發(fā)布時間：2018-05-25 08:27

  本文選題：ICF分類 + 膝骨關節(jié)炎�。� 參考：《成都體育學院》2017年碩士論文

【摘要】：研究目的:現(xiàn)今主用于膝骨關節(jié)炎(KOA)患者臨床測評的是WOMAC(Western Ontario and McMaster Universities Osteoarthritis Index)量表。但各國間文化背景差異是一定存在并無法避免的,這就妨礙了研究結果、數(shù)據(jù)國際化的比較及分析。本研究以WOMAC量表中有意義概念為參照,根據(jù)國際ICF(International Classification of Functioning,Disability and Health)關聯(lián)法則,抽取相關的ICF條目組合。通過初步的臨床驗證及信效度的檢驗,建立可用于實際臨床評估工作的關于KOA患者功能評估的ICF條目組合。旨在使用國際通用標準化語言實現(xiàn)KOA患者功能評估結果跨文化交流與比較,并為骨關節(jié)炎(OA)的ICF核心分類的發(fā)展及完善提供更多的臨床參考。研究對象:130名KOA患者(男33例,女97例)。研究方法:1.提取WOMAC量表中有意義概念,兩名研究員嚴格按照《ICF國際關聯(lián)法則》,獨立進行ICF條目匹配,得到ICF條目組合。3.由第三名研究員對匹配結果進行匯總,并根據(jù)專家建議對得出的ICF條目進行修正統(tǒng)一,得到評估KOA患者膝關節(jié)功能的ICF條目組合。3.對兩名研究員的匹配結果進行一致性檢驗,并將其運用于臨床測評,分析其內部信度、校標效度及與WOMAC的相關性。同時選取上述測試者中的24例(住院患者)在初次評估的24h后進行重測實驗。研究結果:1.經(jīng)整理,共提取了23個WOMAC中有意義概念,并關聯(lián)到27個ICF條目(身體結構1個;身體功能4個;活動及參與19個;環(huán)境因素未涉及)。2.兩名研究員整體匹配的一致性良好(Kappa值為0.790.75)。其中,身體結構、功能的Kappa值均為1,說明匹配結果完全一致。活動及參與的Kappa值為0.73也顯示了較好的一致性。因此,2人匹配結果可靠。3.就兩表相關性而言,ICF與WOMAC整體呈高度正相關(r=0.826);除身體功能維度與WOMAC總分相關性弱外,身體結構維度、活動及參與維度與兩表相關性均較好。兩量表各維度間,除僵硬及身體功能維度相關性較弱,其他維度相關性均在中等相關及以上。4.就ICF條目組合內在信度而言,除身體結構維度因只有一項無法測得,身體功能維度Cranbach’sα值為0.686;活動及參與維度Cranbach’sα值為0.796,結果均表明內部一致性好。5.ICF條目組合重測信度:整體及各部分的ICC值均在0.7及以上,顯示重測信度高。研究結論:1.WOMAC量表與提取的ICF條目間的匹配具有較高的可靠性,且得到的評估KOA患者功能的ICF條目組合(共26項,其中身體結構1項;身體功能4項;活動及參與21項)具有良好的信度及效度。2.評估KOA患者功能的ICF條目組合與WOMAC量表整體存在很強的正相關性,且WOMAC總分與除身體功能維度外的ICF條目套組各維度相關性良好,可用于實際臨床工作。3.本實驗獲得的ICF條目套組可成為國際化的交流工具,用于不同國家、文化背景下的膝骨關節(jié)炎患者功能的評估。
[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 偽 value was 0.686, and the activity and participation dimension Cranbach's 偽 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.
【學位授予單位】：成都體育學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R684.3

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