居家护理压力性损伤风险评估量表的评分者间信度：一项多中心横断面研究
Inter-Rater Reliability of a Pressure Injury Risk Assessment Scale for Home Care: A Multicenter Cross-Sectional Study.
作者信息
Kohta Masushi, Ohura Takehiko, Tsukada Kunio, Nakamura Yoshinori, Sukegawa Mishiho, Kumagai Eiko, Kameda Yuki, Kitte Toshihiro
机构信息
Medical Engineering Laboratory, ALCARE Co. Ltd., Tokyo, Japan.
Pressure Ulcers and Wound Healing Research Center, Sapporo, Japan.
出版信息
J Multidiscip Healthc. 2020 Dec 22;13:2031-2041. doi: 10.2147/JMDH.S291162. eCollection 2020.
PURPOSE
The aim of the current study was to assess the inter-rater reliability and agreement of the Pressure Injury Primary Risk Assessment Scale for Home Care (PPRA-Home), a risk assessment scale recently developed for Japan-specific social welfare professionals called care managers, to predict pressure injury risk in geriatric individuals who require long-term home care needs.
METHODS
A multicenter cross-sectional study was conducted at 30 home-based geriatric support services facilities located at four local districts in Japan. Eligible participants were individuals who needed partial or full assistance for daily living under Japan's long-term care insurance system (care levels 1-5). The degree of agreement and kappa coefficient were calculated for each item and the total score, after which inter-rater reliability was determined. The effect of the participant's care level on reliability was also evaluated as secondary analysis.
RESULTS
A total of 96 participants were assessed by 83 care managers (two assessors scored each participant). The degree of agreement and calculated kappa coefficient of the PPRA-Home total score were 59% and 0.72, respectively, with the inter-rater reliability for the total score determined to be "Substantial". Our subgroup analysis showed that the inter-rater reliability differed according to the participant's care level. Accordingly, the kappa coefficient for the total score was lower in subgroup "care level 1-3" than in subgroup "care level 4-5" (0.51 and 0.76, respectively).
CONCLUSION
Our result showed that the PPRA-Home has substantial inter-rater reliability for evaluation of risks of pressure injury development at home care. However, some research focusing on intra-later reliability and validity of the PPRA-Home with adequate sample sizes are required to provide categorical conclusions on whether it can be used for the risk assessment scale in actual clinical settings.
目的
本研究旨在评估居家护理压力性损伤初级风险评估量表（PPRA-Home）的评分者间信度和一致性。PPRA-Home是一种最近为日本特定的社会福利专业人员（称为护理经理）开发的风险评估量表，用于预测需要长期居家护理的老年个体发生压力性损伤的风险。
方法
在日本四个地区的30个居家老年支持服务设施中进行了一项多中心横断面研究。符合条件的参与者是根据日本长期护理保险制度需要部分或全部日常生活协助的个体（护理级别1-5）。计算每个项目和总分的一致性程度和kappa系数，然后确定评分者间信度。作为次要分析，还评估了参与者护理级别对信度的影响。
结果
共有96名参与者由83名护理经理进行评估（两名评估者对每名参与者进行评分）。PPRA-Home总分的一致性程度和计算出的kappa系数分别为59%和0.72，总分的评分者间信度被确定为“高度一致”。我们的亚组分析表明，评分者间信度因参与者的护理级别而异。因此，“护理级别1-3”亚组的总分kappa系数低于“护理级别4-5”亚组（分别为0.51和0.76）。
结论
我们的结果表明，PPRA-Home在评估居家护理中压力性损伤发生风险方面具有较高的评分者间信度。然而，需要一些以足够样本量关注PPRA-Home内部信度和效度的研究，以就其是否可用于实际临床环境中的风险评估量表提供明确结论。
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