Preston N, Horton M, Levesley M, Mon-Williams M, O'Connor R J
Academic Department of Rehabilitation Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, United Kingdom of Great Britain and Northern Ireland.
School of Mechanical Engineering, University of Leeds, Leeds, United Kingdom of Great Britain and Northern Ireland.
Physiother Res Int. 2018 Jan;23(1). doi: 10.1002/pri.1684. Epub 2017 Jan 23.
Upper limb activity measures for children with cerebral palsy have a number of limitations, for example, lack of validity and poor responsiveness. To overcome these limitations, we developed the Children's Arm Rehabilitation Measure (ChARM), a parent-reported questionnaire validated for children with cerebral palsy aged 5-16 years. This paper describes both the development of the ChARM items and response categories and its psychometric testing and further refinement using the Rasch measurement model.
To generate valid items for the ChARM, we collected goals of therapy specifically developed by therapists, children with cerebral palsy, and their parents for improving activity limitation of the upper limb. The activities, which were the focus of these goals, formed the basis for the items. Therapists typically break an activity into natural stages for the purpose of improving activity performance, and these natural orders of achievement formed each item's response options. Items underwent face validity testing with health care professionals, parents of children with cerebral palsy, academics, and lay persons. A Rasch analysis was performed on ChARM questionnaires completed by the parents of 170 children with cerebral palsy from 12 hospital paediatric services. The ChARM was amended, and the procedure repeated on 148 ChARMs (from children's mean age: 10 years and 1 month; range: 4 years and 8 months to 16 years and 11 months; 85 males; Manual Ability Classification System Levels I = 9, II = 26, III = 48, IV = 45, and V = 18).
The final 19-item unidimensional questionnaire displayed fit to the Rasch model (chi-square p = .18), excellent reliability (person separation index = 0.95, α = 0.95), and no floor or ceiling effects. Items showed no response bias for gender, distribution of impairment, age, or learning disability.
The ChARM is a psychometrically sound measure of upper limb activity validated for children with cerebral palsy aged 5-16 years. The ChARM is freely available for use to clinicians and nonprofit organisations.
脑瘫患儿上肢活动测量存在诸多局限性，例如缺乏效度且反应性不佳。为克服这些局限性，我们开发了儿童手臂康复测量量表（ChARM），这是一份由家长报告的问卷，已在5至16岁的脑瘫患儿中得到验证。本文描述了ChARM项目及反应类别的确立过程，以及使用拉施测量模型进行的心理测量测试和进一步完善。
为生成ChARM的有效项目，我们收集了治疗师、脑瘫患儿及其家长专门制定的改善上肢活动受限的治疗目标。这些目标所关注的活动构成了项目的基础。治疗师通常会将一项活动分解为自然阶段以提高活动表现，这些自然的完成顺序构成了每个项目的反应选项。对项目进行了内容效度测试，参与测试的有医疗保健专业人员、脑瘫患儿家长、学者和普通民众。对来自12家医院儿科服务机构的170名脑瘫患儿家长填写的ChARM问卷进行了拉施分析。对ChARM进行了修订，并对148份ChARM问卷（患儿平均年龄为10岁1个月；范围为4岁8个月至16岁11个月；85名男性；手动能力分类系统I级=9例，II级=26例，III级=48例，IV级=45例，V级=18例）重复该过程。
最终的19项单维问卷符合拉施模型（卡方p = 0.18），具有出色的信度（个人分离指数 = 0.95，α = 0.95），且无地板效应或天花板效应。项目在性别、损伤分布、年龄或学习障碍方面未显示出反应偏差。
ChARM是一种心理测量学上合理的上肢活动测量工具，已在5至16岁的脑瘫患儿中得到验证。ChARM可供临床医生和非营利组织免费使用。
