頭皮冷卻法預防化療引起之掉髮

我國「身心障礙者權益保障法」，以世界衛生組織之「國際健康功能與身心障礙分類系統」（簡稱ICF）做為身心障礙分類之依據。為此，未來身心障礙之鑑定需以ICF 為基礎設計鑑定評估表。本研究乃以ICF「自我照顧」與「居家生活」，即活動與參與（d）成份中第五、六章（d5, d6）之重要二位碼，設計「ICF日常生活活動量表-成人版」初稿，並對中風患者初步建立信效度，以為未來修正之參考。研究者透過文獻收集與多次的專家會議建立「ICF 日常生活活動量表-成人版」，其施測項目分為兩個分量表：「自我照顧」及「居家生活」。「自我照顧」分量表包含「個人清洗」、「照顧身體部位」、「如廁」、「穿著」、「進食」、「飲用飲料」以及「照料個人健康」等七個題項。「居家生活」分量表則包含「取得商品與服務」、「準備餐點」、「做家事」以及「照顧家用物品」等四個題項。並以50 位中風個案，建立施測者間信度以及再測信度。並以「巴氏量表」和「工具性日常生活功能」做為效標，建立效標關聯效度。結果發現，「ICF 日常生活活動量表-成人版」限定值施測者間信度Kappa 值介於0.43-1.00 之間，所有項目皆達顯著（p<0.01）；限定值再測信度Kappa 值介於0.31-1.00 之間，所有項目皆達顯著（p<0.01），顯示大部分日常生活量表項目的施測者間信度及再測信度在可接受範圍內。效標關聯效度部分，「ICF 日常生活活動量表-成人版」中之「自我照顧」分量表之七個題項以及「居家生活」分量表中的「取得商品與服務」，分別與「巴氏量表」及「工具性日常生活量表」之部分項目達顯著相關（Spearman rho=0.44-0.84, p<0.01）。在「居家生活」部分，由於國人生病後常由家人代勞從事相關活動，因此，在「準備餐點」、「做家事」、及「照顧家用物品」等題項回答「不適用」的比例偏高，未來於實務使用上應謹慎。由以上研究結果得知，「ICF 日常生活活動量表-成人版」應用於中風個案之評估具有良好的信效度。研究建議將此量表未來可應用於不同診斷及障礙類別的個案，並建立其信效度，以增進本量表未來的可用性。

People with Disabilities Rights Protection Act revised in 2007 has adopted the International Classification of Functioning, Disability and Health (ICF) framework to define the eligibility of persons with disabilities in Taiwan. In order to assure a standardized process for eligibility, several scales were developed to fulfill the purpose. The "ICF Scale of Activities of Daily Living" was developed as one of the scales for disability eligibility. It was developed from the chapter 5 (self-care) and chapter 6 (domestic life) of the part of activities and participates from ICF. The aims of this study were to establish the items of The "ICF Scale of Activities of Daily Living" and to examine the inter-rater reliability, test-retest reliability and concurrent validity of it. The "ICF Scale of Activities of Daily Living" includes 11 items, which are washing oneself, caring for body parts, toileting, dressing, eating, drinking, looking after one's health, acquisition of goods and services, preparing meals, doing housework, and caring for house objects. Inter-rater reliability was established from 2 occupational therapists to evaluate the clients at the same time and the test-retest reliability was established to assess the same client twice with 2 weeks apart. In addition, concurrent validity was established to examine the relationship between "Scale of Activities of Daily Living" and "Barthel Index" and "Instrumental Activity of Daily Living." 50 stroke patients aged between 33 and 90 years from out-patient rehabilitation clinics participated in this study. All the participants were eligible to have physical disabilities. Data was analyzed by SPSS 18.0. The results indicated the followings: inter-rater reliability of the "ICF Scale of Activities of Daily Living" was acceptable with Kappa values of 0.43-1.00 (p<.01). The test-retest reliability of the "ICF Scale of Activities of Daily Living" were with Kappa values of 0.31-1.00 (p<.01). Concurrent validity with "Barthel Index" and "Instrumental Activity of Daily Living" was acceptable with rho of 0.44-0.84 (p<.01). The results indicate that the self-care part of "ICF Scale of Activities of Daily Living" possesses satisfactory inter-rater reliability, test-retest reliability and concurrent validity. The "ICF Scale of Activities of Daily Living" seems clinically useful to provide functional profile of activities of daily living in with stroke patients. Further studies should recruit more clients from different diagnosis and disabilities to enhance the utilities of the "ICF Scale of Activities of Daily Living".