褚氏日常生活評量表應用於思覺失調症 個案之心理計量特性分析

An Investigation of the Psychometric Properties of the Chu’ s Activities of Daily Living Rating Scale in Patients with Schizophrenia

鄭進清

思覺失調症 ； 再測一致性 ； 最小可偵測變化值 ； 反應性 ； Schizophrenia ； Test-retest reliability ； Minimal detectable change ； Responsiveness

中山醫學大學醫學檢驗暨生物技術學系碩士班學位論文

2016年

碩士

呂文賢

繁體中文

研究背景與動機：褚氏日常生活評量表第三版 (Chu’ s Activities of daily living Rating Scale, 3rd edition, Chu’ s ADLRS-III) 是目前在台灣精神醫療臨床中，最為普遍用來評估日常生活功能的工具之一。此工具應用於思覺失調症(schizophrenia)病人的再測信度與最小可偵測之變化值(minimal detectable change, MDC)與反應性仍未驗證，限制針對此工具測量結果的解釋與應用。目的：本研究的目的在驗證Chu’ s ADLRS-III之再測一致性、MDC及反應性。研究方法：研究者徵召50名在日間型精神復健機構的思覺失調症病人，由一位受過特別訓練之治療師以Chu’ s ADLRS-III進行測量，前後二次，間隔二週。研究者利用組內相關係數(intra-class correlation coefficient, ICC)驗證Chu’ s ADLRS-III測驗各項結果之再測一致性，同時計算測量標準誤(standard error of measurement, SEM)及MDC。另以Chu’ s ADLRS-III施測於50位亞急性思覺失調症病人(急病病房住院第7天以及第42天)之資料估算Chu’ s ADLRS-III之反應性，包含團體層級反應性：效應值d (effect size d)、標準化反應平均值(standardized response mean, SRM)及配對t 檢定；個別層級反應性：量表偵測病人於發病7~42 天期間總分數改變超過最小可偵測變化值之人數比例。結果： ICC=0.94，顯示Chu’ s ADLRS-III之再測一致性高。SEM為4.6， MDC95為12.8，為平均得分的20.3%，顯示為可接受之測量誤差。團體層級反應性結果顯示， ES=0.45)代表「低度效應」；SRM=1.16代表「高度效應」。t = 8.125， (p ＜ .001)具統計顯著性。個別層級反應性顯示，病人之前後測差異改變量超過MDC95者佔16%。建議與結論：本研究結果顯示Chu’ s ADLRS-III應用於思覺失調症病人具有良好之再測一致性，而計算出之MDC值，有助於臨床工作者及研究者判讀測驗前後測差異分數與制定決策。在團體層級反應性的部分，不同指標顯示為低至高效應，個別層級反應性似乎較低。

Background: Chu’s Activities of Daily Living Rating Scale, third edition (the ADLRS-III) is widely used to assess activities of daily living in mental health clinics in Taiwan. However, the test-retest reliability and the minimal detectable change (MDC) of this scale have not been validated in patients with schizophrenia, limiting the explanation and applicability of this measure. Purpose: The purpose of this study was to verify the test-retest reliability, MDC, and responsiveness of the ADLRS-III. Method: A total of 50 patients with schizophrenia in a psychiatric day-care rehabilitation institution were evaluated by a trained therapist with the ADLRS-III twice, two weeks apart. The intra-class correlation coefficient (ICC) was employed both to verify the test-retest reliability of the ADLRS-III and to calculate the standard error of measurement (SEM) and MDC. In addition, a total of 50 sub-acute patients with schizophrenia were evaluated with the ADLRS-III twice (on the 7th day and 42nd days after admission to the acute ward) to estimate the responsiveness of the ADLRS-III, including group-level responsiveness: effect size d, a standardized response mean and paired t test; and individual-level responsiveness: the percentage of those whose difference scores between the 7th and 42nd days exceeded the MDC. Results: The ICC for the ADLRS-III was 0.94, representing high test-retest reliability. The SEM for the ADLRS-III was 4.6, and the MDC95 was 12.8 (20.3% of mean score), indicating acceptable measurement error. In terms of group-level responsiveness, the ES was 0.45, representing a low effect; the SRM was 1.16, representing a high effect. The t-test result was statistically significant ( t=8.125, p ＜ .001). In terms of individual-level responsiveness, the percentage of patients whose difference scores between test and retest sessions exceeded the MDC was 16%. Recommendations and Conclusions: The results of this study show that the ADLRS-III has good test-retest reliability in patients with schizophrenia, and the MDC value is helpful to clinicians and researchers in interpreting the difference score of the ADLRS-III between consecutive sessions and in making decisions. In terms of group-level responsiveness, the effect ranged from low to high based on various indexes. The individual-level responsiveness appeared to be low.

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