Au Eunice H, McCluskey Annie, Lannin Natasha A
Discipline of Occupational Therapy, The University of Sydney, Sydney, New South Wales, Australia.
Aust Occup Ther J. 2012 Oct;59(5):347-54. doi: 10.1111/j.1440-1630.2012.01035.x.
BACKGROUND/AIM: Legibility is important for functional, handwritten communication. Deficits in legibility can impair occupational performance following stroke or trauma. Few instruments are available to assess adult handwriting legibility during rehabilitation. The aim of this study was to compare inter-rater reliability of a new four-point legibility rating instrument with two existing instruments, and describe scale structure and item difficulty of each instrument.
Three trained raters scored 60 handwriting samples using: (i) a Four-Point Scale (FPS); (ii) the modified Evaluation Tool of Children's Handwriting (mETCH); and (iii) the new modified FPS. Rater concordance and exact agreement were investigated using the intra-class correlation coefficient (ICC(3,1) ), multi-rater kappa (κ) and Krippendorff's alpha (α). Cronbach's alpha was calculated to examine internal consistency reliability, and Rasch modelling was used to examine scale structure and item difficulty.
Rater concordance for the FPS was fair (ICC(3,1) = 0.37); exact agreement was poor (κ = 0.19; α = 0.19). Rater concordance for the two mETCH subtests was fair to moderate (ICC(3,1) = 0.39-0.50), but with no exact agreement (κ < 0.00). Rater concordance for three subtests of the modified FPS was slight to moderate (ICC(3,1) = 0.16-0.51); exact agreement ranged from nil to fair (κ = -0.06-0.30; α = -0.05-0.30). Rasch modelling confirmed internal consistency of instruments, but was low between-rater consistency (rater severity variability).
A reliable instrument for measuring change over time remains elusive. In the meantime, these instruments can be used by individual clinicians to diagnose and rate legibility.
背景/目的：易读性对于功能性手写交流很重要。易读性缺陷会损害中风或创伤后的职业表现。在康复过程中，用于评估成人手写易读性的工具很少。本研究的目的是比较一种新的四点易读性评分工具与两种现有工具之间的评分者间信度，并描述每种工具的量表结构和项目难度。
三名经过培训的评分者使用以下方法对60份手写样本进行评分：(i) 四点量表（FPS）；(ii) 改良儿童手写评估工具（mETCH）；(iii) 新的改良FPS。使用组内相关系数（ICC(3,1)）、多评分者kappa（κ）和克里彭多夫阿尔法（α）来研究评分者一致性和完全一致性。计算克朗巴哈阿尔法系数以检验内部一致性信度，并使用拉施模型来检验量表结构和项目难度。
FPS的评分者一致性一般（ICC(3,1)=0.37）；完全一致性较差（κ=0.19；α=0.19）。mETCH两个子测试的评分者一致性一般到中等（ICC(3,1)=0.39 - 0.50），但无完全一致性（κ<0.00）。改良FPS三个子测试的评分者一致性轻微到中等（ICC(3,1)=0.16 - 0.51）；完全一致性从无到一般（κ=-0.06 - 0.30；α=-0.05 - 0.30）。拉施模型证实了工具的内部一致性，但评分者间一致性较低（评分者严格程度变异性）。
一种可靠的用于测量随时间变化的工具仍然难以找到。与此同时，这些工具可被个体临床医生用于诊断和评估易读性。
