一种用于创伤性脑损伤的参与和执行功能的新评估 (A-PEX)：一项有效性研究。
A novel assessment of participation and executive functions (A-PEX) for traumatic brain injury: a validity study.
机构信息
Department of Occupational Therapy, Faculty of Welfare and Health Sciences, University of Haifa, Haifa, Israel -
Department of Occupational Therapy, Loewenstein Rehabilitation Medical Center, Ra'anana, Israel -
出版信息
Eur J Phys Rehabil Med. 2023 Jun;59(3):317-326. doi: 10.23736/S1973-9087.23.07868-1. Epub 2023 Apr 21.
BACKGROUND
Executive function deficits are a main cause of participation restrictions post-traumatic brain injury (TBI). Assessing executive functions through actual daily participation may provide valuable information for treatment planning and progress.
AIM
This study aimed to validate the Assessment of Participation and Executive Functions (A-PEX), a tool for evaluating executive function deficits through actual participation in the inpatient rehabilitation context during the subacute phase following TBI.
DESIGN
A cross-sectional with a longitudinal component.
SETTING
Inpatient rehabilitation facility.
POPULATION
This study included 56 participants divided into two groups: 30 with orthopedic or spinal cord injuries and 26 with TBI.
METHODS
Internal consistency was evaluated by Cronbach's alpha, and test-retest reliability was assessed using interclass correlation coefficients. Known-group construct validity was examined by comparing the A-PEX scores between the two groups, and A-PEX convergent construct validity for patients with TBI was examined using correlations between scores on the A-PEX, Multiple Errands Test-hospital version (MET-HV), and Color Trail Test (CTT).
RESULTS
Cronbach's alpha coefficients for the A-PEX domains ranged between 0.83 and 0.96, indicating good-to-excellent internal consistency. Interclass correlations calculated for the control group indicated moderate test-retest reliability for most A-PEX components. Participants with TBI scored significantly lower than those with orthopedic or spinal cord injury for all A-PEX components (P<0.001). Within the TBI group, significant moderate-to-strong correlations were found between all A-PEX components and the MET-HV (0.52<r<0.73, P<0.05) and between the A-PEX executive function scales and the CTT (r=0.52, P<0.05).
CONCLUSIONS
The findings provide evidence for the initial reliability and validity of the A-PEX as a measure of post-TBI executive functions.
CLINICAL REHABILITATION IMPACT
By evaluating actual everyday participation, the A-PEX provides valuable clinical insight into the interrelationship between executive functions and participation in the post-TBI subacute phase.
背景
执行功能缺陷是创伤性脑损伤（TBI）后参与受限的主要原因。通过实际日常参与评估执行功能可以为治疗计划和进展提供有价值的信息。
目的
本研究旨在验证评估参与和执行功能（A-PEX），这是一种在 TBI 亚急性期通过实际参与住院康复环境来评估执行功能缺陷的工具。
设计
具有纵向成分的横断面研究。
设置
住院康复设施。
人群
这项研究包括 56 名参与者，分为两组：30 名骨科或脊髓损伤患者和 26 名 TBI 患者。
方法
采用 Cronbach's alpha 评估内部一致性，采用组内相关系数评估重测信度。通过比较两组之间的 A-PEX 评分来检验 A-PEX 的已知组构效度，通过 A-PEX、多项差事测试-医院版（MET-HV）和色迹测试（CTT）之间的评分相关性来检验 A-PEX 在 TBI 患者中的收敛构效关系。
结果
A-PEX 各领域的 Cronbach's alpha 系数在 0.83 至 0.96 之间，表明具有良好至优秀的内部一致性。为对照组计算的组内相关系数表明，大多数 A-PEX 成分具有中等程度的重测信度。与骨科或脊髓损伤患者相比，TBI 患者在所有 A-PEX 成分上的得分明显较低（P<0.001）。在 TBI 组内，所有 A-PEX 成分与 MET-HV 之间存在显著的中度至强相关性（0.52<r<0.73，P<0.05），A-PEX 执行功能量表与 CTT 之间存在显著的中度相关性（r=0.52，P<0.05）。
结论
这些发现为 A-PEX 作为 TBI 后执行功能的测量工具的初步可靠性和有效性提供了证据。
临床康复影响
通过评估实际的日常参与，A-PEX 提供了有价值的临床洞察力，了解了执行功能与 TBI 亚急性期参与之间的相互关系。
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