Árnadóttir Guðrún, Atladóttir Laufey Halla, Ingvarsson Garðar, Sigtryggsson Helgi, Atlason Bjarni Ármann
Landspitali, 105 Reykjavik, Iceland.
Faculty of Medicine, University of Iceland, 102 Reykjavik, Iceland.
Brain Sci. 2025 Aug 23;15(9):904. doi: 10.3390/brainsci15090904.
Measurements are necessary in rehabilitation for evaluating service effectiveness. The ADL-focused Occupation-based Neurobehavioral Evaluation (A-ONE) is used for evaluating ADL performance and the impact of neurobehavioral impairments on the performance. Recently, Rasch-based software was constructed for the A-ONE ADL and neurobehavioral scales. It converts ordinal rating scale scores into measures, estimates missing data values and calculates the statistical significance of changes. To expand the A-ONE software by developing a cerebrovascular accident (CVA) neurobehavioral subscale. Additionally, to pilot-test whether the ADL and CVA scales of the software can detect statistically significant improvements. Rasch analysis was used for evaluating the item fit, PCA, person separation and reliability to establish the internal validity of the CVA subscale ( = 222). The external validity ( = 22) was obtained by comparing A-ONE software measures to Winsteps measures. Subsequently 21 pre-post-intervention comparisons were made of stroke patients using both the ADL and CVA scales. All set criteria for internal and external validity were met. By using the software clinically after incorporating the CVA subscale, statistically significant changes were detected in 90.5% of comparisons using the ADL scale and 36.4% using the CVA scale. The intervention program used was determined to consist of 66.4% occupation-based activities. This study is the first to deliver a clinically deployable Rasch-based CVA subscale integrated into routine occupational therapy software. The A-ONE software offers considerable time saving for therapists and the potential to detect significant differences in performance and impairment impact. It contributes to the removal of clinical obstacles toward the use of the instrument as an outcome measure and encourages the use of measures in rehabilitation.
在康复过程中，测量对于评估服务效果是必要的。以日常生活活动（ADL）为重点的基于职业的神经行为评估（A-ONE）用于评估ADL表现以及神经行为损伤对其表现的影响。最近，针对A-ONE的ADL和神经行为量表构建了基于拉施模型的软件。它将有序评分量表分数转换为测量值，估计缺失数据值并计算变化的统计学意义。为了通过开发脑血管意外（CVA）神经行为子量表来扩展A-ONE软件。此外，初步测试该软件的ADL和CVA量表是否能检测出具有统计学意义的改善。拉施分析用于评估项目拟合度、主成分分析、人员区分度和信度，以确立CVA子量表的内部效度（n = 222）。通过将A-ONE软件测量值与Winsteps测量值进行比较获得外部效度（n = 22）。随后，对21名中风患者在干预前后使用ADL和CVA量表进行了比较。内部和外部效度的所有既定标准均得到满足。在纳入CVA子量表后在临床使用该软件时，使用ADL量表的比较中有90.5%检测到具有统计学意义的变化，使用CVA量表的为36.4%。所使用的干预方案确定为由66.4%的基于职业的活动组成。本研究首次提供了一个可临床应用的、基于拉施模型的CVA子量表，并将其整合到常规职业治疗软件中。A-ONE软件为治疗师节省了大量时间，并且有潜力检测出表现和损伤影响方面的显著差异。它有助于消除将该工具用作结果测量的临床障碍，并鼓励在康复中使用测量方法。
