뇌졸중 환자의 단순화된 뇌졸중 자세 평가 척도와 버그 균형 척도의 비교 연구

The Comparison of Simplified Postural Assessment Scale for Stroke and Berg Balance Scale Used for Stroke Patients

목적 : 뇌졸중 환자를 대상으로 4점 척도인 뇌졸중 자세 평가 척도(Postural Assessment Scale for Stroke: PASS) 와 5점 척도인 버그 균형 척도(Berg Balance Scale, BBS)를 3점 척도로 단순화시켜 원본 PASS, BBS와 특성을 비교하고 신뢰도 및 타당도를 알아보고자 하였다. 연구방법 : 만성뇌졸중 환자 62명을 대상으로 PASS(0-1-2-3)는 PASS-3Level(0-1.5-3)로 BBS( 0-1-2- 3-4)는 BBS-3Level(0-2-4)로 기록하여 비교하였다. PASS-3L과 BBS-3L 평가의 측정자내·측정자간 신 뢰도는 급간내 상관계수를(ICC3,1), 절대적 신뢰도는 표준 오차 측정(Standard Error Measurement: SEM)과 최 저 실제 차이(Small Reference Differences: SRD)를 이용하였고, 내적 일치도를 알아보기 위하여 Cronbach’s α 계수를 구하였다. PASS(PASS-3L), BBS(BBS-3L)의 동시 타당도와 수정된 바델 지수(Modified Barthel Index, MBI)와 퓨글 마이어 운동(Fugl Meyer-Motor: FM-M)과의 수렴 타당도를 알아보기 위하여 피어슨 상관 분석을 하였다. 결과 : PASS-3L과 BBS-3L의 검사 재검사 신뢰도는 각각 ICC = .96, .96, 측정자간 신뢰도는 각각 ICC = .95, .94이었다. PASS-3L과 BBS-3L의 SEM은 각각 .99, 1.55, SRD는 1.74, 4.30, Cronbach's α계수는 .77, .85로 신뢰도가 높게 나타났다. PASS-3L의 동시 타당도는 PASS(r=.93), BBS(r=.75), BBS-3L(r=.80)과 유의한 관 련이 있었고, BBS-3L은 PASS(r=.80)와 BBS(r=.93)와 유의한 상관관계가 있었다(p<.01). PASS-3L의 수렴 타당도는 MBI(r=.60), FM-M(r=.42)과 유의한 관련이 있었고, BBS-3L은 MBI(r=.79), FM-M(r=.48)와 유 의한 상관관계가 있었다(p<.01). 결론 : 2개의 단순화된 PASS-3L과 BBS-3L은 PASS, BBS와 비교하여 매우 높은 신뢰도와 타당도를 보여 뇌졸 중 환자의 균형을 평가하는데 적합하다고 할 수 있다.

Objective : The purpose of this study is to simplify the Postural Assessment Scale for Stroke Patients - 4 Level (PASS-4L), and Berg Balance Scale - 5 Level (BBS-5L), into a 3 Level Assessment Scale. The data obtained from the simplified 3 Level Assessment Scale is then compared with those from both PASS-4L and BBS-5L in order to ascertain their reliability as well as validity characteristics. Methods : This study used data from 62 patients in total. Data recorded in the form of PASS-4L(0-1-2-3) was converted into adjusted PASS-3L (ie, 0-1.5-3) in order to form PASS-3 Levels. Similarly, data recorded in the form of BBS-5L (0-1-2-3-4) was converted into adjusted PASS-3L (ie, 0-2-4). To examine the test-retest reliability, the PASS-3L and BBS-3L were administrated to each participant by rater A in 2 testing sessions 3 days apart. To allow the evaluation of inter-rater reliability, the score was rated simultaneously by raters B (PASS, BBS-3L) and C (BBS, PASS-3L) in the latter testing session. The reliability indexes (intra-class correlation coefficient, ICC3,1) of both simplified PASS-3L & BBS 3L were used for the intra-rater and inter-rater reliability, and Cronbach's αwas obtained. Standard Error Measurement (SEM) and Smallest Real Difference (SRD) methods were used to obtain the reliability index of measurement errors. We also made a correlation assessment using a Pearson's correlation coefficient to figure ou the concurrent validity between PASS (PASS-3L) and BSS (BSS-3L) as well as the convergent validity between Modified Barthel Index (MBI) and Fugl Meyer-Motor (FM-M) Scale. Results : The PASS-3L and BBS-3L showed high intra-rater (ICC3,1 = .96, .96, respectively) and interrater reliabilities (.95, .94, respectively). The absolute reliability of the PASS-3L and BBS-3L released more accurate measurements (SEM = .99, 1.55; SRD = 1.74, 4.30, respectively). The internal consistencies of PASS-3L and BBS-3L are expressed using Cronbach's αcoefficient as .77 and .85, respectively. The PASS-3L and BBS-3L showed high concurrent validity (r=.75-.93, p<.01) and convergent validity with the MBI and FM-M scores (r=.42-.79, p<.01). Conclusion : The PASS-3L BBS-3L showed high reliability and validity, and thus it can be stated that the proposed simplified 3-Level scale will be a useful clinical tool for evaluating balance in stroke patients.