目的 探讨《国际功能、残疾和健康分类康复组合》(ICF-RS)评价膝骨关节炎(KOA)患者身体功能、活动功能、社会参与功能的信效度.方法 选择2022年10-12月厦门市第五医院骨伤康复门诊和湖北襄阳市中心医院收治的KOA患者60例.采用ICF-RS对患者进行功能评估;分析ICF-RS量表与膝关节临床常用量表[疼痛视觉模拟(VAS)评分、美国特种外科医院(HSS)膝关节评分标准、改良巴氏指数(MBI)、健康调查简表(SF-36)]的校标关联效度,评价ICF-RS量表评估KOA患者功能与活动表现的有效性程度.采用内部一致性和项目区分度评价ICF-RS的信效度.结果 ① ICF-RS功能状态:60%KOA患者功能为没有障碍和轻度障碍.身体功能方面最常见中度至重度障碍,包括b280痛觉54例(90.00%)、b455运动耐受功能44例(73.33%)、b134睡眠功能28例(46.67%);活动功能方面最常见中度至重度障碍,包括d455到处移动52例(86.67%)、d410改变身体的基本姿势30例(50.00%);参与方面最常见中度至重度障碍,包括d660帮助别人38例(63.33%)、d850有报酬的就业32例(53.33%)、d920娱乐与休闲38例(63.33%).② 校标关联效度:ICF-RS身体功能评分与HSS评分呈负相关(|r|＞0.4,P＜0.05),ICF-RS身体活动评分与MBI、HSS、SF-36 BP评分呈负相关(|r|＞0.6,P＜0.05).ICF-RS参与情况评分与MBI、HSS评分呈负相关(|r|＞0.6,P＜0.05).③信效度分析:KOA患者ICF-RS的Cronbach's α为0.932(P＜0.05).除了删除b620排尿功能、b730肌肉力量功能、d710基本人际交往、d850有报酬的就业外,ICF-RS量表其余条目的Cronbach's α系数均降低.70.00%(21/30)条目在区分轻度和重度的功能障碍方面具有明显差异,其中d420移动自身、d510盥洗自身、d640做家务、d470利用交通工具(|r|＞0.8)能有效划分出高分和低分功能的KOA患者.结论 ICF-RS具有较好的信效度和校标关联效度,可用于评估KOA患者功能状态.
Reliability and Validity Study of the International Classification of Functioning,Disability and Health Rehabilitation Set in Rehabilitation of Knee Osteoarthritis
Objective To explore the reliability and validity of the International Classification of Functioning,Disability and Health Rehabilitation Set(ICF-RS)in assessing the body function,activities and social participation of patients with knee osteoar-thritis(KOA).Methods A total of 60 KOA patients in the Outpatient Department of Orthopedic Rehabilitation in the Fifth Hospi-tal of Xiamen and the Xiangyang Central Hospital from October to December 2022 were recruited.The ICF-RS was used to assess the patients'function;the criterion-related validity between the ICF-RS scale and the commonly used clinical scales for knee joints[visual analogue scale(VAS)for pain,hospital for special surgery(HSS)knee score,modified Barthel index(MBI)and 36-item short form health survey(SF-36)]was used to evaluate the effectiveness of ICF-RS scale in assessing the function and activity per-formance of patients with KOA.Internal consistency and item discriminant validity were used to evaluate reliability and validity of the ICF-RS.Results(1)ICF-RS functional status:about 60%of KOA patients had no or mild functional impairments.The most common moderate to severe impairments in body function domain included b280 sensation of pain(54 cases,90.00%),b455 exer-cise tolerance(44 cases,73.33%),and b134 sleep function(28 cases,46.67%);the most common moderate to severe impairments in activities included d455 moving around(52 cases,86.67%)and d410 changing basic body position(30 cases,50.00%);the most common moderate to severe impairments in participation included d660 assisting others(38 cases,63.33%),d850 remunerative em-ployment(32 cases,53.33%)and d920 recreation and leisure(38 cases,63.33%).(2)Criterion-related validity:the ICF-RS body function score was negatively correlated with HSS score(|r|>0.4,P<0.05),the ICF-RS physical activity score was negatively corre-lated with the MBI,HSS and the bodily pain dimension score of SF-36(|r|>0.6,P<0.05).The ICF-RS participation score was nega-tively correlated with the MBI and HSS scores(|r|>0.6,P<0.05).(3)Reliability and validity analysis:the Cronbach's α for the ICF-RS of KOA patients was 0.932(P<0.05).The Cronbach's α coefficients for the remaining items of the ICF-RS decreased except for deleting b620 urinary function,b730 muscle strength function,d710 basic interpersonal interactions and d850 remunerative employ-ment.70.00%(21/30)of the items showed significantly differences in distinguishing between mild and severe dysfunctions,in which items with|r|>0.8 could effectively distinguish KOA patients with high and low score function,including d420 changing body position,d510 washing oneself,d640 doing household chores and d470 using transportation.Conclusion ICF-RS could be used to assess the functional status of KOA patients with good reliability,validity and criterion-related validity.
knee osteoarthritisInternational Classification of Functioning,Disability and Health Rehabilitation Setfunction-al assessmentreliability and validity
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