Canny Anne, Robertson Frances, Knight Peter, Redpath Adam, Witham Miles D
Ageing and Health, University of Dundee, Dundee, UK.
Joint Improvement Team, Scottish Government, ᅟ, ᅟ
BMC Geriatr. 2016 Jul 28;16:147. doi: 10.1186/s12877-016-0321-3.
The Indicator of Relative Need (IoRN) instrument is designed for both health and social care services to measure function and dependency in older people. To date, the tool has not undergone assessment of validity. We report two studies aimed to evaluate psychometric properties of the IoRN.
The first study recruited patients receiving social care at discharge from hospital, those rehabilitating in intermediate care, and those in a rehabilitation at home service. Participants were assessed using the IoRN by a single researcher and by the clinical team at baseline and 8 weeks. Comparator instruments (Barthel ADL, Nottingham Extended ADL and Townsend Disability Scale) were also administered. Overall change in ability was assessed with a 7 point Likert scale at 8 weeks. The second study analysed linked routinely collected, health and social care data (including IoRN scores) to assess the relationship between IoRN category and death, hospitalisation and care home admission as a test of external validity.
Ninety participants were included in the first study, mean age 77.9 (SD 12.0). Cronbach's alpha for IoRN subscales was high (0.87 to 0.93); subscales showed moderate correlation with comparator tools (r = 0.43 to 0.63). Cohen's weighted kappa showed moderate agreement between researcher and clinician IoRN category (0.49 to 0.53). Two-way intraclass correlation coefficients for IoRN subscales in participants reporting no change in ability were high (0.88 to 0.98) suggesting good stability; responsiveness coefficients in participants reporting overall change were equal to or better than comparator tools. 1712 patients were included in the second study, mean age 81.0 years (SD 7.7). Adjusted hazard ratios for death, care home admission and hospitalisation in the most dependent category compared to the least dependent IoRN category were 5.9 (95 % CI 2.0-17.0); 7.2 (95 % CI 4.4-12.0); 1.1 (95 % CI 0.5-2.6) respectively. The mean number of allocated hours of care 6 months after assessment was higher in the most dependent group compared to the least dependent group (5.6 vs 1.4 h, p = 0.005).
Findings from these analyses support the use of the IoRN across a range of clinical environments although some limitations are highlighted.
相对需求指标（IoRN）工具专为健康和社会护理服务设计，用于衡量老年人的功能和依赖性。迄今为止，该工具尚未经过效度评估。我们报告两项旨在评估IoRN心理测量特性的研究。
第一项研究招募了出院时接受社会护理的患者、在中级护理机构康复的患者以及接受居家康复服务的患者。在基线和8周时，由一名研究人员和临床团队使用IoRN对参与者进行评估。还使用了比较工具（巴氏日常生活活动能力量表、诺丁汉扩展日常生活活动能力量表和汤森德残疾量表）。在8周时，用7点李克特量表评估能力的总体变化。第二项研究分析了常规收集的关联健康和社会护理数据（包括IoRN分数），以评估IoRN类别与死亡、住院和入住养老院之间的关系，作为外部效度的检验。
第一项研究纳入了90名参与者，平均年龄77.9岁（标准差12.0）。IoRN子量表的克朗巴哈系数较高（0.87至0.93）；子量表与比较工具显示出中度相关性（r = 0.43至0.63）。科恩加权kappa系数显示研究人员和临床医生对IoRN类别的一致性为中度（0.49至0.53）。在报告能力无变化的参与者中，IoRN子量表的双向组内相关系数较高（0.88至0.98），表明稳定性良好；报告总体变化的参与者的反应性系数等于或优于比较工具。第二项研究纳入了1712名患者，平均年龄81.0岁（标准差7.7）。与IoRN依赖性最低的类别相比，依赖性最高的类别中死亡、入住养老院和住院的调整后风险比分别为5.9（95%置信区间2.0 - 17.0）；7.2（95%置信区间4.4 - 12.0）；1.1（95%置信区间0.5 - 2.6）。评估后6个月，依赖性最高的组分配的平均护理小时数高于依赖性最低的组（5.6对1.4小时，p = 0.005）。
这些分析结果支持在一系列临床环境中使用IoRN，尽管也突出了一些局限性。
