Swaine B R, Sullivan S J
Ecole de readaptation, Faculté de Médecine, Université de Montréal, Canada.
Brain Inj. 1996 Apr;10(4):263-76. doi: 10.1080/026990596124449.
The purpose of this study was to determine the intra- and inter-rater reliability of selected variables measuring motor function in adults following severe traumatic brain injury (TBI). Twelve adults with a severe TBI participated in the study and were assessed (independently) by two physical therapists with extensive clinical experience. Standardized testing protocols and two- or three-point ordinal rating scales were used to evaluate the following categories of variables: primitive reflexes, equilibrium/protective reactions and several motor skills. Intra-rater reliability was generally high for all variables, with kappa values exceeding 0.65 except for the scoring of equilibrium reactions in sitting and standing. Overall, inter-rater reliability was slightly lower, with kappa values ranging from 0.39 to 1.0, indicating 'fair' to 'almost perfect' agreement. The highest level of agreement was consistently reported for the scoring of motor skills. These results suggest that physical therapists trained in the use of standardized testing and scoring procedures can reliably assess primitive reflexes, equilibrium and protective reactions and a range of motor skills in TBI adults during the acute stage of recovery. Moreover, the results provide important information which will assist in the interpretation of data collected as part of a concurrently conducted longitudinal study of early motor recovery.
本研究的目的是确定用于测量重度创伤性脑损伤（TBI）成年患者运动功能的选定变量在评估者内和评估者间的可靠性。12名重度TBI成年患者参与了本研究，并由两名具有丰富临床经验的物理治疗师（独立地）进行评估。采用标准化测试方案和两点或三点顺序评定量表来评估以下几类变量：原始反射、平衡/保护性反应和若干运动技能。除坐位和站立位平衡反应的评分外，所有变量的评估者内可靠性一般较高，kappa值超过0.65。总体而言，评估者间可靠性略低，kappa值范围为0.39至1.0，表明一致性为“中等”至“几乎完美”。运动技能评分的一致性水平始终最高。这些结果表明，接受过标准化测试和评分程序使用培训的物理治疗师能够在恢复急性期可靠地评估TBI成年患者的原始反射、平衡和保护性反应以及一系列运动技能。此外，研究结果提供了重要信息，有助于解释作为同时进行的早期运动恢复纵向研究一部分所收集的数据。
