Barthel指数在长期护理机构老年痴呆患者中的适用性分析

doi:10.3761/j.issn.0254-1769.2019.07.010

摘要/Abstract

摘要：

目的检验Barthel指数在长期护理机构老年痴呆患者日常生活活动能力评估中的适用性,为制订量表整体难度与老年痴呆患者实际能力相符的Barthel指数提供参考依据。方法采用横断面调查法,便利选取广州市某长期护理机构的160例老年痴呆患者进行Barthel指数评估,并对测量结果进行Rasch分析。结果 Barthel指数第一维度解释了91%的变异,第二维度解释了0.6%的变异,各条目相互独立,量表具有良好的单维性,但“平地行走”条目与Rasch模型拟合欠佳（infit MNSQ=1.53,Z=3.8）。Barthel指数条目难度与老年痴呆患者实际能力不匹配,且各条目之间的难度间距离均偏小（<1.4 logits）,尤其是“平地行走”条目。Barthel指数各条目在不同性别及不同痴呆严重程度患者中无功能差异。Barthel指数的受试者信度为0.91,条目信度为0.99。结论 Barthel指数是一个单维性量表,有良好的信度,但量表整体难度与老年痴呆患者实际能力不符,有必要降低条目难度,调整条目之间的难度间距,以提高Barthel指数在长期护理机构老年痴呆患者中的适用性。

关键词: 痴呆, 长期护理机构, Barthel指数, 日常生活活动, Rasch分析, 老年护理

Abstract:

Objective To investigate the applicability of the original Barthel Index（BI） in long-term care facility of institutionalized patients with dementia,to provide a reference for the Barthel Index of the overall difficulty of the scale and the actual ability of institutionalized patients with dementia.Methods A total of 160 patients with dementia were included in this cross-sectional study from a nursing home in Guangzhou. The BI was administered among patients and data was analyzed by Rasch analysis.Results The Rasch first dimension explained 91% of the variance,while the second dimension explained 0.6%. Local dependence and item bias had not been detected. The item“mobility”（infit MNSQ=1.53,Z=3.8） showed misfit to the Rasch model. The item-person maps demonstrated that the mistargeting of the BI to the patient. The items had narrow intervals between response categories（<1.4 logits）. DIF had not been detected between gender subgroups,as well as subgroups among severity of dementia. The reliability of the Barthel Index person reliability was 0.91,item reliability was 0.99.Conclusion Although the Barthel Index is an unidimensional and reliable scale,however,the overall difficulty of the scale is not consistent with the actual ability of dementia patients. The revision of the Barthel Index,such as decreasing the item difficulty and adjusting the intervals between response categories,is necessary to improve the applicability of the scale in institutionalized patients with dementia.

Key words: Dementia, Long-Term Care Facility, Barthel Index, Activity of Daily Living, Rasch Analysis, Geriatric Nursing

丁琳, 陈素虹, 吴家岚, 易雅研, 廖晓艳. Barthel指数在长期护理机构老年痴呆患者中的适用性分析[J]. 中华护理杂志, 2019, 54(7): 1012-1016.

DING Lin, CHEN Suhong, WU Jialan, YI Yayan, LIAO Xiaoyan. Applicability of Barthel Index in long-term care facility of institutionalized patients with dementia[J]. Chinese Journal of Nursing, 2019, 54(7): 1012-1016.

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