목적 : 본 연구는 뇌졸중 환자의 Hemiplegic Motor Behavior Test(HMBT)에 대한 타당도와 신뢰도를 알아보고자 하였다. 연구방법 : 본 연구를 위하여 국립재활원에 입원한 34명의 뇌졸중 환자를 대상으로 Hemiplegic Motor Behavior Tests(HMBT)가 임상적으로 뇌졸중 환자의 운동기능을 평가하기에 적합한지 알아보고자 하였다. 기준관련 타당도 분석을 이용하여 일상생활동작 수행 정도(Modified Barthel Index: MBI), 기능적 독립 수준(Modified Rankin Scale: MRS)과 상지기능 수행 평가 도구인 Brunnstrom Stage Scale(BSS), Hand Movement Scale(HMS), 자세조절(Postural Assessment Scale for Stroke: PASS-MP/CP), 체간 조절(Trunk Control Test: TCT)과의 피어슨(Pearson correlation)상관관계를 알아보았다. HMBT의 측정자내 신뢰도(Inter-rater reliability)와 측정자간 신뢰도(Intra-rater reliability)를 알아보기 위하여 Kappa계수와 Intraclass Correlation Coefficient(ICC)를 구하였으며, HMBT항목들의 내적 일치도를 알아보기 위하여 Cronbach's alpha coefficient를 구하였다. 결과 : HMBT의 U/E, H/F에 대한 측정자내 신뢰도는 각각 Kappa=.960～.950, ICC=.995～.994이었으며, 측정자간 신뢰도는 Kappa=.959～.918, ICC=.990～.986으로 신뢰도는 높은 것으로 나타났고 내적일치도는 Cronbach's alpha=.931로서 매우 높게 나타났다. HMBT는 MBI(r=.64～.66), MRS(r=-.63～.71), HMS(r=.82), BSS-Arm/Hand(r=.81～.82)와도 높은 상관관계를 보였고 PASS-MP/CP(r=.42～.52), TCT(r=.55～.64)간에 유의한 상관관계가 있는 것으로 나타나 신뢰도와 타당도가 높은 것으로 나타났다. 결론 : 본 연구 결과에서 뇌졸중 환자를 위한 HMBT는 MBI, HMS, BSS, PASS-MP/CP, TCT, MRS에서 유의한 상관관계가 있는 것으로 나타났으며, 높은 타당도와 신뢰도 및 내적 일치도를 보여 뇌졸중 환자의 실제적인 임상 평가도구로 활용이 가능할 것이다.
Objective : The purpose of this study was to assess the reliability and validity of a hemiplegic motor behavior test as applied to hemiplegic stroke patients. Methods : The subjects consisted of 34 stroke patients from the Korea National Rehabilitation Center in Seoul. The Hemiplegic Motor Behavior Tests(HMBTs) were divided into three areas(upper extremities, hands and fingers, and lower extremities) on a six-point ordinal scale(stages 1-6). The HMBT/U/E․H/F score was compared with Barthel Index(BI), Hand Movement Scale(HMS), and Brunstrumm Stage Scale (BBS-Arm/hand). and the Postural Assessment Scale for Stroke patients(PASS-MP/CP), Trunk Control Test(TCT), Modified Rankin Scale(MRS) were analyzed using a Pearson product correlation. Intra-rater reliability was measured by comparing the results from the therapists who examined the patients twice. To determine inter-rater reliability, the results of both therapist who observed the patient simultaneously were compared. The intra-rater, inter-rater reliability was measured using the kappa coefficient and intraclass correlation coefficient. The internal consistency of the scale was evaluated using Cronbach's alpha. Results : Intra-rater and Inter-rater reliability were high; kappa values and ICC values for different items ranged from .960 to .950, .995 to .994, and from .918 to .959, .986 to .990, respectively. The internal consistency was excellent (Cronbach's alpha = 0.931). There were significant correlations between the HMBT and MBI (r=.64 to .66), MRS (r=-.63 to -.71), HMS (r=.82), BBS-Arm/hand (r=.81 to .82), PASS-MP/CP (r=.42 to .52), and TCT (r=-.55 to .64). Conclusion : The HMBT is acceptable for the evaluation of motor behavior of stroke patients in clinical practice. These findings provide strong evidence of the predictive value of motor behavior tests on ADL function, independence state, and performance of U/E functionality in stroke patients. A guideline for the treatment and level of quality of motor behavior can be derived from the assessment.
Ⅰ. 서 론 Ⅱ. 연구 방법 Ⅲ. 연구 결과 Ⅳ. 고 찰 Ⅴ. 결 론 참고문헌
