Gerdes N, Funke U-N, Schüwer U, Themann P, Pfeiffer G, Meffert C
Hochrhein-Institut am RehaKlinikum, Bad Säckingen.
Rehabilitation (Stuttg). 2012 Oct;51(5):289-99. doi: 10.1055/s-0031-1287805. Epub 2012 Apr 2.
In the context of developing and testing a procedure for "Outcome-oriented payment for rehabilitation after stroke", we found that the instruments commonly used to measure the outcomes of rehabilitation after stroke (e. g., Barthel-Index or FIM) were not meeting the special requirements of the new payment system. Therefore the "Scores of Independence for Neurologic and Geriatric Rehabilitation" (SINGER) was developed as a new assessment instrument. This instrument is based on the ICF and measures 20 aspects of "independence in activities of daily living". The characteristic feature of the SINGER is, above all, the way all items are graded in 6 steps: the gradation does not refer to the degree of disability but to the kind and amount of help required for the respective activity, i. e.: 0 = totally dependent on professional help; 1 = professional contact help needed; 2 = contact help by (instructed) lay persons sufficient; 3 = preparation or supervision by lay persons still needed; 4 = independent with assistive device or still slow; 5 = independent without assistive device. For experienced personnel in neurologic rehabilitation, these gradations are "intuitively plausible". A manual moreover describes each grade in detail for each item so that the instrument can be used in rehabilitation facilities without extensive training. The SINGER has been tested and validated in a pilot study (n = 100) and in 2 subsequent studies with large case numbers in neurologic rehabilitation (n = 1058 and n = 700 patients after stroke in all categories of severity). Factor analyses showed that the instrument contains 2 dimensions which can be interpreted as "physical activities" and "activities of communication and cognition". Each of these 2 dimensions can be split into 2 sub-dimensions that can be assigned to the tasks of therapeutical professions in care/Occupational Therapy, physiotherapy, logopedics, and neuro- psychology. The test criteria of reliability, sensitivity, convergent validity, floor and ceiling effects as well as sensitivity to change show good to very good results. Particular emphasis can be given to the high degree of interrater reliability and the wide range of possible applications in clinical practice as well as in research. A limitation of the instrument to be taken into account is the fact that the SINGER has not yet been tested and validated in geriatric rehabilitation facilities.
在制定和测试“中风后康复的结果导向型支付程序”的背景下，我们发现，常用于衡量中风后康复效果的工具（如巴氏指数或功能独立性测量）不符合新支付系统的特殊要求。因此，开发了“神经和老年康复独立评分”（SINGER）作为一种新的评估工具。该工具基于国际功能、残疾和健康分类（ICF），测量“日常生活活动独立性”的20个方面。SINGER的显著特点首先是所有项目按6个步骤分级的方式：分级不是指残疾程度，而是指相应活动所需帮助的种类和数量，即：0 = 完全依赖专业帮助；1 = 需要专业接触帮助；2 = （受过指导的）非专业人员的接触帮助足够；3 = 仍需要非专业人员的准备或监督；4 = 使用辅助设备独立或仍较慢；5 = 无需辅助设备独立。对于神经康复方面的经验丰富的人员来说，这些分级“直观上合理”。此外，手册还针对每个项目详细描述了每个等级，以便该工具在康复机构中无需大量培训即可使用。SINGER已在一项试点研究（n = 100）以及随后两项神经康复大样本研究（所有严重程度类别中的中风患者n = 1058和n = 700）中进行了测试和验证。因子分析表明，该工具包含2个维度，可解释为“身体活动”和“沟通与认知活动”。这2个维度中的每一个都可细分为2个子维度，可以分配给护理/职业治疗、物理治疗、言语治疗和神经心理学等治疗专业的任务。可靠性、敏感性、收敛效度、地板效应和天花板效应以及对变化的敏感性等测试标准显示出良好到非常好的结果。可以特别强调评分者间信度的高度以及在临床实践和研究中广泛的可能应用。该工具需要考虑的一个局限性是，SINGER尚未在老年康复机构中进行测试和验证。
