Nieuwboer A, De Weerdt W, Dom R, Bogaerts K, Nuyens G
Neuromotor Unit, Department of Rehabilitation Science, Faculty of Physical Education and Physiotherapy, University of Leuven, Tervuursevst 101, 3001 Heverlee, Belgium.
Phys Ther. 2000 Nov;80(11):1087-96.
Functional mobility in people with advanced Parkinson disease, some of whom have a variable response to drug treatment, is often difficult to evaluate. The objectives of this study were to investigate the interrater reliability of measurements obtained with a scale designed to measure mobility and to determine the impact of self-rated dyskinesias and fluctuations on the measure. SSUBJECTS: Twenty-nine people with Parkinson disease and with disability and considerable disease duration (mean=11.7 years, SD=4.9, range=6-22) took part in the study.
The subjects' performance on a 10-item scale was videotaped. The videotapes were then scored by 2 independent raters, and the scores were used to determine interrater reliability. The stability of 6 repeated measurements was examined in the home situation, taking into account self-rated fluctuations of motor performance.
Weighted Kappa values of agreement (.86-.98) confirmed the reliability between testers. Measurement during the "on" phase (when medication was working optimally) and the "off" phase (when the action of medication was strongly decreased or absent) led to different measurements. Measuring frequently within "on" and "off" phases gave relatively stable measurements for total function, bed transfers, and gait akinesia, the latter during the "off" phase only (intraclass correlation coefficients [ICCs]=.70-.93). However, more modest repeatability applied to transfers from a chair (ICC=.65-.67).
To ensure valid results in future effect studies, clinical differentiation between "on" and "off" phase measurements is proposed on the basis of patients' own perception of their medication status.
晚期帕金森病患者的功能活动能力通常难以评估，其中一些患者对药物治疗的反应存在差异。本研究的目的是调查一种旨在测量活动能力的量表所获得测量结果的评分者间信度，并确定自我评定的异动症和症状波动对该测量的影响。
29名患有帕金森病、有残疾且病程较长（平均=11.7年，标准差=4.9，范围=6-22年）的患者参与了本研究。
对受试者在一个10项量表上的表现进行录像。然后由2名独立评分者对录像进行评分，评分用于确定评分者间信度。在家庭环境中检查6次重复测量的稳定性，同时考虑运动表现的自我评定波动情况。
一致性加权Kappa值（.86-.98）证实了测试者之间的信度。“开”期（药物作用最佳时）和“关”期（药物作用显著降低或消失时）的测量结果不同。在“开”期和“关”期内频繁测量，对于总功能、床上转移和步态失动症（仅在“关”期）能得到相对稳定的测量结果（组内相关系数[ICC]=.70-.93）。然而，从椅子上转移的重复性则相对较低（ICC=.65-.67）。
为确保未来疗效研究的有效结果，建议根据患者对自身用药状态的感知，对“开”期和“关”期测量进行临床区分。
