Liu M, Domen K, Chino N
Department of Rehabilitation Medicine, Saitama Prefecture General Rehabilitation Center, Japan.
Arch Phys Med Rehabil. 1997 Feb;78(2):166-72. doi: 10.1016/s0003-9993(97)90259-8.
To develop standardized comorbidity measures for use in stroke outcome research.
Retrospective review of medical records to analyze comorbidities and to study reliability and validity of the newly developed measures, comorbidity index (CI), and weighted comorbidity index (w-CI).
Tertiary rehabilitation center in Japan.
106 stroke patients, age 56.5 +/- 13.2 yr, admitted and discharged during the year from May 1994 to December 1995. The median days of duration of stroke, onset to admission, and length of stay (LOS) were 199, 83, and 105.5, respectively. The median admission and discharge Functional Independence Measure (FIM) raw scores were 85 and 110, respectively.
Assessment of interrater reliability with intraclass correlation coefficient (ICC) for total scores and weighted kappa for subscores; assessment of concurrent validity by relating the measures to Charlson's comorbidity index, total numbers of medications, laboratory studies, therapeutic interventions, consultations, and days of interruption (Spearman's rank correlation method); study of predictive validity with discharge FIM score and LOS as dependent variables.
The ICCs were .896 for CI and .997 for w-CI, and weighted kappa ranged from .615 to 1.00. CI and w-CI correlated significantly with Charlson index and the above indices of validity. They also correlated negatively with discharge FIM scores and positively with LOS. With stepwise multiple regression analysis, 79.8% of the variance of discharge FIM scores could be explained by w-CI, days from onset to admission, admission FIM score, and deviation in tape bisection task.
The newly developed comorbidity measures are reliable and valid for use in stroke outcome research.
制定用于卒中结局研究的标准化共病测量方法。
回顾性审查病历以分析共病情况，并研究新开发的测量方法——共病指数（CI）和加权共病指数（w-CI）的可靠性和有效性。
日本的三级康复中心。
1994年5月至1995年12月期间收治并出院的106例卒中患者，年龄56.5±13.2岁。卒中发病至入院的中位天数、入院至出院的中位天数分别为199天、83天和105.5天。入院和出院时功能独立性测量（FIM）原始评分的中位数分别为85分和110分。
采用组内相关系数（ICC）评估总分的评分者间信度，采用加权kappa评估子评分的评分者间信度；通过将这些测量方法与Charlson共病指数、药物总数、实验室检查、治疗干预、会诊及中断天数相关联（Spearman等级相关法）来评估同时效度；以出院时FIM评分和住院时间（LOS）作为因变量研究预测效度。
CI的ICC为0.896，w-CI的ICC为0.997，加权kappa范围为0.615至1.00。CI和w-CI与Charlson指数及上述效度指标显著相关。它们与出院时FIM评分呈负相关，与住院时间呈正相关。通过逐步多元回归分析，w-CI、发病至入院天数、入院时FIM评分及线段二等分任务偏差可解释出院时FIM评分79.8%的方差。
新开发的共病测量方法在卒中结局研究中具有可靠性和有效性。
