脊髓损伤痉挛评估量表的信度及各量表间的相关性分析

目的 探讨分析脊髓损伤痉挛状态评估工具(SCI-SET)量表、改良Penn痉挛频率(MPSFS)量表、脊髓痉挛性反应评估工具(SCATS)量表和目测类比法量表(VAS)评估脊髓损伤患者肌肉痉挛的信度及各量表间相关性。 方法 2位治疗师分别应用上述4个量表对35例脊髓损伤患者的痉挛情况进行评估。首先，第一位物理治疗师应用上述4个量表对患者的肌肉痉挛情况进行第1次评估，另一位物理治疗师在第一位物理治疗师评估结束约半个小时后对患者再进行1次评估。3d后，由第一位物理治疗师在相同时间段和环境下对所有患者进行第2次重复评估。计算各量表重复评估及不同测试者间评估的组内相关系数（ICC）及其相应的测量标准误（SEM）、最小可测得差异值（MDD95），分析第一位治疗师首次评估结果各量表间的相关性。 结果 SCI-SET量表的重测信度和不同测试者间的信度均为优秀（ICC=0.969和0.989）；MPSFS量表的重测信度为优秀（ICC=0.940），不同测试者间的信度为好（ICC=0.898）；SCATS量表的重测信度和不同测试者间的信度均为优秀（ICC=0.948和0.939）；VAS量表评估痉挛的重测信度和不同测试者间的信度均为优秀（ICC=0.962和0.974）。SCI-SET、MPSFS、SCATS以及VAS等脊髓损伤痉挛评估量表的相关性分析结果显示，各痉挛量表间均有显著相关性（P<0.05），其中SCI-SET与其它量表间呈负相关，而其余各量表间均呈正相关。SCI-SET与MPSFS间（r=-0.421）、SCI-SET与SCATS间（r=-0.457）以及MPSFS与SCATS间（r=0.498）呈中等相关性，而其它量表两两之间相关性较高（r=0.548～0.938），且差异均有统计学意义（P<0.05）。 结论 MPSFS、SCATS、VAS 和SCI-SET量表具有良好的重测信度和测试者间信度，适用于脊髓损伤后痉挛的评估。

The reliability and utility of spasticity scales for patients with spinal cord injury

Objective To explore the reliability of the modified Penn spasm frequency scale (MPSFS), the spinal cord assessment tool for spasticity (SCATS), the spinal cord injury spasticity evaluation tool (SCI-SET) and visual analogue scales (VASs) and their inter-correlation so as the provide evidence for clinical application. Methods The spasticity of thirty-five patients with spinal cord injury was assessed by 2 raters using the 4 scales with an interval of half an hour between assessments. Three days later, all of the subjects were again evaluated by one of the 2 raters in the same environment. The intra-class correlation coefficient (ICC), standard error of measurement (SEM) and minimal detectable difference (MDD95) were calculated, and the correlations among the 4 scales were analyzed. Results The test-retest ICC for the MPSFS was 0.94 and the inter-rater reliability ICC was 0.90. For the SCATS they were 0.948 and 0.939 respectively., For the VAS they were 0.962 and 0.974, and for the SCI-SET they were 0.969 and 0.989. There was significant inter-correlation among all four scales, with negative correlation between the SCI-SET and the others. The observed correlations were all of medium strength (r=-0.421 to -0.5), except for a high correlation between the SCI-SET and VAS results (r=0.55 to 0.94). Conclusion The MPSFS, SCATS, VAS and SCI-SET are all reliable tools for evaluating spasticity among people with spinal cord injury. All can be applied in clinical practice.