OT and PT was 0.97 (95% CI: 0.94-0.98), and the ICC value of OT and primary caregivers was 0.92 (95% CI: 0.86-0.95). Among 1~2, 2~3 and 3~4 years old group, all three age groups showed high retest reliability (ICC value between 0 remarks ~1.00), and 3 ~4 inter rater reliability between the evaluators was lower than 1~2 and 2~3 years old groups; In particular, the reliability between OT and primary caregivers was significantly lower than that of the other two groups (ICC= 0.64). There was a good parallel validity between Mini-MACS and fine motor ability score, and Spearman correlation coefficient was -0.76.Conclusion: The Chinese version of Mini MACS has a good inter rater reliability and parallel validity. It is suitable for the classification of younger children with cerebral palsy.