重症肌无力严重程度量表的研制与考核
发布时间：2018-01-13 14:11
本文关键词：重症肌无力严重程度量表的研制与考核 出处：《青岛大学》2017年博士论文 论文类型：学位论文
更多相关文章： 重症肌无力 量表 Delphi法 信度 效度
【摘要】：目的:研制适合我国临床使用的重症肌无力(MG)严重程度量表。方法:1.根据4个国内外常用的MG严重程度量表(QMGs、MGC、MMS和ARS-MG)建立条目池,结合收集的5位独立观察者对60例MG患者评分的数据,采用Delphi法调查国内MG领域专家的意见,来自全国21个MG中心的32位专家组成议题小组参与调查,本课题组研究者组成核心小组,负责完成调查并形成初始量表。完成第一轮调查后,向专家反馈第一轮调查意见汇总及前期评价中各条目在原始量表中的表现,进行第二轮调查,选择第二轮调查结果中专家推荐一致性高且前期评价好的条目,建立初始量表。2.使用这60例MG患者的测评数据,用条目的观察者间信度、条目对Cronbachɑ系数的作用、条目相关系数和因子分析法筛选条目,编制完整量表。3.对形成的完整量表,评价每个条目的观察者间信度,量表的内部一致性、量表的观察者间信度和重测信度、量表的结构效度和量表的效标关联效度。4.选取完整量表中患者能自行评价的条目形成自评量表,并评价其内部一致性、观察者间信度、重测信度、结构效度和效标关联效度。结果:1.核心小组拟定的条目池包含来自上述4个量表的19个条目。两轮专家调查的积极系数分别为91.4%和96.9%,专家权威系数分别为0.79和0.80,专家对条目综合评分的Kendall协同系数分别为0.22(P㩳0.01)和0.42(P㩳0.01)。选取专家支持度高且意见差异小(M为3且IQR≤1)的条目,并增加复视的条目,形成初始量表,包括10个条目。2.对初始量表进行评价后,因观察者间信度表现差删除1个条目(睑裂),其他9个条目构成完整量表,涉及眼肌、球部肌、面肌、四肢肌、中轴肌和呼吸肌6个肌群。3.评价完整量表,各条目的观察者间信度较好(К=0.43~0.80,P㩳0.01)。完整量表的内部一致性较好(Cronbachɑ=0.65),观察者间信度(ICC=0.89,P㩳0.01)和重测信度(ICC=0.87,P㩳0.01)均很好;因子分析法显示量表有4项公因子,累积方差贡献率68.46%,结构效度良好;量表与MG-ADL、MGC中度相关(r=0.62~0.77,P㩳0.01),与QMGs、ARS-MG高度相关(r=0.86~0.89,P㩳0.01)。4.删除眼肌和面肌条目形成自评量表,包括6个条目,涉及球部肌、四肢肌、中轴肌和呼吸肌4个肌群。自评量表的内部一致性较好(Cronbachɑ=0.77),观察者间信度和重测信度(ICC均为0.93,P㩳0.01)很好;因子分析法显示自评量表有2项公因子,累积方差贡献率64.24%,结构效度较好;自评量表与ARS-MG、完整量表高度相关(r=0.80~0.82,P㩳0.01),与MG-ADL、QMGs、MGC中度相关(r=0.51~0.75,P㩳0.01)。结论:采用Delphi法结合前期条目评价筛选出代表性条目,形成全面反映MG严重程度的初始量表,采用多种考评方法进一步筛选条目后形成完整量表,选取完整量表中患者能自行评价条目形成自评量表。完整量表和自评量表均有良好的信度和效度,能可靠有效地评价MG的严重程度。
[Abstract]:Objective: to prepare for our clinical use of myasthenia gravis (MG) severity scale. Methods: 1. according to the 4 commonly used at home and abroad MG severity scale (QMGs, MGC, MMS and ARS-MG) the item pool with the collection of 5 independent observers on 60 cases of patients with MG score according to the number of using Delphi method, investigation of domestic MG domain experts, 32 experts from the 21 MG center consists of focus group involved in the investigation, the research group composed of the core group, responsible for the completion of the investigation and formed the initial scale. After the completion of the first round of survey, feedback each item the first round of the survey and summary views of previous evaluations in the original scale in the second round of expert investigation, expert selection of the second round survey recommended high consistency and pre evaluation items, establish the initial scale of.2. using the 60 cases of MG were observed by the evaluation data, a purpose The role of inter rater reliability, Cronbach alpha coefficient entries, entries correlation coefficient and factor analysis method to screen items, the preparation of complete scale.3. to complete the formation of the amount of each item, evaluate the interobserver reliability and internal consistency of the scale, the scale of the interobserver reliability and test-retest reliability, construct validity and the scale effect scale criterion related validity of.4. scale to select the complete evaluation in patients with items in the checklist, and evaluate the internal consistency, interobserver reliability, test-retest reliability, construct validity and criterion related validity. Results: 1. the core group proposed item pool contains from the 4 scale and 19 items. The positive coefficient of two rounds of expert investigation were 91.4% and 96.9%, the expert authority coefficient were 0.79 and 0.80, experts on the comprehensive score of the entry Kendall coordination coefficient were 0.22 (P? 0.01) and 0.42 (P? 0.01). Select expert support 搴﹂珮涓旀剰瑙佸樊寮傚皬(M涓，
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