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研究生:凃雯齡
研究生(外文):WEN-LING TU
論文名稱:「兒童嗓音障礙指數」量表中文版的信度與效度
論文名稱(外文):The Reliability and Validity of the Pediatric Voice Handicap Index – Taiwan Mandarin
指導教授:盛華盛華引用關係
指導教授(外文):Sheng Hwa Chen
口試委員:陳素秋方端仁
口試委員(外文):Su-Chiu ChenTuan-Jen Fang
口試日期:2013-05-31
學位類別:碩士
校院名稱:國立臺北護理健康大學
系所名稱:聽語障礙科學研究所
學門:醫藥衛生學門
學類:復健醫學學類
論文種類:學術論文
論文出版年:2013
畢業學年度:101
語文別:中文
論文頁數:117
中文關鍵詞:「兒童嗓音障礙指數」量表中文版信度效度切截分數
外文關鍵詞:Pediatric Voice Handicap Index – Taiwan Mandarinreliabilityvaliditycutoff point
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本研究目的為中文化「兒童嗓音障礙指數」量表(pVHI)。將「兒童嗓音障礙指數」量表翻譯成繁體中文版。以嗓音障礙兒童為研究對象,進行pVHI信度與臨床效度的考驗,以做為國內臨床工作者在兒童嗓音生活品質上的評估工具。
  受試者招募分為嗓音異常組及嗓音正常組,年齡介於三歲至十二歲間的兒童。受試者總計60位,包含30位嗓音異常兒童,男女不拘,以及30位嗓音正常兒童。嗓音正常兒童在性別及年齡上與嗓音異常組配對。受試者參與過程分為兩階段進行。第一階段為篩選階段,收集願意參與本研究之兒童,主要照顧者完成同意書填寫後進行篩選流程。第二階段為正式施測階段,研究者以數位式錄音筆(SONY-ICD950)搭配指向性麥克風(Audio-technica AT9941),進行所有受試者嗓音樣本的錄音,嗓音樣本包括:數數字1~10、日常對話、以及圖片命名或敘述。於錄音完成後以GRBAS 量表進行聽知覺評估。所有主要照顧者需完成「兒童嗓音障礙指數」量表中文版填寫。
本研究「兒童嗓音障礙指數」量表中文版以下列方法進行信、效度分析。1.信度分析包括:(1)以Cronbach’s analysis進行內部一致性分析;(2)以Pearson’s correlation 進行再測信度分析;(3)以Mann-Whitney test分析「兒童嗓音障礙指數」量表中文版嗓音異常的特定性(specificity);2.效度分析包括:(1)專家審查進行內容效度考驗;(2)以Pearson’s correlation驗證「兒童嗓音障礙指數」量表中文版量表的建構效度;(3)以聽知覺評估 GRBAS參數進行「兒童嗓音障礙指數」量表中文版效標關聯效度之同時效度的分析;以及(4)以ROC曲線分析「兒童嗓音障礙指數」量表中文版敏感度與特異度所對應的切截分數。
研究結果顯示本量表的內部一致性好,Cronbach’s α為0.96。再測信度高,全量表、功能面、生理面和情感面再測信度分別為0.97、0.92、0.96和0.95。「兒童嗓音障礙指數」量表中文版和GRBAS中的GRBS有中度相關,r=0.41~0.67;本研究「兒童嗓音障礙指數」量表分量表和全量表有中高度相關,r=0.61~0.83;「兒童嗓音障礙指數」量表中文版並提供不同敏感度和特異度所對應的切截分數。
  「兒童嗓音障礙指數」量表中文版證實可以作為臨床評估兒童嗓音障礙生活品質評估工具。語言治療師及耳鼻喉科醫師可以用其作為嗓音治療介入前後評估嗓音生活品質改善依據。

The present research was aimed to translate the "Pediatric Voice Handicap Index (pVHI)" into Taiwan Mandarin, and to evaluate its reliability and validity in the clinical settings in Taiwan.
Sixty subjects, aged from 3 to 12, were assigned to the voice disorder and the normal groups according to their voice quality, and paired in terms of age, with each pair’s age difference was no bigger than six months. There were 2 stages in the experiment: the stage I was a screening, and the stage II was the formal test, which involved voice sample collection. Only those whose primary care givers signed the consent forms and passed the stage I experiment could join the stage II experiment. The collected voice samples, which were recorded by IC recorder (SONY-ICD-SX950) with directional microphone (Audio-technica AT9941), included number counting 1 to 10, conversational speech, sustained vowel /a/ phonation, and picture naming (or story telling). After recording, GRBAS scale was used for auditory perceptual analysis. All the primary caregivers completed the Pediatric Voice Handicap Index (pVHI) – Taiwan Mandarin.
The Pediatric Voice Handicap Index – Taiwan Mandarin (pVHI-Taiwan Mandarin) was analyzed through reliability and validity analyses. 1. Reliability analysis was included : (i) the internal consistency by the Cronbach’s coefficient; (ii) the test-retest reliability analysis by Pearson’s correlation; (iii)the validity was assessed by comparing the obtained scores in the two groups using the Mann-Whitney test; 2. Validity analysis was included : (i) the content validity was assessed by expert opinions; (ii) the construct validity was assessed by Pearson’s correlation; (iii) the concurrent validity of criterion-related validity between pVHI and the GRBAS parameters was assessed; (iv) the cutoff point was assessed by ROC curve.
The results showed that pVHI – Taiwan Mandarin provided a high internal consistency (Cronbach’s α =0.96); the test-retest reliability in the parents of both groups of children was high for total(T) (r=0.97), functional(F) (r=0.92), physical (P) (r=0.96), and emotional(E) (r=0.95). The pVHI scores were moderately positive correlated with the GRBS perceptual parameters in the GRBAS (r=0.41~0.67). The correlation for pVHI – Taiwan Mandarin sub-scores and total-score showed moderate to high correlation (r=0.61~0.84), and these results were similar to the original pVHI. Last, the research provided pVHI – Taiwan Mandarin cutoff point scores comparison table.
The results from the present research suggested that the pVHI – Taiwan Mandarin is a useful supplementary tool for assessing children’s voice dysfunction, thus it can be applied to measure both the influence of voice disorders in the child’s quality of life and measuring treatment efficacy before and after therapeutic intervention.

中文摘要………………………………………………………………….. I
英文摘要………………………………………………………………….. II
表目錄…………………………………………………………………….. VI
圖目錄…………………………………………………………………….. VII
第一章 緒論……………………………………………………………..1
第一節 研究背景與動機………………………………………..1
第二節 研究目的………………………………………………..5
第三節 待答問題………………………………………………..6
第二章 文獻探討………………………………………………………..7
第一節 兒童喉部生理結構………………………………………7
第二節 兒童嗓音異常的分類及嗓音問題………………………9
第三節 兒童嗓音異常與健康生活品質的相關…………………14
第四節 兒童嗓音生活品質評估工具……………………………19
第五節 「兒童嗓音障礙指數」量表中文化過程………………23
第三章 研究方法………………………………………………………..29
第一節 研究架構………………………………………………....29
第二節 研究對象………………………………………………….32
第三節 研究工具………………………………………………….35
第四節 研究步驟………………………………………………….41
第五節 統計方法………………………………………………….46
第六節 預試篩選條件與預試流程……………………………….47
第七節 預試結果………………………………………………….50
第四章 研究結果…………………………………………………………53
第一節 受試者基本資料…………………………………………..53
第二節 「兒童嗓音障礙指數」量表中文版信度檢驗結果……..57
一、「兒童嗓音障礙指數」量表中文版的內部一致性….57
二、「兒童嗓音障礙指數」量表中文版的再測信度…….58
三、嗓音異常組及嗓音正常組在「兒童嗓音障礙指數」量表中文版的疾病特定性……………………………………62
第三節 「兒童嗓音障礙指數」量表中文版效度檢驗結果………65
一、「兒童嗓音障礙指數」量表中文版的內容效度……..65
二、「兒童嗓音障礙指數」量表中文版的效標關聯效度..67
三、「兒童嗓音障礙指數」量表中文版的建構效度……..71
四、「兒童嗓音障礙指數」量表中文版的切截分數……..74
第五章 研究討論…………………………………………………………77
第一節 「兒童嗓音障礙指數」量表中文版的信度………………77
一、「兒童嗓音障礙指數」量表中文版的內部一致性……77
二、「兒童嗓音障礙指數」量表中文版的再測信度……..82
三、嗓音異常組及嗓音正常組在「兒童嗓音障礙指數」量表中文版的疾病特定性………………………………88
第二節 「兒童嗓音障礙指數」量表中文版的效度………………89
一、「兒童嗓音障礙指數」量表中文版的內容效度……89
二、「兒童嗓音障礙指數」量表中文版的效標關聯效度......89
三、「兒童嗓音障礙指數」量表中文版的建構效度………91
四、「兒童嗓音障礙指數」量表中文版的切截分數……93
第三節 結論………………………………………………………95
第四節 研究限制…………………………………………………96
第五節 未來研究建議………………………………………………98
參考文獻
英文文獻……………………………………………………………103
中文文獻……………………………………………………………105
附件………………………………………………………………………106
附件一 英文版「兒童嗓音障礙指數」量表授權同意書………………107
附件二 英文版「兒童嗓音障礙指數」量表授權同意書(二)………109
附件三 林口長庚醫院臨床試驗同意證明書…………………………110
附件四 台北馬偕醫院臨床試驗通知及同意函………………………114
附件五 「兒童嗓音障礙指數」量表(送審版)…………………………116
附件六 「兒童嗓音障礙指數」量表中文版翻譯人員與專家效度參與人員名單…………………………………………………………117

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