Wagner Lisa V, Davids Jon R, Hardin James W
Shriners Hospital for Children Greenville, Greenville, SC, USA.
Shriners Hospital for Children Northern California, Sacramento, CA, USA.
Dev Med Child Neurol. 2016 Jun;58(6):612-7. doi: 10.1111/dmcn.12949. Epub 2015 Nov 3.
The ability to determine the relationship between selective motor control and upper extremity function in children with unilateral cerebral palsy (CP), and to measure the functional outcome and efficacy of interventions designed to improve selective motor control, has been limited by the lack of an objective, validated tool. The primary objective of this study is to describe the development of a clinical tool entitled Selective Control of the Upper Extremity Scale (SCUES), and present evidence of its validity and reliability.
Content validity was established through an expert panel (eight clinicians, mean and median of 17y of clinical experience, range 2-30y). Intra- and interrater reliability was determined by six occupational therapists who scored 10 participant studies. Construct validity of the SCUES was established by comparison to the spontaneous functional analysis section of the Shriners Hospitals Upper Extremity Evaluation, the Manual Ability Classification System, and the Box and Block test for 25 children with unilateral CP.
The content validity ratio values were greater than 0 (indicating >50% agreement) for 33 of the 34 items (97%), and equal or greater than 0.5 (indicating ≥75% agreement) for 26 of the 34 items (76%). Intrarater reliability was excellent (intraclass correlation coefficient [ICC] >0.75) for all segments and joints of the affected extremity. Interrater reliability was excellent for all segments and joints of the affected extremity except the shoulder (ICC=0.72). The SCUES was strongly correlated with the SHUEE (Spearman's rho=0.69, p=0.003). The SCUES was not correlated with the Manual Ability Classification System (rho=-0.24, p=0.369) or the Box and Block test (rho=0.47, p=0.066).
Psychometric analysis of the SCUES revealed comparable validity to other accepted video-based clinical assessment tools for the upper extremity in children with CP.
由于缺乏客观、经过验证的工具，确定单侧脑瘫（CP）患儿选择性运动控制与上肢功能之间关系以及测量旨在改善选择性运动控制的干预措施的功能结果和疗效的能力受到限制。本研究的主要目的是描述一种名为上肢选择性控制量表（SCUES）的临床工具的开发过程，并提供其有效性和可靠性的证据。
通过专家小组（8名临床医生，临床经验平均17年，中位数17年，范围2 - 30年）确定内容效度。由6名职业治疗师对10项受试者研究进行评分，以确定评分者内和评分者间信度。通过与施莱宁儿童医院上肢评估的自发功能分析部分、手动能力分类系统以及对25名单侧CP患儿进行的方块搭积木测试相比较，确立SCUES的结构效度。
34项条目中的33项（97%）的内容效度比值大于0（表明一致性>50%），34项条目中的26项（76%）等于或大于0.5（表明一致性≥75%）。患侧肢体所有节段和关节的评分者内信度极佳（组内相关系数[ICC]>0.75）。除肩部外，患侧肢体所有节段和关节的评分者间信度极佳（ICC = 0.72）。SCUES与施莱宁儿童医院上肢评估（SHUEE）密切相关（斯皮尔曼等级相关系数rho = 0.69，p = 0.003）。SCUES与手动能力分类系统（rho = -0.24，p = 0.369）或方块搭积木测试（rho = 0.47，p = 0.066）无相关性。
对SCUES的心理测量分析表明，其有效性与其他公认的基于视频的CP患儿上肢临床评估工具相当。
