目的: 探究上肢运动功能Fugl-Meyer评定法(fugl-meyer assessment of upper extremity, FMA-UE)、简易上肢功能评定量表(simple test for evaluating hand function, STEF)、上肢功能测试量表(test évaluant les membres supérieurs des personnes agées, TEMPA)的相关性,观察三者应用于不同程度脑卒中患者时是否出现天花板效应或地板效应,并比较3个量表的反应性,为临床中量表选择提供指导。方法: 对216例脑卒中患者使用FMA-UE、STEF、TEMPA进行上肢功能的评估,采用Spearman法分析三个量表的相关性,计算取得接近最大/最小分值人数所占总人数的比例,观察是否出现天花板效应或地板效应。另选取20例处于亚急性期的患者进行常规上肢康复训练,2周后再次用TEMPA量表、FMA-UE、STEF进行上肢功能评估,分别观察三个量表的反应性。结果: FMA-UE与STEF的相关系数r=0.767,与TEMPA各维度的相关系数r=0.559~0.848;STEF与TEMPA各维度的相关系数为r=0.840~0.908。FMA-UE在上肢轻度障碍患者中表现出天花板效应,STEF在上肢中度障碍患者中表现出明显地板效应、在上肢重度障碍患者中全部患者得分为0分,TEMPA量表未表现出天花板效应或地板效应。三个量表的反应性均较好,其中效应尺度(ES):FMA-UE＞STEF＞TEMPA任务分析维度＞TEMPA功能评分维度,标准化反应均数(SRM)、基于中位数的效应尺度(MES):FMA-UE＞TEMPA任务分析维度＞STEF＞TEMPA功能评分维度。结论: 三个上肢功能评估量表之间具有高度相关性且反应性均较好。但FMA-UE在上肢轻度障碍患者中出现天花板效应,STEF只适用于上肢轻度障碍患者,TEMPA量表未发现天花板效应或地板效应,可应用范围较广。
Objective: To explore the correlation of upper limb motor function Fugl-Meyer rating scale (FMA-UE), simple upper limb function assessment scale (STEF) and test évaluant les membres supérieurs des personnes agées (TEMPA), to observe the ceiling effect or floor effect in patients with different degrees of stroke, and to compare the responsiveness of the three scales, so as to provide guidance for the selection of scales in clinic. Methods: FMA-UE, STEF and TEMPA were used to evaluate the upper limb function in patients with stroke. Spearman method was used to analyze the correlation of the three scales, and the proportion of people close to the maximum / minimum score was calculated to observe whether there was ceiling effect or floor effect. Twenty patients in subacute stage were selected for routine upper limb rehabilitation training. Two weeks later, the upper limb function was evaluated with TEMPA, FMA-UE and STEF, and the responsiveness of the three scales was observed. Results: The correlation coefficient between FMA-UE and STEF was 0.767, and that between STEF and TEMPA was 0.559~0.848, and that between STEF and TEMPA was 0.840~0.908. FMA-UE showed ceiling effect in patients with mild upper limb disorders, STEF showed significant floor effect in patients with moderate upper limb disorders, and all patients with severe upper limb disorders scored 0. TEMPA scale did not show ceiling effect or floor effect. The responsiveness of the three scales was good, including effect scale (ES): FMA-UE > STEF > TEMPA task analysis dimension > TEMPA function score dimension, standardized response mean (SRM), median effect scale (MES): FMA-UE > TEMPA task analysis dimension > STEF > TEMPA function score dimension. Conclusion: There is a high correlation and good responsiveness among the three upper limb function assessment scales. However, FMA-UE shows ceiling effect in patients with mild upper limb disorders. STEF is only suitable for the evaluation of patients with mild upper limb disorders. TEMPA scale does not find ceiling effect or floor effect, so it can be used widely.
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