臺灣博碩士論文加值系統

摘要
本研究主要目的在於探討訪談法施測功能獨立自主量表（FIM）之可行性，所以檢測訪談法之再測信度與施測者間信度，同時分析訪談法與家訪觀察法間之相等信度，以期減少施測時間，方便做出院後門診追蹤；另外針對認知領域部分，進一步分析功能獨立自主量表與簡易智能狀態量表，高雄認知功能狀態量表及神經精神病徵指標之關聯性，以檢測其同時效度。
再測信度部分評估20位中風病人，兩次施測在7天內完成。施測間信度由兩位物理治療師獨立訪談另外20位中風病人。訪談法與家訪觀察之相等信度部分是評估35位門診中風病人，由一位治療師在門診完成訪談法施測FIM，再由另一位物理治療師至病人家中實際觀察FIM之表現。認知領域同時效度部分，受試者同為相等信度之病人，在物理治療師完成訪談後，接著由心理治療師執行高雄認知功能狀態量表及神經精神病徵指標之施測。
再測信度統計分析結果顯示FIM總分、動作領域及認知領域ICC值皆達.99以上；Kappa一致性解釋度皆在良好（含）以上。施測者間信度統計分析結果顯示FIM總分、動作領域及認知領域ICC值分別為.99，.98，.99；Kappa一致性解釋度有77％在優、良好或中等程度。相等信度統計分析結果顯示FIM總分、動作領域及認知領域ICC值分別為.98，.99，.90；Kappa一致性解釋度有83％在良好或中等程度。認知領域同時效度部分，訪談法FIM理解、表達、解決問題能力、記憶力四項分數和與簡易智能狀態量表總分之相關係數為.71（p<.05）、與高雄認知功能狀態量表相對項目之關聯性相關係數分別為.74，.70，.59，.47（p<.05）；而社交能力與神經精神病徵指標相對項目之關聯性相關係數為-.40（p< .05）。
本研究結論為以訪談法施測FIM與家訪觀察法具有良好的相等信度，同時也具有很好的再測信度及施測者間信度。所以本研究結果可提供臨床人員作為以訪談方式代替直接觀察施測FIM於中風病人之依據。有關認知領域，訪談法施測FIM與神經心理測驗至少有明顯中度相關以上。

Abstract
The main purpose of this study was to investigate the feasibility of scoring Functional Independence Measure (FIM) by interview, in order to reduce evaluation time and to enhance follow-up. The test-retest and inter-rater reliability of the interviewed FIM, and the comparison of home-visit and interviewed FIM were investigated. The association between the cognitive items of the FIM and three neuropsychological measures, MMSE(minimental status examination), KCSE (Kaohsiung cognitive status examination) and NPI(neuropsychiatric inventory), was also explored for concurrent validity.
Twenty stroke patients were interviewed twice in 7 days for the test-retest reliability, while another 20 stroke patients were interviewed by two physical therapists within 7 days for inter-rater reliability. Thirty-five stroke patients were recruited for testing the equivalence of direct observed and interviewed FIM; firstly patients were interviewed in the clinics, within 7 days the observation sessions took place at their own homes, conducted by another physical therapist. The performance of FIM''s cognitive domain of these 35 patients was then compared with KCSE and NPI, both assessed by a psychologist, for concurrent validity.
The results indicated that the scores of FIM total, motor domain and cognitive domain achieved excellent test-retest reliability (ICC  0.99) with good strength of Kappa coefficient. The inter-rater reliability of the respective scores showed similar finding (ICC  0.98, 77 % with moderate or above strength of Kappa coefficient). For the equivalence analysis (interview VS. direct observation), the ICC values were 0.98, 0.99 and 0.90 respectively (83 % with moderate or good strength of Kappa coefficient). Furthermore, the concurrent validity of the cognitive domain of the interview based FIM, such as comprehension, expression, problem-solving memory and social interaction items, were found correlated with corresponding KCSE and NPI items ( ρ = 0.74, 0.70, 0.59 0.47 and 0.40 respectively, p < 0.05). And the good correlation coefficient was found between the cognitive domain (except social interaction) of the interview based FIM and MMSE.( ρ = 0.74, p < 0.05).
The interview based FIM has shown good reliability and validity in this study. The results of this study suggest the interview based FIM is able to provide clinicians a convenient, less time-consuming alternative for functional assessment. The good correlation between cognitive FIM domain and KCSE and NPI, also implies the possibility of the interview based FIM in assessing neuropsychological problems in stroke patients.

目 錄
頁次
摘要……………………………………………………………………Ⅰ
表目次…………………………………………………………………Ⅴ
圖目次…………………………………………………………………Ⅷ
第一章 緒論
第一節 研究背景與研究動機………………………………….1
第二節 名詞定義………………………………………………4
第二章 文獻回顧及探討
第一節 功能性評估之重要性及參考架構……………………6
第二節 功能獨立自主量表之文獻回顧
一、 功能獨立自主量表之發展史……………………………….9
二、功能獨立自主量表之項目………………………….10
三、信度與效度………………………………………….13
四、臨床與研究上之應用……………………………….14
五、功能獨立自主量表之局限………………………………..15
第三節 研究目的及假設……………………………………18
第三章 研究材料與方法
第一節 研究對象……………………………………………20
第二節 資料收集……………………………………………21
第三節 研究步驟……………………………………………25
第四節 資料分析……………………………………………27
第四章 研究結果
第一節 再測（施測者內）信度資料分析結果……………31
第二節 施測者間信度資料分析結果……………………..33
第三節 訪談與家訪觀察之相等信度資料分析結果……..35
第四節 認知領域同時效度資料分析結果………………..37
第五章 討論
第一節 再測（評估者內）信度結果討論…………………..64
第二節 評估者間信度結果討論……………………………..66
第三節 相等信度資料結果討論……………………………..68
第四節 認知領域同時效度結果討論………………………..70
第五節 未來研究方向…………………………………………72
第六章 結論與貢獻…………………………………………………73
參考文獻……………………………………………………………74
附錄

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