不熟练的评分者是否可以使用运动障碍损害量表？一项可靠性研究。
Can the Dyskinesia Impairment Scale be used by inexperienced raters? A reliability study.
机构信息
Katholieke Universiteit Leuven, Department of Rehabilitation Sciences, Belgium; Dienstencentrum GID(t)S, Dominiek Savio Institute, Belgium.
出版信息
Eur J Paediatr Neurol. 2013 May;17(3):238-47. doi: 10.1016/j.ejpn.2012.10.004. Epub 2012 Nov 22.
BACKGROUND
The Dyskinesia Impairment Scale (DIS) is a new scale for measuring dystonia and choreoathetosis in dyskinetic Cerebral Palsy (CP). Previously, reliability of this scale has only been assessed for raters highly experienced in discriminating between dystonia and choreoathetosis.
AIMS
The aims of this study are to examine the reliability of the DIS used by inexperienced raters, new to discriminating between dystonia and choreoathetosis and to determine the effect of clinical expertise on reliability.
METHODS
Twenty-five patients (17 males; 8 females; age range 5-22 years; mean age = 13 years 6 months; SD = 5 years 4 months) with dyskinetic CP were filmed with the DIS standard video protocol. Two junior physiotherapists (PTs) and three senior PTs, all of whom were new to discriminating between dystonia and choreoathetosis, were trained in scoring the DIS. Afterward, they independently scored all patients from the video recordings using the DIS. Reliability was assessed by (1) Intraclass Correlation Coefficient (ICC), (2) Standard Error of Measurement (SEM) and Minimal Detectable Difference (MDD) and (3) Cronbach's alpha for internal consistency.
RESULTS
Interrater reliability for the total DIS, and for the dystonia and choreoathetosis subscales was good for the junior PTs and moderately high to excellent for the senior PTs. SEM and MDD values for the total DIS were 6% and 15% respectively for the junior PTs and 4% and 12% respectively for the senior PTs. Cronbach's alpha ranged between 0.87 and 0.95 for the junior PTs and between 0.76 and 0.93 for the senior PTs.
CONCLUSIONS
Reliability of the DIS scores for the inexperienced junior and senior PTs was sufficient in comparison with scores from the experienced raters in the previous study, indicating that the DIS can be used by inexperienced PTs new to discriminating between dystonia and choreoathetosis, and also that its reliability is not dependent on clinical expertise. However, based on the measurement errors and questionnaire data, familiarity with operational definitions of dystonia and choreoathetosis is crucial to improve scoring reliability.
背景
运动障碍障碍量表（DIS）是一种用于测量脑瘫（CP）运动障碍患者的肌张力障碍和舞蹈手足徐动症的新量表。此前，该量表的可靠性仅在对肌张力障碍和舞蹈手足徐动症有高度鉴别经验的评估者中进行了评估。
目的
本研究旨在检验缺乏鉴别肌张力障碍和舞蹈手足徐动症经验的评估者使用 DIS 的可靠性，并确定临床专业知识对可靠性的影响。
方法
对 25 例运动障碍型 CP 患者（男 17 例，女 8 例；年龄 5-22 岁；平均年龄 13 岁 6 个月；标准差 5 岁 4 个月）进行 DIS 标准视频录像。2 名初级物理治疗师（PT）和 3 名高级 PT 接受了鉴别肌张力障碍和舞蹈手足徐动症的培训，并使用 DIS 对所有视频录像进行了独立评分。采用（1）组内相关系数（ICC）、（2）测量误差（SEM）和最小可检测差异（MDD）和（3）内部一致性的克朗巴赫 α 评估可靠性。
结果
初级 PT 的 DIS 总分和肌张力障碍及舞蹈手足徐动症分量表的评分具有良好的组内信度，高级 PT 的评分具有中度到高度的组内信度。初级 PT 的 DIS 总分 SEM 和 MDD 值分别为 6%和 15%，高级 PT 的 SEM 和 MDD 值分别为 4%和 12%。初级 PT 的克朗巴赫 α 值在 0.87 到 0.95 之间，高级 PT 的克朗巴赫 α 值在 0.76 到 0.93 之间。
结论
与之前研究中经验丰富的评估者的评分相比，缺乏经验的初级和高级 PT 的 DIS 评分具有足够的可靠性，这表明 DIS 可用于缺乏鉴别肌张力障碍和舞蹈手足徐动症经验的初级 PT，且其可靠性不依赖于临床专业知识。然而，根据测量误差和问卷调查数据，熟悉肌张力障碍和舞蹈手足徐动症的操作定义对于提高评分的可靠性至关重要。
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