| 徐 浪,张 芹,江钟立,王晨光,高 婧,陆 鹏,林 枫.基于ICF和项目反应理论建模评估老年终末期肾病血液透析患者的活动和参与的研究[J].中国康复医学杂志,2023,(10):1385~1392 |
| 基于ICF和项目反应理论建模评估老年终末期肾病血液透析患者的活动和参与的研究 点此下载全文 |
| 徐 浪 张 芹 江钟立 王晨光 高 婧 陆 鹏 林 枫 |
| 南京医科大学康复医学院，江苏省南京市，211100 |
| 基金项目：南京医科大学附属逸夫医院临床重点科室建设专项（YFZDXK02—7）；南京医科大学科技发展基金（NMUB20210353） |
| DOI：10.3969/j.issn.1001-1242.2023.10.009 |
| 摘要点击次数: 505 |
| 全文下载次数: 409 |
| 摘要： |
| 摘要
目的：探索老年终末期肾病（end-stage renal disease，ESRD）血液透析（maintenance hemodialysis，MHD）患者随疗程延续而发生的活动和参与功能改变。
方法：纳入48例ESRD-MHD患者（老年32例和中青年16例）进行相隔6个月的先后2次ICF评估。以其中活动和参与成分的20个类目为起点，构建四种项目反应理论（item response theory，IRT）模型备选。从中选择最优模型，计算患者的个人能力水平（θ）、类目难度和区分度。对θ进行年龄（被试间因素）和测次（被试内因素）的混合方差分析。同时，结合θ对类目难度和区分度的康复意义进行解析。
结果：本研究选取了含12个ICF类目的4参数逻辑斯蒂模型（4PLM）。该模型具有最佳的模型拟合优度（P=0.0657，M2统计量=42.4282）和高信度（潜在类别信度系数=0.9043）。所有条目经标记卡方检验（S-X2检验）均拟合良好（矫正P值都>0.05）。对4PLM估算的θ值进行混合方差分析发现，年龄（P=0.020）和测次（P=0.002）都有显著效应。在半年随访时，老年组比入组时θ值更低（P=0.0106），而且显著低于同时期中青年组（P=0.0002）。d9205（社会活动，﹣0.1708 Logit）和d450（步行，﹣0.4222 Logit）难度高于半年随访时的老年组平均能力水平（﹣0.5211 Logit）。
结论：基于ICF的项目反应理论模型，为评估终末期肾病血液透析患者的个人能力水平提供了新的可能。 |
| 关键词：国际功能、残疾和健康分类 终末期肾病 血液透析 项目反应理论 康复 |
| CF-based assessment of activities and participation for aged persons with end-stage renal disease and maintenance hemodialysis via item response theory modeling Download Fulltext |
|
| School of Rehabilitation， Nanjing Medical University， 210031 |
| Fund Project: |
| Abstract: |
| Abstract
Objective： To detect the change of functioning level in activities and pariticipation for aged persons with end-stage renal disease （ESRD） and maintenance hemodialysis （MHD）.
Method： Forty-eight ESRD-MHD patients （n=32 in older group， and 16 in younger group） completed ICF evaluations for the first time and 6-month follow-up. Twenty categories in activities and participation component of ICF were selected for generating 4 candidate IRT models. We calculated the person abilities （θ）， item difficulty and discrimination for the model with best goodness-of-fit. The θ was compared via mixed analysis of variance （mixed-ANOVA） with age as between-subject factor and time as within-subject factor. The item difficulty and discrimination were interpreted for their relationships with θ.
Result： Four-parametric logistic model （4PLM） with 12 ICF categories was selected. The 4PLM had best goodness-of-fit （P=0.0657，M2 statistic=42.4282） and high internal consistency （latent category reliability coefficient=0.9043）. All categories were tested with signed chi-square （S-X2） method and were proved to be with good fitness， i.e.， the adjusted P values were all >0.05. The mixed-ANOVA showed that both age（P=0.020） and time（P=0.002） had significant effects on θ. The older group had significantly（P=0.0106） decreased θ values at the follow-up timepoint in comparison with the initial test. They also had significantly（P=0.0002） small θ values in comparison with the values of younger group at the follow-up timepoint. The d9205 （socializing， ﹣0.1708 Logit） and d450 （walking， ﹣0.4222 Logit） are more difficult than the average level of the person abilities in older group.
Conclusion： The Item response theory model based on ICF provides a new possibility for evaluating the individual ability level of hemodialysis patients with end-stage renal disease. |
| Keywords:International Classification of Functioning Disability and Health（ICF） end-stage renal disease hemodialysis item response theory rehabilitation |
|
| 查看全文 查看/发表评论 |
