ICF核心要素量表用于卒中患者吞咽功能评估的信度与效度：中国湖南的一项单中心研究

文献信息

中文摘要

目的： 评估21条目国际功能、残疾和健康分类（ICF）卒中吞咽障碍核心类目量表（ICCSDS）在中国卒中患者吞咽障碍评估中的信度与效度。
方法： 由6名经验丰富的康复医师评估该量表的内容效度。两名评定者（一名康复医师和一名吞咽治疗师）接受标准化培训。康复医师使用多伦多床旁吞咽筛查试验筛查并纳入80例疑似吞咽困难患者。随后由一名吞咽治疗师以Gugging吞咽筛查（GUSS）作为实用性参考标准进行ICCSDS初始评估。4小时后，由一名康复医师在同一地点进行第二次ICCSDS评估，以评价评定者间信度。
结果： ICCSDS所有条目在高分组与低分组之间均存在显著差异（均p<0.01）。康复医师和吞咽治疗师评估的Cronbach's α系数分别为0.864和0.829。S-CVI值为0.978，I-CVI值范围为0.83至1.00。探索性因子分析显示，康复医师和吞咽治疗师评估的Kaiser-Meyer-Olkin（KMO）值分别为0.887和0.848（均p<0.01），累积方差贡献率分别为75.69%和73.65%。以GUSS作为实用性参考标准时，康复医师和吞咽治疗师评估的ICCSDS效标关联效度系数分别为0.790和0.683（均p<0.01）。评定者间信度分析显示ICC（2,1）为0.924，ICC（2,k）为0.961。14个条目的加权kappa系数超过0.80，1个条目达到0.799，6个条目范围为0.420至0.547。
结论： 21条目ICCSDS在中国卒中后吞咽困难患者中显示出可接受的内部一致性、内容效度和评定者间信度。效标关联效度分析的初步证据支持其与临床床旁评估工具的关联。

英文摘要

OBJECTIVE: To evaluate the reliability and validity of the 21-item ICF Core Category Scale for Dysphagia in Stroke (ICCSDS) in assessing swallowing disorders in Chinese stroke patients.
METHODS: Six experienced rehabilitation physicians evaluated the content validity of the scale. Two raters (a rehabilitation physician and a swallowing therapist) received standardized training. Rehabilitation physicians screened and enrolled 80 patients with suspected swallowing difficulties using the Toronto Bedside Swallowing Screening Test. A swallowing therapist subsequently performed the initial ICCSDS assessment using the Gugging Swallowing Screen (GUSS) as a practical reference standard. Four hours later, a rehabilitation physician conducted a second ICCSDS assessment at the same site to evaluate interrater reliability.
RESULTS: Significant differences were observed between the high-score and low-score groups for all the ICCSDS items (all p < 0.01). The Cronbach's α coefficients for assessments performed by the rehabilitation physician and swallowing therapist were 0.864 and 0.829, respectively. The S-CVI value was 0.978, and the I-CVI values ranged from 0.83 to 1.00. Exploratory factor analysis revealed that the Kaiser-Meyer-Olkin (KMO) values for assessments by the rehabilitation physician and the swallowing therapist were 0.887 and 0.848, respectively (both p < 0.01), with cumulative variance contributions of 75.69 and 73.65%, respectively. When the GUSS was used as the practical reference standard, the criterion-related validity coefficients of the ICCSDS assessed by the rehabilitation physician and the swallowing therapist were 0.790 and 0.683, respectively (both p < 0.01). Interrater reliability analysis revealed an ICC (2, 1) of 0.924 and an ICC (2, k) of 0.961. The weighted kappa coefficients exceeded 0.80 for 14 items, reached 0.799 for one item, and ranged from 0.420 to 0.547 for six items.
CONCLUSION: The 21-item ICCSDS demonstrated acceptable internal consistency, content validity, and interrater reliability in Chinese patients with poststroke dysphagia. The preliminary evidence from the criterion-related validity analysis supports its association with clinical bedside assessment tools.