뇌졸중 환자들을 위한 한국어판 Dynamic Gait Index의 신뢰도와 타당도 = Reliability and Validity the Korean Version of the Dynamic Gait Index in Patients With Stroke

국문 초록 (Abstract)

본 연구의 목적은 Dynamic Gait Index(DGI)를 한국어로 번안하여 측정자간, 검사-재검사간의 신뢰도 및 동시 타당도를 검증하는 것이다. 본 연구에서 26명의 참가자는 뇌졸중 발병 후 최소 4개월 이상이며, 도움 없이 최소한 10m는 보행할 수 있는 자로 하였다. 한국어판 DGI의 검사-재검사 신뢰도를 조사하기 위해 3일 간격으로 2명의 독립적인 평가자가 2번의 검사를 시행하였다. 측정자간 신뢰도는 두 번째 검사에 2명의 검사자가 동시에 평가하였다. 총 점수와 항목별 점수 분석은 급간내 상관계수(ICC2,1)를 이용하였다. 10m 보행 검사, Timed Up & Go test(TUG), Berg Balance Scale(BBS) 결과를 상호 연관하여 동시 타당도를 검사하였다. 검사-재검사간 및 측정자간 신뢰도(ICCs)는 각각 .92, .88로 높은 신뢰도를 나타낸 반면 단일 항목 점수에 대한 신뢰도는 .60 ~ .92의 수준을 보였다. 내적 일치도는 크론바 알파 0.89로 높았다. DGI는 BBS(r =.80)와 중등도의 양의 상관관계가 있었고, 10m 보행 검사(r =-.76), TUG(r =-.79)와는 음의 상관관계가 있었다. 한국어판 DGI는 신뢰도와 다른 균형 및 움직임을 평가하는 척도와 높은 타당도가 있음을 알 수 있었다. 따라서 한국어판 DGI는 뇌졸중 환자의 이동시 동적 균형을 평가하기 위한 유용한 임상 도구이다.

다국어 초록 (Multilingual Abstract)

The purpose of this study is to introduce the Dynamic Gait Index(DGI) into Korea,
In addition, is to examine the inter-rater and test-retest reliability, as well as
the concurrent validity of the DGI for people with stroke. A consecutive sample
of 26 participants, at least 4 months post-stroke and able to walk at least 10m with or without a walking aid, participated in the study. Two independent raters rated performances on the DGI. The DGI was administered in 2 testing sessions 3 days apart. In the second session, the participants were rated by 2 raters. Intraclass correlation coefficients (ICCs), model 2,1, used to analyze total scores and item scores. Concurrent validity was tested by correlating results to the 10m Walking Test(10m WT), the Timed Up & Go test(TUG), and the Berg Balance Scale(BBS).
ICCs for test-retest and inter-rater reliability of total scores were good (.92, .88, respectively) whereas reliability for single item scores was moderate to good (range, .60 ~ .92). The internal consistency was very high(Cronbach’s ？？=.89). The DGI demon strated moderate concurrent validity with the 10m WT(r =-.76) and the TUG(r =-.79) and the BBS(r =.80). The DGI showed high reliability and showed evidence of concurrent validity with other balance and mobility scales. It is a useful clinical tool for evaluating dynamic balance in ambulatory people with stroke.

목차 (Table of Contents)

• Ⅰ. 서론 2
• 1. 연구의 필요성 및 목적 2
• Ⅱ. 연구 방법 4
• 1. 연구 대상자 4
• 2. 연구 방법 5
• 3. 평가 도구 5
• 4. 분석 방법 7
• Ⅲ. 연구 결과 7
• 1. 각종 평가 결과 7
• 2. 한국어판 DGI의 검사-재검사 및 측정자간 신뢰도와 내적일치도 8
• 3. 동시 타당도 9
• Ⅳ. 고찰 9
• Ⅴ. 결론 11

참고문헌 (Reference)

1 박소연, "지역사회에 거주하는 노인을 대상으로 한 한글판 동적보행지수의 타당성" 한국전문물리치료학회 17 (17): 43-52, 2010

2 이상호, "뇌졸중 환자에서 Dynamic Gait Index와 Berg Balance Scale 및 Timed Up & Go 검사간의 상관관계" 15 (15): 1-8, 2008

3 Schumway-Cook, A, "Woollacott M. Predicting the probability of falls in community-dwelling older adults using the Timed Up & Go Test" 80 (80): 896-903, 2000

4 Cattaneo, D, "Validity of six balance disorders scales in persons with multiple sclerosis" 28 (28): 789-795, 2006

5 Lark, S. D, "Validity of a Functional Dynamic Walking Test for the Elderly" 90 (90): 470-474, 2009

6 Chiu, Y, "Use of item response analysis to investigate measurement properties and clinical validity of data for the dynamic gait index" 86 (86): 778-787, 2006

7 Podsiadlo, D, "The timed “Up and Go”: a test of basic functional mobility for frail elderly persons" 39 (39): 142-148, 1991

8 Ng, S, "The timed up & go test: its reliability and association with lower-limb impairments and locomotor capacities in people with chronic stroke" 86 (86): 1641-1647, 2005

9 Trombly, C, "The issue is - Anticipating the future: Assessment of occupational function" 47 (47): 199-201, 1993

10 Shumway-Cook, A, "The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults" 77 (77): 46-57, 1997

11 Whitney, S, "The dynamic gait index relates to self-reported fall history in individuals with vestibular dysfunction" 10 (10): 99-105, 2000

12 Berg, K, "The balance scale: reliability assessment with elderly residents and patients with an acute stroke" 27 (27): 27-36, 1995

13 Wrisley, D. M, "Reliability, internal consistency, and validity of data obtained with the functional gait assessment" 84 (84): 906-918, 2004

14 Wrisley, D. M, "Reliability of the Dynamic Gait Index in people with vestibular disorders" 84 (84): 1528-1533, 2003

15 McConvey, J, "Reliability of the Dynamic Gait Index in individuals with multiple sclerosis" 86 (86): 130-133, 2005

16 Jonsdottir, J, "Reliability and validity of the Dynamic Gait Index in persons with chronic stroke" 88 (88): 1410-1415, 2007

17 Harris, J. E, "Relationship of balance and mobility to fall incidence in people with chronic stroke" 85 (85): 150-158, 2005

18 Shrebnik, D. S, "Psychometric properties and utility of the problem severity summary for adults with serious mental illness" 53 (53): 1010-1017, 2002

19 Lin, M. R, "Psychometric comparisons of the timed up and go, one-leg stand, functional reach, and Tinetti balance measures in community dwelling older people" 52 (52): 1343-1348, 2004

20 Hall, C, "Prediction of fall risk reduction as measured by Dynamic Gait Index in individuals with unilateral vestibular hypofunction" 25 (25): 746-751, 2004

21 Shumway-Cook, A, "Predicting the probability for falls in community dwelling older adults" 77 (77): 812-819, 1997

22 Dickstein, R, "Postural sway of the affected and nonaffected pelvic and leg in stance of hemiparetic patients" 81 (81): 364-367, 2000

23 Lamontagne, A, "Postural adjustments to voluntary head motions during standing are modified following stroke" 18 (18): 832-842, 2003

24 Brown, K. E, "Physical therapy outcomes for persons with bilateral vestibular loss" 111 (111): 1812-1817, 2001

25 Wrisley, D. M, "Physical therapy for migraine-related vestibulopathy and vestibular dysfunction with history of migraine" 110 (110): 1528-1534, 2000

26 Tinetti, M. E, "Performance-orientated assessment of mobility problems in elderly patients" 34 (34): 119-126, 1986

27 Fisher, A. G, "Nationally speaking - Improving functional assessment in occupational therapy: Recommendations and philosophy for chance" 47 (47): 199-201, 1993

28 Schumway-Cook, A, "Motor control: theory and practical applications" Williams & Wilkins 1995

29 Wade, D, "Measurement in neurological rehabilitation" Oxford Univ Pr 1992

30 황수진, "Intrarater and Interrater Reliability of the Dynamic Gait Index in Persons With Parkinson’s Disease" 한국전문물리치료학회 17 (17): 55-60, 2010

31 Beaton, D. E, "Guidelines for the process of cross-cultural adaptation of self-report measures" 25 (25): 3186-3191, 2000

32 Ishizuka, M. A, "Falls by elders with moderate levels of movement functionality" 60 (60): 41-46, 2005

33 Mackintosh, S, "Falls and injury prevention should be part of every stroke rehabilitation plan" 19 (19): 441-451, 2005

34 Tinetti, M. E, "Fall risk index for elderly patients based on number of chronic disabilities" 80 (80): 429-434, 1986

35 Ikai, T, "Dynamic postural control in patients with hemiparesis" 82 (82): 463-469, 2003

36 Guillemin, F, "Cross-Cultural adaptation of Health-Related Quality of Life Measures: Literature Review an Proposed Guidelines" 46 (46): 1417-1432, 1993

37 Whitney, S, "Concurrent validity of the Berg Balance Scale and the Dynamic Gait Index in people with vestibular dysfunction" 8 (8): 178-186, 2003

38 Berg, K. O, "Clinical and laboratory measures of postural balance in an elderly population" 73 (73): 1073-1080, 1992

39 Mathias, S, "Balance in elderly patients: the “get-up and go” test" 67 (67): 387-389, 1986

40 De, Bujanda. E, "Associations between lower limb impairments, locomotor capacities and kinematic variables in the frontal plane during walking in adults with chronic stroke" 35 (35): 259-264, 2003

41 Pai, Y. C, "Alterations in weight transfer capabilities in adults with hemiparesis" 74 (74): 647-659, 1994