以WOMAC为参照提取的ICF条目在膝骨关节炎患者功能评估中的应用研究

发布时间：2018-05-25 08:27

本文选题：ICF分类 + 膝骨关节炎　；参考：《成都体育学院》2017年硕士论文

【摘要】：研究目的:现今主用于膝骨关节炎(KOA)患者临床测评的是WOMAC(Western Ontario and McMaster Universities Osteoarthritis Index)量表。但各国间文化背景差异是一定存在并无法避免的,这就妨碍了研究结果、数据国际化的比较及分析。本研究以WOMAC量表中有意义概念为参照,根据国际ICF(International Classification of Functioning,Disability and Health)关联法则,抽取相关的ICF条目组合。通过初步的临床验证及信效度的检验,建立可用于实际临床评估工作的关于KOA患者功能评估的ICF条目组合。旨在使用国际通用标准化语言实现KOA患者功能评估结果跨文化交流与比较,并为骨关节炎(OA)的ICF核心分类的发展及完善提供更多的临床参考。研究对象:130名KOA患者(男33例,女97例)。研究方法:1.提取WOMAC量表中有意义概念,两名研究员严格按照《ICF国际关联法则》,独立进行ICF条目匹配,得到ICF条目组合。3.由第三名研究员对匹配结果进行汇总,并根据专家建议对得出的ICF条目进行修正统一,得到评估KOA患者膝关节功能的ICF条目组合。3.对两名研究员的匹配结果进行一致性检验,并将其运用于临床测评,分析其内部信度、校标效度及与WOMAC的相关性。同时选取上述测试者中的24例(住院患者)在初次评估的24h后进行重测实验。研究结果:1.经整理,共提取了23个WOMAC中有意义概念,并关联到27个ICF条目(身体结构1个;身体功能4个;活动及参与19个;环境因素未涉及)。2.两名研究员整体匹配的一致性良好(Kappa值为0.790.75)。其中,身体结构、功能的Kappa值均为1,说明匹配结果完全一致。活动及参与的Kappa值为0.73也显示了较好的一致性。因此,2人匹配结果可靠。3.就两表相关性而言,ICF与WOMAC整体呈高度正相关(r=0.826);除身体功能维度与WOMAC总分相关性弱外,身体结构维度、活动及参与维度与两表相关性均较好。两量表各维度间,除僵硬及身体功能维度相关性较弱,其他维度相关性均在中等相关及以上。4.就ICF条目组合内在信度而言,除身体结构维度因只有一项无法测得,身体功能维度Cranbach’sα值为0.686;活动及参与维度Cranbach’sα值为0.796,结果均表明内部一致性好。5.ICF条目组合重测信度:整体及各部分的ICC值均在0.7及以上,显示重测信度高。研究结论:1.WOMAC量表与提取的ICF条目间的匹配具有较高的可靠性,且得到的评估KOA患者功能的ICF条目组合(共26项,其中身体结构1项;身体功能4项;活动及参与21项)具有良好的信度及效度。2.评估KOA患者功能的ICF条目组合与WOMAC量表整体存在很强的正相关性,且WOMAC总分与除身体功能维度外的ICF条目套组各维度相关性良好,可用于实际临床工作。3.本实验获得的ICF条目套组可成为国际化的交流工具,用于不同国家、文化背景下的膝骨关节炎患者功能的评估。
[Abstract]:Objective: to evaluate the WOMAC(Western Ontario and McMaster Universities Osteoarthritis Index) scale in patients with knee osteoarthritis and osteoarthritis. However, cultural background differences between countries are inevitable, which hinders the comparison and analysis of research results and data internationalization. In this study, the relevant ICF items were extracted according to the international ICF(International Classification of functional disability and health based on the meaningful concepts in the WOMAC scale. A combination of ICF items for functional evaluation of KOA patients was established through preliminary clinical validation and reliability and validity tests. The purpose of this study is to use international standardized language to realize cross-cultural communication and comparison of functional evaluation results of KOA patients, and to provide more clinical reference for the development and improvement of ICF core classification of osteoarthritis. Participants: one hundred and thirty KOA patients (33 males and 97 females) were enrolled in the study. Research method: 1. The meaningful concepts in WOMAC scale were extracted. The two researchers carried out the matching of ICF items independently according to the International Association Rule of ICF and got the combination of ICF items. 3. The matching results were summarized by the third researcher, and the ICF items were revised and unified according to the expert's suggestion to get the ICF item combination of evaluating the knee joint function of KOA patients. 3. The matching results of the two researchers were tested and applied to clinical evaluation to analyze the internal reliability, calibration validity and correlation with WOMAC. At the same time, 24 of the subjects (inpatients) were re-tested 24 hours after the initial evaluation. The result of the study was: 1. A total of 23 meaningful concepts were extracted from 23 WOMAC, and 27 ICF entries (body structure 1; body function 4; activity and participation 19; environmental factors not related to. 2. 2. The overall matching consistency of the two researchers was good and the Kappa value was 0.790.75. The Kappa values of body structure and function are all 1, indicating that the matching results are consistent. A Kappa of 0. 73 for activity and participation also showed good consistency. Therefore, the match between the two people is reliable. 3. In terms of the correlation between ICF and WOMAC, there was a high positive correlation between ICF and WOMAC, except for the weak correlation between the physical function dimension and the total score of WOMAC, the correlation between the physical structure dimension, activity dimension and participation dimension was better. Between the two scales, except stiffness and physical function, the correlation of other dimensions was moderate and above. 4. As far as the intrinsic reliability of ICF item combinations is concerned, except for one dimension of body structure that cannot be measured, The physical function dimension Cranbach's 伪 value was 0.686, and the activity and participation dimension Cranbach's 伪 value was 0.796. The results showed that the internal consistency was good. 5.ICF item combination retest reliability: the whole and each part of the ICC value was 0.7 and above, showing high test-retest reliability. Conclusions\ Activity and participation 21) have good reliability and validity. The combination of ICF items for evaluating the function of KOA patients had a strong positive correlation with the whole WOMAC scale, and the total WOMAC score had a good correlation with each dimension of the ICF item set group except the physical function dimension, which could be used in clinical work. 3. The set of ICF items obtained in this study can be used as an international communication tool for assessing the function of patients with knee osteoarthritis in different countries and cultures.
【学位授予单位】：成都体育学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R684.3

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