摘要
目的对现有脑卒中疗效评价指标进行系统评价与比较,探讨其改善方法。方法采取横断面调查与前瞻性随访研究相结合的方法,测量245例次脑卒中患者的神经功能缺损计分、总的生活能力状态分级、日常生活活动能力、中医脑卒中诊疗标准、中医证候相关症状体征评价表及健康调查简表SF-36、生活质量指数,用多元相关、线性回归、因子分析、内部一致性α系数、反应度法等方法,评价各指标信度、效度、灵敏度及各指标之间的相关性。结果神经功能缺损计分与中医脑卒中诊疗标准相关性大于0.9,综合二者优点的改良神经功能评价表效度、信度和反应度均优于原量表,敏感度比原量表提高了8.5%;Barthel指数在评价轻度脑卒中时存在“地板效应”,SF-36中的生理功能量表中有部分条目不适合用于评价脑卒中患者,二者可合并成一个新的生理功能评价表;心理健康指数(MHI5)等国外知名的心理健康评价量表、社会功能、生理职能评价量表,用于本研究人群有较多缺点。结论对现有疗效评价指标进行全方位严格评价,并在必要改善的基础上,对不同分期、不同严重程度的脑卒中患者运用不同的指标进行综合、动态的评价。
Aim To assess and compare the indexes of clinical outcomes of stroke comprehensively and to explore the way to improve them so as to evaluate the efficacy of traditional Chinese medicine (TCM) therapies on stroke more comprehensively, dynamically and scientifically.Methods 245 patients with stroke, 159 males and 86 females, aged (66± 10) years, 79 with a course less than 1 month, 47 with a course of 1- 3 months, and 57 with a course of 3- 6 months, 17% being illiterate, 38% having received the education of primary school level, 32% having the education of middle school level, and 13% having received higher education, were assessed by cross sectional study combined with prospective follow up to measure the neurological defect scale(NDS), living ability, activities of daily living (ADL,Barthel index).TCM diagnostic and evaluation criteria of stroke, scales of TCM syndrome related indexes. Quality of life was measured with Medical Outcomes Study 36 Item Short Form Health Survey(MOS SF 36 Health Survey)and quality of life index(QOI).Some patients were re evaluated 2 months after the first evaluation. The methods of multivariate relative regression and linear regression, factor analysis and principle component analysis, Cronbach's α coefficients, and the estimation of responsiveness were used to evaluate the validity, reliability and responsiveness of the indexes.Results The correlation of NDS score with score based on TCM criteria was higher than 0.9. The reliability, validity, and effect size of the modified neurological functioning scale were 8.5% higher than those of the original scales. The Barthel index showed a ' floor effect' in evaluating mild stroke patients and several items of the physical functioning scale of SF 36 did not fit for evaluating stroke patients.These two scales could be combined to form a new scale. Many famous foreign mental health scales, social functioning and physical role scales, such as Mental Health Inventory (MHI 5) showed shortages in this study.Conclu
出处
《中国临床康复》
CSCD
2003年第19期2699-2701,共3页
Chinese Journal of Clinical Rehabilitation
基金
国家"九五"科技攻关课题(96-903-01-11)
国家中医药管理局资助课题(00-01LP16)~~
