腦性麻痺青少年生活品質量表中文版之信效度探討

Abstract

研究目的：腦性麻痺青少年生活品質量表在英語系國家已被用以評估腦性麻痺青少年的生活品質相關問題。本研究將腦性麻痺青少年生活品質量表翻譯為中文版本並且檢驗其心理計量特性，並進一步使用中文版腦性麻痺青少年生活品質量表來探討家長和腦性麻痺青少年對於自評測驗的一致性。 研究方法：此研究將腦性麻痺青少年生活品質量表翻譯為中文版本，並由三位職能治療專業專家進行內容效度審核。113位13至18歲腦性麻痺青少年（平均年齡15.6歲，標準差1.54，75 位男性青少年，38 位女性青少年）及58位主要照顧者(7位父親，45位母親，1位祖父母，5位其他) 有效填答中文版腦性麻痺青少年生活品質量表自評量表及主要照顧者量表。內部一致性取樣樣本自青少年自填版本以及主要照顧者版本，再測信度間隔四個星期並取樣17位腦性麻痺青少年及其主要照顧者。效標效度則是比較腦性麻痺青少年生活品質量表的七個領域與台灣簡明版生活品質問卷各範疇。建構效度則是使用探索性因素分析來檢驗原版腦性麻痺青少年生活品質量表的重要因素。 結果：中文版腦性麻痺青少年生活品質量表具備可高度的內部一致性(Cronbach’s α=0.83 - 0.92:青少年、Cronbach’s α= 0.76 -0.92:主要照顧者)、再測信度為中度到高度相關(青少年自填版本:CCs= 0.46- 0.96，主要照顧者版本之再測信度:ICCs= 0.27- 0.92)。探索性因素分析顯示各項目在中文版本中僅有兩個因子，與台灣簡明版世界衛生組織生活品質問卷比較之效標效度為低度到中度相關 (rs = 0.232-0.640)。施測中文版腦性麻痺青少年生活品質量表的青少年及其主要照顧者對於生活品質的 看法呈現中度一致性 (ICCs= 0.53-0.70)。 結論：本研究結果顯示，中文版腦性麻痺青少年生活品質量表是一個具有良好信效度用以評估生活品質的評量工具，適用於評量台灣及中文語系的腦性麻痺青少年之生活品質。

Purpose: Health-related quality of life (HRQoL) has been attracting attention of clinicians working with children with the adolescents with Cerebral Palsy (CP). It is of great importance to provide clinicians a well-developed measurement for assessing the HRQoL of the adolescents with CP..The present study is aimed to cross culturally translate the Cerebral Palsy Quality of Life questionnaire-for adolescents (CPQOL-Teen) into Mandarin Chinese and evaluate its psychometric properties when used in Taiwanese Adolescents with CP. Methods: The study was conducted in two phases. In Phases one, four steps were followed, i.e, 1) forward translation of the CPQOL-Teen according to guidelines developed by Beton, Bombardier, Guilemin, and Feraz (2000) for cross-cultural adaptation of instruments by a committee, 2) expert evaluation of the translation, 3) blind back-translation, and 4) pilot testing and cognitive interviewing. In Phase II, the evaluation of the psychometric properties of the Chinese version of the CPQOL-Teen was conducted. The Chinese version of the CPQOL-Teen was administered to 113 adolescents with CP along with 58 primary caregivers from a medical center, a special school for children and adolescents with CP, senior and junior high schools in Greater Taipei area and long-term care facilities in Taiwan. Internal consistency was examined by using Cronbach alpha, item- subscale correlations by Pearson correlation, test-retest reliability by intraclass correlation (ICC). In addition, content validity was investigated by expert validation, construct validity by both confirmatory and exploratory factor analyses. Criterion-related validity were evaluated by the correlation of the CP-QOL Teen with the WHOQOL BREF Taiwan version using ICC. Agreement between the adolescents with their primary caregivers was also investigated by ICC.. Results: A total of 113 adolescents with CP aged thirteen to eighteen years (mean age = 15.6 years, SD = 1.54, 75 males, 38 females) along with fifty-eight primary caregivers (7 fathers, 45 mothers, 1 grandparent, 5 other caregivers) completed the Chinese version CPQOL-Teen questionnaire. The Chinese version of the CPQOL-Teen demonstrated acceptable to good internal consistency (Cronbach’s αs= 0.83 -0.92: adolescent self- report version; Cronbach’s αs = 0.76- 0.92: primary caregiver version), moderate to good test-retest reliability for adolescent self-report (ICCs= 0.49- 0.96), and poor to good test-retest reliability for primary caregiver version (ICCs= 0.27 - 0.92). Most correlations (Self report: General wellbeing and participation: 0.42-0.77, Communication and physical health: 0.43-0.77, School wellbeing: 0.62-0.80, Social wellbeing: 0.54-0.83, Feeling with functioning: 0.70- 0.83; Primary caregiver report: General wellbeing and participation: 0.52-0.80, Communication and physical health: 0.50-0.75, School wellbeing: 0.68-0.86, Social wellbeing: 0.64-0.82, Feeling with functioning: 0.55- 0.84, Access to service: 0.20-0.89, Family health: 0.84-0.93) were higher between items and subscales of the original English version than those with other subscales. Exploratory factor analysis of the Chinese version CPQOL-Teen resulted in a two- factors pattern. Concurrent validity with the WHOQOL-BREF Taiwan version showed poor to moderate (0.232-0.640) subscales correlations. Agreement between the adolescents and primary caregivers was moderate (0.53-0.70). Conclusions: Results of the study suggest that the Chinese version CPQOL-Teen is c a reliable and valid instrument for evaluating adolescents with CP’s HRQoL in Taiwan. Agreement between adolescents with CP and their primary caregiver showed moderate correlation.