보행에 제한이 있는 뇌졸중 환자들의 한국어 번안 기능적 앉기 검사의 신뢰도와 타당도 = The Reliability and Validity of the Korean version of Function in Sitting Test in Patients with Stroke who are limited walking ability

국문 초록 (Abstract)

국내에서 뇌졸중 환자들의 앉기 균형 평가에 관한 표준화된 평가 도구는 거의 없다. 본 연구의 목적은 기능적 앉기 검사(Function In Sitting Test, FIST)를 한글로 번안하여 보행에 제한이 있는 뇌졸중 환자들의 앉기 균형 평가의 신뢰도와 타당도를 검증하고자 하였다. 피 실험자 43명을 대상으로 FIST 개별 항목과 총점의 측정자간 신뢰도(Inter-rater reliability)는 가중치 카파 계수(Weighted kappa coefficient)와 급간 내 상관계수(Intra class coefficient, ICC_2,1)를 이용하였다. FIST 개별 항목과 총점간의 관련성은 스피어만 상관 계수(Spearman correlation coefficient)를 이용하였고, 문항 내적 일치도는 크론바 알파 계수(Cronbach`s α coefficient)로 구하였다. 또한 절대적 신뢰도 지수인 FIST의 표준 측정 오차(Standard error measurement, SEM)와 최소 감지 변화(Minimal detectable change, MDC)를 구하였다. FIST의 동시 타당도는 체간 조절 검사(Trunk Control Test, TCT), 뇌졸중 자세 평가 척도(Postural Assessment Scale for Stroke, PASS), 수정된 델지수(Modified Barthel Index, MBI)를 이용하여 스피어만 상관 계수를 구하였다. 본 연구 결과 FIST 1∼14번 개별 항목의 가중치 카파 계수는 .80∼.96, FIST 총점의 ICC=.99(.98∼.99)이었다. FIST 개별 항목과 총점간의 관련성은 r=.82∼.93이었고, FIST의 문항 내적 일치도는 .97로 높은 수준이었다. FIST의 SEM은 0.95점(평균 점수 29.95점의 10%미만), MDC는 2.63점으로(FIST평가 최고 점수인44점의 20%미만)신뢰할만하였다. FIST의 동시 타당도는 TCT(r=.85), PASS(r=.82), MBI(r=.81)와는 매우 높은 상관관계가 있었다. FIST 평가는 보행에 제한이 있는 뇌졸중 환자들의 앉기 균형을 평가 하는데 매우 적합한 것으로 확인되었다. 따라서 FIST는 임상에서 앉기 균형 평가에서 시작하여 서기자세 균형과 보행에 필요한 동적 균형 능력을 평가하는데 보조적인 평가 방법이 될 수 있을 것이다.

다국어 초록 (Multilingual Abstract)

In Korea, there is no standardized assessment tool for sitting balance assessment of stroke patients. The purpose of this study was to adopt FIST into Korean in order to verify the reliability and validity of a sitting balance assessment of stroke patients who had limited walking abilities. The study was held with 43 subjects who were measured using the FIST individual item score and Inter-rater reliability with the Weight Kappa Coefficient and Intra Class Coefficient (ICC2,1). The relevance between the individual items of FIST and total scores was calculated through Cronbach`s ａ coefficient. In addition, absolute reliability indexes including the Standard Error Measurement(SEM) of FIST and Minimal Detectable Change(MDC) were measured. Concurrent Validity of the FIST Trunk Control Test(TCT), Postural Assessment Scale(PAS) for Stroke, Modified Barthel Index(MBI) were measured in relation to the Spearman correlation coefficient. According to this study, the Weighted Kappa coefficient of the FIST individual items 1-14 was 0.80 to 0.96 times, and the FIST total score was ICC=.99 (.98~.99). The relevance of the FIST score and individual items was r=.82~.93 which showed high relevant levels between the two items. The Crohn`s alpha coefficient of FIST bar was high at 0.97. The SEM of FIST was 0.95 points and was less than 10%(average 29.95score). The MDC was fairly reliable by only being 2.63 points, less than 20%(FIST highest rating 44score). The concurrent validity of FIST has been confirmed to have a very high correlation with the TCT(r=.85), PASS(r=.82) and MBI(r=.81). The FIST assessment has been found to be very suitable for a sitting balance evaluation of stroke patients with limited walking. Therefore, FIST could be useful as a secondary evaluation method in assessing functions ranging from sitting balance to standing balance and evaluating the dynamic balance skills needed for clinical postural and gait.

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