中風病人姿勢控制評估量表之心理計量特性

The Psychometric Characteristics of the Postural Assessment Scale for Stroke Patients

中風病人姿勢控制量表(Postural Assessment Scale for Stroke patients, PASS)為1999年發展出來的新量表，主要評量中風病人之平衡能力。由於PASS的心理計量特性尚未完備，本研究首度驗證PASS應用於中風初期病人的信度、效度與反應性(responsiveness)。82位中風病人（平均年齡約71歲），於發病後第7天與第14天參與本研究。研究者以Cronbach alpha檢驗PASS項目之內在一致性，再以 intraclass correlation coefficient(ICC)檢驗 PASS 之施測者間信度。以 Spearman rho 檢驗病人於PASS 得分與其他具備良好心理計量之量表的關連程度，藉以驗證PASS之效度。再以效應值(effect size)驗證PASS呈現病人於發病後第7～14天期間之恢復程度，藉以驗證PASS之反應性。結果發現（1）信度方面：PASS之內在一致性高(alpha =0.96)，且具有相當高的施測者間信度（總分的ICC=0.92）。（2）效度度方面：PASS與伯格氏平衡量表(Berg Balance Scale)總分之間的關連程度極高(Spearman rho =0.93)， 顯示PASS具有良好的同時效度。PASS與巴氏日常生活功能量表(Barthel Index)總分之間的關連程度高(rho =0.84)，顯示PASS具有良好的收斂效度。另外，PASS與福格邁爾動作量表（Fugl-Meyer motor test測量病人之動作能力，可代表病人之損傷程度）總分之間的關連程度高rho=0.75，顯示病人於PASS之得分與其病情之嚴重程度關連性高，代表PASS之區辨效度好。（3）反應性方面：病人中風第7天至第14天期間，PASS分數變化之效應值為0.78，且Wilcoxon Z=6.32，p<0.001，顯示PASS 具備良好的反應性。以上結果顯示：PASS使用於評估中風初期病人時具有良好的心理計量特性。PASS施測簡便、快速，適合推廣於臨床使用。

The Postural Assessment Scale for Stroke Patients (PASS) was developed in 1999 to measure balance function in stroke patients. However, the psychometric characteristics of the PASS have rarely been examined. The purpose of this study was to examine the reliability (inter-rater reliability and internal consistency), validity (concurrent validity, convergent validity, and discriminant validity) and responsiveness of the PASS in the acute stage of stroke patients. Eighty-two patients (with a mean age of 71) on the 7th and 14th days after stroke onset participated in this study. The internal consistency and inter-rater reliability of the PASS were good (Cronbach’s alpha = 0.96, intraclass correlation coefficient = 0.93, respectively). The PASS scores closely correlated with scores of the Berg balance scale, Barthel index (measuring self-care) and Fugl-Meyer motor test (Spearman’s rho=0.93, 0.84 and 0.75, respectively, p<0.0001), indicating a high level of validity for the PASS. The results of effect size (0.78) and Wilcoxon’s matched-pairs signed-rank tests (Z=6.32, p<0.001) demonstrated that this measure also had good responsiveness. These results showed very acceptable levels of reliability, validity, and responsiveness of the PASS for both clinicians and researchers.