發(fā)布時(shí)間：2018-01-13 14:11

  本文關(guān)鍵詞：重癥肌無力嚴(yán)重程度量表的研制與考核　出處：《青島大學(xué)》2017年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 重癥肌無力 量表 Delphi法 信度 效度

【摘要】：目的:研制適合我國(guó)臨床使用的重癥肌無力(MG)嚴(yán)重程度量表。方法:1.根據(jù)4個(gè)國(guó)內(nèi)外常用的MG嚴(yán)重程度量表(QMGs、MGC、MMS和ARS-MG)建立條目池,結(jié)合收集的5位獨(dú)立觀察者對(duì)60例MG患者評(píng)分的數(shù)據(jù),采用Delphi法調(diào)查國(guó)內(nèi)MG領(lǐng)域?qū)＜业囊庖?來自全國(guó)21個(gè)MG中心的32位專家組成議題小組參與調(diào)查,本課題組研究者組成核心小組,負(fù)責(zé)完成調(diào)查并形成初始量表。完成第一輪調(diào)查后,向?qū)＜曳答伒谝惠喺{(diào)查意見匯總及前期評(píng)價(jià)中各條目在原始量表中的表現(xiàn),進(jìn)行第二輪調(diào)查,選擇第二輪調(diào)查結(jié)果中專家推薦一致性高且前期評(píng)價(jià)好的條目,建立初始量表。2.使用這60例MG患者的測(cè)評(píng)數(shù)據(jù),用條目的觀察者間信度、條目對(duì)Cronbachɑ系數(shù)的作用、條目相關(guān)系數(shù)和因子分析法篩選條目,編制完整量表。3.對(duì)形成的完整量表,評(píng)價(jià)每個(gè)條目的觀察者間信度,量表的內(nèi)部一致性、量表的觀察者間信度和重測(cè)信度、量表的結(jié)構(gòu)效度和量表的效標(biāo)關(guān)聯(lián)效度。4.選取完整量表中患者能自行評(píng)價(jià)的條目形成自評(píng)量表,并評(píng)價(jià)其內(nèi)部一致性、觀察者間信度、重測(cè)信度、結(jié)構(gòu)效度和效標(biāo)關(guān)聯(lián)效度。結(jié)果:1.核心小組擬定的條目池包含來自上述4個(gè)量表的19個(gè)條目。兩輪專家調(diào)查的積極系數(shù)分別為91.4%和96.9%,專家權(quán)威系數(shù)分別為0.79和0.80,專家對(duì)條目綜合評(píng)分的Kendall協(xié)同系數(shù)分別為0.22(P�d0.01)和0.42(P�d0.01)。選取專家支持度高且意見差異小(M為3且IQR≤1)的條目,并增加復(fù)視的條目,形成初始量表,包括10個(gè)條目。2.對(duì)初始量表進(jìn)行評(píng)價(jià)后,因觀察者間信度表現(xiàn)差刪除1個(gè)條目(瞼裂),其他9個(gè)條目構(gòu)成完整量表,涉及眼肌、球部肌、面肌、四肢肌、中軸肌和呼吸肌6個(gè)肌群。3.評(píng)價(jià)完整量表,各條目的觀察者間信度較好(К=0.43~0.80,P�d0.01)。完整量表的內(nèi)部一致性較好(Cronbachɑ=0.65),觀察者間信度(ICC=0.89,P�d0.01)和重測(cè)信度(ICC=0.87,P�d0.01)均很好;因子分析法顯示量表有4項(xiàng)公因子,累積方差貢獻(xiàn)率68.46%,結(jié)構(gòu)效度良好;量表與MG-ADL、MGC中度相關(guān)(r=0.62~0.77,P�d0.01),與QMGs、ARS-MG高度相關(guān)(r=0.86~0.89,P�d0.01)。4.刪除眼肌和面肌條目形成自評(píng)量表,包括6個(gè)條目,涉及球部肌、四肢肌、中軸肌和呼吸肌4個(gè)肌群。自評(píng)量表的內(nèi)部一致性較好(Cronbachɑ=0.77),觀察者間信度和重測(cè)信度(ICC均為0.93,P�d0.01)很好;因子分析法顯示自評(píng)量表有2項(xiàng)公因子,累積方差貢獻(xiàn)率64.24%,結(jié)構(gòu)效度較好;自評(píng)量表與ARS-MG、完整量表高度相關(guān)(r=0.80~0.82,P�d0.01),與MG-ADL、QMGs、MGC中度相關(guān)(r=0.51~0.75,P�d0.01)。結(jié)論:采用Delphi法結(jié)合前期條目評(píng)價(jià)篩選出代表性條目,形成全面反映MG嚴(yán)重程度的初始量表,采用多種考評(píng)方法進(jìn)一步篩選條目后形成完整量表,選取完整量表中患者能自行評(píng)價(jià)條目形成自評(píng)量表。完整量表和自評(píng)量表均有良好的信度和效度,能可靠有效地評(píng)價(jià)MG的嚴(yán)重程度。
[Abstract]:Objective: to prepare for our clinical use of myasthenia gravis (MG) severity scale. Methods: 1. according to the 4 commonly used at home and abroad MG severity scale (QMGs, MGC, MMS and ARS-MG) the item pool with the collection of 5 independent observers on 60 cases of patients with MG score according to the number of using Delphi method, investigation of domestic MG domain experts, 32 experts from the 21 MG center consists of focus group involved in the investigation, the research group composed of the core group, responsible for the completion of the investigation and formed the initial scale. After the completion of the first round of survey, feedback each item the first round of the survey and summary views of previous evaluations in the original scale in the second round of expert investigation, expert selection of the second round survey recommended high consistency and pre evaluation items, establish the initial scale of.2. using the 60 cases of MG were observed by the evaluation data, a purpose The role of inter rater reliability, Cronbach alpha coefficient entries, entries correlation coefficient and factor analysis method to screen items, the preparation of complete scale.3. to complete the formation of the amount of each item, evaluate the interobserver reliability and internal consistency of the scale, the scale of the interobserver reliability and test-retest reliability, construct validity and the scale effect scale criterion related validity of.4. scale to select the complete evaluation in patients with items in the checklist, and evaluate the internal consistency, interobserver reliability, test-retest reliability, construct validity and criterion related validity. Results: 1. the core group proposed item pool contains from the 4 scale and 19 items. The positive coefficient of two rounds of expert investigation were 91.4% and 96.9%, the expert authority coefficient were 0.79 and 0.80, experts on the comprehensive score of the entry Kendall coordination coefficient were 0.22 (P? 0.01) and 0.42 (P? 0.01). Select expert support 搴﹂珮涓旀剰瑙佸樊寮傚皬(M涓，

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