平衡量表於中風住院病人之臨床應用

Clinical Applications of Balance Measures in Stroke Inpatients

柏格氏平衡量表（Berg balance scale, BBS）及福格邁爾運動量表之平衡次量表（Fugl-Meyer motor assessment scale-balance subscale, FB）常用來評量中風病人之平衡能力。BBS及FB雖有信度及部分效度之驗證，但尚無反應性與預測效度（predictive validity）之驗證及比較，本研究首度驗證與比較二平衡量表用於復健部之中風病人，以BBS及FB評估其於住院初期及出院時之平衡能力。結果發現：BBS及FB於復健住院期間之四種反應性指標：1. 效應值（effect size）為0.99（BBS）及1.09（FB）；2. 標準化之反應平均值（standardized reponse mean）：1.73（BBS）及1.24（FB）；3. 配對t檢定之t值：12.6（BBS）及9（FB）；4. 病人住院期間二量表之變化量與巴氏日常生活量表之變化量呈現中度相關，r=0.44（BBS）與0.52（FB）。病人住院初期二平衡量表之分數與出院時行走功能之相關性高Spearman rho=0.71（BBS）與0.65（FB）；病人住院初期二平衡量表之分數與出院時日常生活功能之相關性高 Pearson r=0.6（BBS）與0.54（FB），代表二量表皆具備預測效度。二量表彼此間及二量表與巴氏日常生活量表之相關性高。以上結果顯示BBS及FB用於復健住院期間之中風病患皆具有良好的反應性與效度。FB之項目少、評分簡單且施測快速，所以FB似較BBS更適於臨床使用。

The Berg balance scale(BBS) and balance subscale of the Fugl-Meyer motor assessment scale (FB) have been widely used to evaluate balance in stroke patients. However, the responsiveness and predictive validity of both scales are rarely examined. The purposes of this study were to compare the responsiveness and predictive validity of the two balance scales in stroke inpatients. The concurrent and construct validity of both scales were also examined. Fifty-three stroke inpatients receiving rehabilitation, who were first stroke onset, participated in this study. The BBS and FB were used to assess the patients’ balance at their admission to and discharge from the Physical Medicine and Rehabilitation Department of National Taiwan University Hospital. Four indexes of responsiveness obtained from two balance scales are listed as follows: 1. effect size: 0.99 for BBS and 1.09 for FB; 2. standardized response mean: 1.73 for BBS and 1.24 for FB; 3. paired t value: 12.6 for BBS and 9 for FB; and 4. The relationship between the change in scores of both BBS and FB, and Barthel Index was moderate (Pearson r=0.44 for BBS and 0.52 for FB). The BBS and FB scores at admission were closely correlated with the ambulation function measuring by Motor assessment scale at discharge (Spearman r=0.7l for BBS and 0.65 for FB). The BBS and FB scores are highly correlated. The BBS and FB scores are closely correlated with the Barthel index score. In conclusion, the responsiveness and validity of both BBS and FB were well accepted in stroke inpatients. Since the FB is easier and faster to administer than the BBS, the FB seems to be more suitable in clinical settings than the BBS.