·世界全科醫(yī)學(xué)工作研究·
國(guó)際版跌倒效能量表漢化后信效度評(píng)價(jià)
郭啟云,郭沐潔,張林,李丹,郭麗娜,高涵,劉堃
作者單位:121001遼寧省錦州市,遼寧醫(yī)學(xué)院護(hù)理學(xué)院(郭啟云,張林,李丹,郭麗娜,高涵,劉堃);濟(jì)寧醫(yī)學(xué)院附屬醫(yī)院CT室(郭沐潔)
通信作者:劉堃,121001遼寧省錦州市,遼寧醫(yī)學(xué)院護(hù)理學(xué)院;E-mail:1951361282@qq.com
【摘要】目的評(píng)價(jià)漢化版跌倒效能量表(FES)的信效度,為其評(píng)價(jià)我國(guó)社區(qū)老年人跌倒風(fēng)險(xiǎn)的價(jià)值提供參考。方法對(duì)英文國(guó)際版FES(FES-I)進(jìn)行翻譯、文化調(diào)適,得到試驗(yàn)版FES。由20名老年人填寫試驗(yàn)版FES,完善后得到漢化版FES。采用方便取樣方法,于2014年3—6月在錦州市區(qū)發(fā)放問卷420份,有效回收400份。選擇40名調(diào)查對(duì)象于2周后進(jìn)行重測(cè)。結(jié)果量表Cronbach′s α系數(shù)為0.921,Guttman分半信度系數(shù)為0.914,各條目得分組內(nèi)相關(guān)系數(shù)為0.472~0.849,各條目得分與量表總分相關(guān)系數(shù)為0.541~0.835(P<0.05)。重測(cè)信度系數(shù)為0.906。5名護(hù)理學(xué)專業(yè)教師對(duì)量表進(jìn)行評(píng)分,各條目?jī)?nèi)容效度指數(shù)(CVI)為0.822~1.000,全體一致性CVI為0.834,平均CVI為0.845。采用主成分分析法,經(jīng)方差正交旋轉(zhuǎn)后得到2個(gè)公因子,特征值均>1,累計(jì)方差貢獻(xiàn)率為69.82%。驗(yàn)證性因子分析(CFA)顯示,卡方/自由度比(CMIN/DF)為1.14,擬合優(yōu)度指數(shù)(GFI)為0.916,調(diào)整的擬合優(yōu)度指數(shù)(AGFI)為0.903,近似誤差均方根(RMSEA)為0.035,規(guī)范擬合指數(shù)(NFI)為0.943,相對(duì)適配指數(shù)(RFI)為0.942,增值擬合指數(shù)(IFI)為0.905,非歸準(zhǔn)適配指數(shù)(TLI)為0.947,比較擬合指數(shù)(CFI)為0.955,標(biāo)準(zhǔn)化回歸系數(shù)0.435~0.668。漢化版FES評(píng)價(jià)社區(qū)老年人跌倒風(fēng)險(xiǎn)價(jià)值的ROC曲線下面積為0.741〔95%CI(0.689,0.794),P<0.05〕??偡峙R界點(diǎn)為35分時(shí),靈敏度為0.71,特異度為0.63。結(jié)論漢化版FES評(píng)價(jià)社區(qū)老年人跌倒風(fēng)險(xiǎn)具有良好的信效度,對(duì)評(píng)價(jià)我國(guó)社區(qū)老年人跌倒效能或自信心具有一定的推廣價(jià)值。
【關(guān)鍵詞】意外跌倒;跌倒效能量表;老年人;信度;效度
【中圖分類號(hào)】R 12
收稿日期:(2015-08-09;修回日期:2015-11-04)
郭啟云,郭沐潔,張林,等.國(guó)際版跌倒效能量表漢化后信效度評(píng)價(jià)[J].中國(guó)全科醫(yī)學(xué),2015,18(35):4273-4276.[www.chinagp.net]
Guo QY,Guo MJ,Zhang L,et al.Evaluation of the reliability and validity of Chinese version of falls efficacy scale[J].Chinese General Practice,2015,18(35):4273-4276.
Evaluation of the Reliability and Validity of Chinese Version of Falls Efficacy ScaleGUOQi-yun,GUOMu-jie,ZHANGLin,etal.SchoolofNursing,LiaoningMedicalUniversity,Jinzhou121001,China
Abstract【】ObjectiveTo evaluate the reliability and validity of Chinese version of Falls Efficacy Scale(FES) and provide references for the risk assessment of the elderly falling down.MethodsThe English version of FES-I was translated into Chinese with an adaptation to Chinese culture,and a trial version of FES was made.The trial version FES-I was filled by 20 elderly people,after which the trial version was improved and the ultimate Chinese version was obtained.Totally 420 questionnaires were sent out and 400 valid ones were retrieved using convenient sampling method in Jinzhou from March to June in 2014.Of the 400 respondents,40 were given the same questionnaire again two weeks later.ResultsCronbach′s α coefficient and split-half reliability coefficient of Guttman were 0.921 and 0.914 respectively.Every item score of the intraclasscorrelation coefficient was 0.472-0.849.The correlation coefficient of every item and total scale score was 0.541-0.835(P<0.05).Test-retest reliability coefficient was 0.906.Scores were give by 5 nursing professional teachers on the scale.Content validity index of every item(CVI)was 0.822-1.000.CVI of the whole consistency and the average were 0.834 and 0.845.Two common factors were obtained after variance orthogonal rotation by principal component analysis and the cumulating contribution rate of the two common factors whose feature value >1 was 69.82%.The confirmatory factor analysis(CFA) indicated that the values of CMIN/DF,GFI,AGFI,RMSEA,NFI,RFI,IFI,TLI,CFI and standardization regression coefficient were 1.14,0.916,0.903,0.035,0.943,0.942,0.905,0.947,0.955 and 0.435-0.668 respectively.Area under curve of ROC was 0.741〔95%CI(0.689,0.794),P<0.05〕 by Chinese version of FES assessing the risk of the aged falling down.The sensibility and specificity were 0.71 and 0.63 respectively when the total score critical point of the scale was 35.ConclusionChinese version of FES has a good reliability and validity in the risk assessment of the elderly falling down.Therefore,it has certain promotional value in the risk assessment.
【Key words】Accidental falls;Fall efficacy scale;Aged; Reliability;Validity
隨著年齡增長(zhǎng),老年人跌倒發(fā)生風(fēng)險(xiǎn)逐年增加,且50%的跌倒會(huì)引起嚴(yán)重的損傷,已嚴(yán)重影響老年人的健康和生活質(zhì)量[1]。跌倒危險(xiǎn)因素的評(píng)估對(duì)預(yù)防和預(yù)測(cè)老年人跌倒尤為重要[2]。通過對(duì)跌倒相關(guān)危險(xiǎn)因素的評(píng)估,制訂相應(yīng)的預(yù)防措施,可有效降低老年人跌倒發(fā)生率[3]。國(guó)際版跌倒效能量表(FES-I)主要測(cè)量老年人在不發(fā)生跌倒的情況下,對(duì)從事簡(jiǎn)單或復(fù)雜身體活動(dòng)和社會(huì)活動(dòng)的擔(dān)憂程度[4-5],已被Kempen等[6]應(yīng)用于英、德、荷蘭等國(guó)家的社區(qū)老年人,結(jié)果均顯示具有良好的信度和效度。該量表最大的優(yōu)勢(shì)在于選擇了更多有關(guān)跨文化的條目,所列的日常活動(dòng)在評(píng)估社區(qū)老年人跌倒風(fēng)險(xiǎn)工具中最為完善,可在不同語言和文化背景下廣泛使用[7-13]。與跌倒效能量表(FES)相比,F(xiàn)ES-I對(duì)害怕跌倒程度較低的老年人有較高的敏感性,而且能較好地測(cè)量與社會(huì)活動(dòng)相關(guān)且需要更多平衡的戶外活動(dòng),對(duì)社區(qū)老年人害怕跌倒的評(píng)估有獨(dú)特作用。目前,尚未見FES-I在中國(guó)社區(qū)老年人群中使用的相關(guān)報(bào)道。本研究旨在引進(jìn)FES-I,對(duì)其進(jìn)行翻譯和信效度評(píng)價(jià),初步探討FES-I在我國(guó)社區(qū)老年人群中的適用性,為制定有效的護(hù)理措施干預(yù)社區(qū)老年人跌倒提供依據(jù)。
1對(duì)象與方法
1.1調(diào)查對(duì)象根據(jù)Kendall工作原則,樣本量為量表?xiàng)l目數(shù)的10~20倍,本研究樣本量確定為420名。采用方便抽樣方法,于2014年3—6月在錦州市區(qū)發(fā)放問卷420份,有效回收400份,有效回收率為95.24%。調(diào)查對(duì)象男172例,女228例;年齡60~96歲,平均年齡(72.4±7.6)歲;已婚301例,喪偶99例;有跌倒史124例,無跌倒史276例。調(diào)查對(duì)象納入標(biāo)準(zhǔn):(1)年齡≥60歲;(2)意識(shí)清楚,有語言表達(dá)能力或閱讀能力,與調(diào)查者無溝通障礙;(3)知情同意,愿意配合本調(diào)查。排除標(biāo)準(zhǔn):(1)非常住人口;(2)有嚴(yán)重心腦肺等疾病。
1.2方法
1.2.1FES-IFES-I是16個(gè)條目組成的4選項(xiàng)求和順序量表,其內(nèi)容包括在室內(nèi)的身體活動(dòng)(打掃房間、穿脫衣服、準(zhǔn)備簡(jiǎn)單的飯菜、洗澡、購(gòu)物、從椅子上站起來或坐下、爬樓梯、接聽電話、拜訪親友、參加社會(huì)活動(dòng))和在室外的身體活動(dòng)(散步、伸手拿高過頭頂?shù)臇|西、在滑的路面上行走、在擁擠的人群中行走、在不平整的路面上行走、上下斜坡)[6]。各條目計(jì)分為1~4分(表示從“一點(diǎn)信心也沒有”到“非常有信心”),總分16~64分,總分越高說明跌倒效能感或自信心越強(qiáng)。
1.2.2翻譯及調(diào)適本研究征得FES-I原作者同意,并由其提供英文版。由3名具有雙語能力的護(hù)理學(xué)在讀碩士對(duì)英文版FES-I進(jìn)行翻譯,再由2名具有較高英語水平的護(hù)理學(xué)專家進(jìn)行文化調(diào)適(正向翻譯、綜合、回譯),以保證翻譯的準(zhǔn)確性,得到試驗(yàn)版量表。由20名老年人填寫試驗(yàn)版量表,根據(jù)填寫、反饋情況再次修改完善,最終得到在中國(guó)文化背景下的漢化版FES。
1.2.3資料收集對(duì)3名調(diào)查者進(jìn)行統(tǒng)一培訓(xùn)(研究方法和條目解釋),采用現(xiàn)場(chǎng)詢問、匿名的方式進(jìn)行問卷調(diào)查。由調(diào)查對(duì)象自愿回答或填寫,對(duì)其隱私嚴(yán)格保密。選擇40名調(diào)查對(duì)象于2周后進(jìn)行重測(cè)。
1.3統(tǒng)計(jì)學(xué)方法采用SPSS 17.0和AMOS 17.0進(jìn)行統(tǒng)計(jì)分析。采用Cronbach′s α系數(shù)和Guttman分半信度系數(shù)評(píng)價(jià)量表的內(nèi)部一致性,Spearman相關(guān)分析評(píng)價(jià)重測(cè)信度;采用內(nèi)容效度指數(shù)(CVI)評(píng)價(jià)量表內(nèi)容效度;將回收到的量表隨機(jī)分為2等份,分別進(jìn)行探索性因子分析(EFA)和驗(yàn)證性因子分析(CFA)以評(píng)價(jià)量表結(jié)構(gòu)效度;以有無跌倒史為標(biāo)準(zhǔn),采用ROC曲線分析量表評(píng)價(jià)跌倒風(fēng)險(xiǎn)的準(zhǔn)確性。以P<0.05為差異有統(tǒng)計(jì)學(xué)意義。
2結(jié)果
2.1信度量表Cronbach′s α系數(shù)為0.921,Guttman分半信度系數(shù)為0.914,各條目得分組內(nèi)相關(guān)系數(shù)為0.472~0.849,各條目得分與量表總分相關(guān)系數(shù)為0.541~0.835(P<0.05)。對(duì)40名調(diào)查對(duì)象2周后重測(cè),重測(cè)信度系數(shù)為0.906。3名調(diào)查者間的信度系數(shù)為0.856。
2.2內(nèi)容效度5名護(hù)理學(xué)專業(yè)教師對(duì)量表進(jìn)行評(píng)分,各條目CVI為0.822~1.000,全體一致性CVI為0.834,平均CVI為0.845。
2.3EFAKMO值為0.872,Bartlett′s球形檢驗(yàn)有統(tǒng)計(jì)學(xué)意義(χ2=3 529.724,P<0.01),可以進(jìn)行因子分析。采用主成分分析法,經(jīng)方差正交旋轉(zhuǎn)后得到2個(gè)公因子,特征值均>1,累計(jì)方差貢獻(xiàn)率為69.82%。公因子1在條目1~7、10、12、16有較大的載荷,公因子2在條目8~9、11、13~15有較大的載荷。各條目共同度為0.681~0.940,絕大多數(shù)接近或超過0.700,2個(gè)公因子已經(jīng)能夠較好地反映條目所包含的大部分信息(見表1)。
表1 因子載荷矩陣及各條目公共度
2.4CFA采用極大似然法對(duì)16個(gè)條目進(jìn)行CFA,經(jīng)修正后得到標(biāo)準(zhǔn)化兩因子結(jié)構(gòu)方程模型,模型擬合指數(shù)良好,卡方/自由度比(CMIN/DF)為1.14,擬合優(yōu)度指數(shù)(GFI)為0.916,調(diào)整的擬合優(yōu)度指數(shù)(AGFI)為0.903,近似誤差均方根(RMSEA)為0.035,規(guī)范擬合指數(shù)(NFI)為0.943,相對(duì)適配指數(shù)(RFI)為0.942,增值擬合指數(shù)(IFI)為0.905,非歸準(zhǔn)適配指數(shù)(TLI)為0.947,比較擬合指數(shù)(CFI)為0.955,標(biāo)準(zhǔn)化回歸系數(shù)0.435~0.668(見圖1)。
2.5ROC曲線漢化版FES評(píng)價(jià)社區(qū)老年人跌倒風(fēng)險(xiǎn)價(jià)值的ROC曲線下面積為0.741〔95%CI(0.689,0.794),P<0.05〕。量表總分臨界點(diǎn)為35分時(shí),靈敏度為0.71,特異度為0.63(見圖2)。
3討論
3.1信度信度又稱可靠性、重復(fù)性、穩(wěn)定性或精密度,反映相同條件下重復(fù)測(cè)定結(jié)果的一致程度。評(píng)價(jià)信度最常用指標(biāo)有Cronbach′s α系數(shù)、組內(nèi)相關(guān)系數(shù)和分半信度[14]。本研究Cronbach′s α系數(shù)為0.921。FES-I Cronbach′s α系數(shù)為0.960,英國(guó)、荷蘭、土耳其、巴西、希臘、德國(guó)版均高于0.900[6-8]。本研究各條目組內(nèi)相關(guān)系數(shù)為0.472~0.849,各條目得分與量表總分呈中高度相關(guān), FES-I各條目間相關(guān)系數(shù)為0.29~0.79,土耳其、意大利、希臘、巴西、荷蘭、德國(guó)版均接近甚至高于0.80[9-13]。漢化版FES與國(guó)際版相比有一定差異,可能是由于地域、東西方文化差異及樣本量導(dǎo)致,但總體各項(xiàng)指標(biāo)達(dá)到統(tǒng)計(jì)學(xué)標(biāo)準(zhǔn),說明此量表的信度較好[14]。
注:圖中數(shù)據(jù)為路徑系數(shù)
圖1修正后的標(biāo)準(zhǔn)化兩因子結(jié)構(gòu)方程模型
Figure 1Structural equation model of two standardized factors after modification
圖2 漢化版FES評(píng)價(jià)社區(qū)老年人跌倒風(fēng)險(xiǎn)價(jià)值的ROC曲線
Figure 2ROC curve of Chinese version of FES assessing the risk of the elderly falling down
3.2效度效度又稱真實(shí)性或準(zhǔn)確性,用以反映測(cè)量結(jié)果與“真實(shí)值”接近程度。評(píng)價(jià)量表效度最常用的指標(biāo)有內(nèi)容效度、結(jié)構(gòu)效度[14]。漢化版FES由5名護(hù)理學(xué)專家評(píng)價(jià)所得CVI為0.822~1.000,全體一致性為CVI為0.834,平均CVI為0.845,均大于0.80,說明其內(nèi)容效度較好[15]。結(jié)構(gòu)效度通常使用EFA和CFA進(jìn)行評(píng)價(jià)。本研究結(jié)果提取的2個(gè)公因子(室內(nèi)活動(dòng)和室外活動(dòng))方差累計(jì)貢獻(xiàn)率>50%,各條目公共度均>0.5,說明EFA結(jié)果較為理想。本研究對(duì)漢化版FES進(jìn)行CFA,結(jié)果顯示,CMIN/DF<3、GFI、AGFI、NFI、RFI、IFI、TLI、CFI均>0.9、RMSEA<0.05,提示本量表模型擬合指標(biāo)基本達(dá)到標(biāo)準(zhǔn),說明結(jié)構(gòu)效度較為穩(wěn)定[16]。
3.3ROC曲線漢化版FES評(píng)價(jià)社區(qū)老年人跌倒風(fēng)險(xiǎn)價(jià)值的ROC曲線下面積為0.741,診斷準(zhǔn)確性中等[14,16],靈敏度、特異度與土耳其版基本一致[7]。
本研究顯示,漢化版FES評(píng)價(jià)社區(qū)老年人跌倒風(fēng)險(xiǎn)有良好的信效度和準(zhǔn)確性,具有一定的推廣價(jià)值。本研究局限于錦州市社區(qū)老年人,未進(jìn)行效標(biāo)效度的測(cè)量,且調(diào)查對(duì)象排除了腦卒中、帕金森人群,抽樣的廣度和深度需完善,未來需開展質(zhì)性、量性研究的結(jié)合,進(jìn)一步評(píng)價(jià)此量表的信效度及推廣應(yīng)用價(jià)值。
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(本文編輯:吳立波)