治療師評估BADL執行能力表現評量表之發展－於實習治療師之信效度驗證

Development of an Assessment of Therapists' Performance to Assess an Individual's Ability to Perform BADL- Reliability and Validity in Occupational Therapy Interns

10.6534/jtotrp.202312_19(2).0004

侯孟真(Mon-Jane How)；王芮瑜(Jui-Yu Wang)；王怡晴(Yi-Ching Wang)；陳安如(An-Ju Chen)；林銘川(Ming-Chuan Lin)；謝清麟(Ching-Lin Hsieh)

基本日常生活活動 ； 執行能力 ； 心理計量特性 ； basic activities of daily living ； ability ； psychometric properties

臺灣職能治療研究與實務雜誌

19卷2期（2023 / 12 / 31）

51 - 65

繁體中文;英文

評估個案基本日常生活活動（basic activities of daily living, BADL）之執行能力是治療師之基礎能力之一。然而目前欠缺評量治療師評估BADL表現之評量表，影響相關教學與研究進展。本研究目的為發展「治療師評估BADL執行能力表現評量表（Assessment of Therapists' Performance to Assess Clients' Ability to Perform BADL, ATP）」與驗證其內容效度、表面效度、評估者間與評估者內信度。研究對象為北部一家醫學中心之34位職能治療實習學生及其提供治療的個案。量表內容包含評估說明與邀請確認意願、使用指導語、說明評估結果、溝通效能、以及評估效率。所評量之BADL執行能力項目包含進食、個人衛生、穿脫衣物、床上位移、輪椅移動、轉位、如廁、洗澡、以及行走等。量表之內容與表面效度由5位治療師驗證之。結果顯示：評估者間信度（個別項目weighted kappa = -0.07～0.89，總分intraclass correlation coefficient = 0.81）個別項目間落差大但總分信度良好。最小可偵測變化值（minimal detectable change, MDC）為13.7，MDC%為11.2%屬良好。評估者內信度優良（個別項目weighted kappa = 0.55～1.00，總分ICC = 0.99），MDC為2.6，MDC%為2.2%屬優良。本研究發展之ATP經初步證實：具備內容效度與表面效度、具有良好的評估者間信度以及極好的評估者內信度。後續研究宜再驗證此量表之其它心理計量特性，如反應性、最小臨床重要差異等。

Assessing individuals' ability to perform basic activities of daily living (BADL) is a fundamental skill for therapists. However, there is currently a lack of assessment tools for assessing therapist's performance in evaluating client's BADL, which affects progress in related teaching and research. This study aimed to develop and validate the "Assessment of Therapists' Performance to Assess Clients' Ability to Perform BADL, (ATP)" tool, focusing on its content validity, face validity, inter-rater reliability, and intra-rater reliability. The participants included 34 occupational therapy interns and the clients they provided therapy to at a medical center in Northern Taiwan. The ATP tool includes assessment instructions and consent, guidance language usage, explanation of assessment results, communication efficiency, and assessment efficiency. The BADL items assessed in this tool include feeding, personal hygiene, dressing and undressing, bed mobility, wheelchair mobility, transferring, toileting, bathing, and walking. The content and face validity of the tool were verified by five therapists. The results indicate good inter-rater reliability (individual item weighted kappa = -0.07~0.89, total score intraclass correlation coefficient = 0.81) despite variability in individual item agreement. The minimal detectable change (MDC) was 13.7, with an MDC% of 11.2%, indicating acceptable random measurement error. The intra-rater reliability showed excellent agreement (individual item weighted kappa = 0.55~1.00, total score ICC = 0.99), with an MDC of 2.6 and an MDC% of 2.2%, indicating high precision. The preliminary findings demonstrate that the ATP has good content validity, face validity, inter-rater reliability, and excellent intra-rater reliability. Further research should explore other psychometric properties of the tool, such as responsiveness and minimal clinically important difference.