Davids Jon R, Peace Laura C, Wagner Lisa V, Gidewall Mary Ann, Blackhurst Dawn W, Roberson W Matthew
Shriners Hospital for Children, 950 West Faris Road, Greenville, SC 29605, USA.
J Bone Joint Surg Am. 2006 Feb;88(2):326-33. doi: 10.2106/JBJS.E.00298.
The Shriners Hospital for Children Upper Extremity Evaluation (SHUEE) is a video-based tool for the assessment of upper extremity function in children with hemiplegic cerebral palsy. This tool includes spontaneous functional analysis and dynamic positional analysis and assesses the ability to perform grasp and release. The purpose of the present study was to assess the reliability, concurrent validity, and construct validity of this instrument.
The Shriners Hospital for Children Upper Extremity Evaluation studies for eleven subjects with hemiplegic cerebral palsy were selected for the evaluation of intraobserver and interobserver reliability. Concurrent validity was determined through analysis of the Shriners Hospital for Children Upper Extremity Evaluation, Pediatric Evaluation of Disability Inventory, and Jebson-Taylor Test of Hand Function scores for twenty children. Construct validity was determined through analysis of Shriners Hospital for Children Upper Extremity Evaluation scores for eighteen children before and after flexor carpi ulnaris to extensor carpi radialis brevis tendon transfer.
The absolute mean differences between the two scoring sessions for three raters were 1.2 and 1.0 for the spontaneous functional analysis and the dynamic positional analysis, respectively. Although the mean differences were significantly different from 0 (p < 0.001 and p = 0.003), the differences were small and not clinically important with regard to the total possible score. There was excellent intraobserver reliability between the two sessions with regard to both spontaneous functional analysis (r = 0.99) and dynamic positional analysis (r = 0.98). Assessment of interobserver reliability revealed absolute mean differences between four raters of 3.8 and 3.7 for the spontaneous functional analysis and the dynamic positional analysis, respectively. These differences were significantly different from 0 (p < 0.001); however, the magnitudes of these differences were not important with regard to total score or clinical interpretation. There was excellent interobserver reliability for both the spontaneous functional analysis (r = 0.90) and the dynamic positional analysis (r = 0.89). There was 100% agreement within and between examiners for the grasp-and-release section. The Shriners Hospital for Children Upper Extremity Evaluation showed fair correlation with the self-care scaled score from the Pediatric Evaluation of Disability Inventory (r = 0.47) and good inverse correlation with the non-dominant total time section of the Jebson-Taylor test (r = -0.76). The Shriners Hospital for Children Upper Extremity Evaluation wrist score improved for all eighteen subjects after the flexor tendon transfer, and the mean improvement was significant (p < 0.001).
The present study establishes the clinical reliability, concurrent validity, and construct validity of the Shriners Hospital for Children Upper Extremity Evaluation for the assessment of upper extremity function in children with hemiplegic cerebral palsy.
施莱宁儿童医院上肢评估（SHUEE）是一种基于视频的工具，用于评估偏瘫型脑瘫患儿的上肢功能。该工具包括自发功能分析和动态位置分析，并评估抓握和松开的能力。本研究的目的是评估该工具的信度、同时效度和结构效度。
选取施莱宁儿童医院上肢评估研究中的11名偏瘫型脑瘫患儿，用于评估观察者内和观察者间信度。通过分析20名儿童的施莱宁儿童医院上肢评估、残疾儿童评定量表和杰布森-泰勒手功能测试得分来确定同时效度。通过分析18名儿童在尺侧腕屈肌至桡侧腕短伸肌腱转移前后的施莱宁儿童医院上肢评估得分来确定结构效度。
三位评估者两次评分之间自发功能分析和动态位置分析的绝对平均差异分别为1.2和1.0。虽然平均差异显著不同于0（p<0.001和p=0.003），但就总分而言差异较小且在临床上不重要。两次评估之间观察者内信度在自发功能分析（r=0.99）和动态位置分析（r=0.98）方面均非常好。观察者间信度评估显示，四位评估者在自发功能分析和动态位置分析方面的绝对平均差异分别为3.8和3.7。这些差异显著不同于0（p<0.001）；然而，就总分或临床解释而言，这些差异的大小并不重要。自发功能分析（r=0.90）和动态位置分析（r=0.89）的观察者间信度均非常好。检查者内部和之间在抓握-松开部分的一致性为100%。施莱宁儿童医院上肢评估与残疾儿童评定量表的自我护理量表得分呈中等程度相关（r=0.47），与杰布森-泰勒测试的非优势手总时间部分呈良好的负相关（r=-0.76）。屈肌腱转移后，所有18名受试者的施莱宁儿童医院上肢评估腕部得分均有所改善，且平均改善显著（p<0.001）。
本研究确立了施莱宁儿童医院上肢评估在评估偏瘫型脑瘫患儿上肢功能方面的临床信度、同时效度和结构效度。
