兒童動作測驗組第二版於學齡兒童之心理計量特性驗證

Abstract

背景：兒童動作測驗組第二版 (Movement Assessment Battery for Children-Second Edition, MABC-2) 為評估學齡兒童動作技巧之常用工具，涵蓋三年齡層。MABC-2應用於學齡兒童有四項優勢：(一) 評估項目依年齡層調整。(二) 評估內容包含粗動作與細動作共三向度：手部靈巧度 (manual dexterity, MD)、瞄準和接住目標物(aiming and catching, AC)，以及平衡 (balance, Bal)。(三) 適用所有學齡兒童。(四) 評估項目精簡，並有良好之心理計量特性。MABC-2之心理計量特性驗證仍有二項不足：(一) 僅四篇反應性之研究，無法確定MABC-2是否能夠有效地反映兒童動作技巧的變化。(二) MABC-2年齡層二和年齡層三於學齡兒童之心理計量研究有限，難以反映此二年齡層評估之穩定與正確性。 目的：驗證MABC-2三年齡層於學齡兒童之信度（再測、評分者間信度與隨機測量誤差）、效度（區辨、收斂與預測效度），以及反應性（團體與個別層級）。 方法：兒童共接受3次MABC-2評估（初評、14天內再評與6個月追蹤），並分成有無動作技巧困難二組。初評時，家長填寫MABC-2檢核表 (MABC-2 Checklist)；追蹤時，家長填寫文蘭適應行為量表第三版 (Vineland Adaptive Behavior Scale-Third Edition, VABS-3) 之自我照顧和家庭生活分量表。信度部分，本研究以組內相關係數 (intraclass correlation coefficient, ICC) 驗證再測與評分者間信度；以最小可偵測差異百分比 (percentage of minimum detectable change, MDC%) 檢驗隨機測量誤差。效度部分，本研究以獨立t檢定或曼惠特尼 (Mann-Whitney) U 檢定驗證區辨效度；並使用MABC-2 Checklist以及VABS-3之自我照顧與家庭生活量表分別作為收斂與預測效度之效標，以相關係數驗證效度。反應性部分，本研究以配對t檢定與效果值 (effect size, ES) 驗證團體層級反應性；並依據MDC將兒童分四組(顯著進步至顯著退步），再計算各組之人數比例以驗證個別層級反應性。 結果：本研究初評與再評於三年齡層納入32至71人（男性佔44–66%），追蹤評估有9至42人。信度方面，再測信度於總分層級之ICC為0.65至0.81，向度層級之ICC為0.47至0.83。評分者間信度於總分層級之ICC為0.80至0.94，向度層級之ICC為0.81至0.93。隨機測量誤差於總分與向度層級均介於中等至大(MDC% = 12.73–66.98%)。效度方面，混齡分析兩組兒童在總分以及MD、Bal向度有顯著差異 (p = 0.001–0.039)；獨立分析僅年齡層二的總分與MD、Bal向度，以及年齡層三的MD與Bal向度有顯著差異 (p = 0.001–0.040)。收斂效度僅於年齡層二與年齡層三之總分與MABC-2 Checklist有顯著中度相關 (r = (-0.42)–(-0.35), p = 0.001–0.021)。預測效度僅於年齡層一之總分與VABS-3之自我照顧與家庭生活有顯著低度相關 (r = 0.43, p = 0.033–0.034)。反應性方面，混齡分析於初評與追蹤評估之MABC-2總分有顯著差異 (p < 0.001)，ES為0.50至0.54；於MD及Bal向度之分數有顯著差異 (p < 0.001)，ES為0.47至0.56。獨立分析於二次評估之MABC-2總分均有顯著差異 (p = 0.001–0.050)，ES為0.23至1.29；向度層級僅於年齡層一AC與Bal，年齡層二MD與AC，年齡層三MD與Bal向度有顯著差異 (p = 0.001–0.042)，ES除年齡層二AC向度為負 (ES = -0.30)，其他為0.34至1.89。個別層級反應性偵測約5–36%兒童之進步分數改變。 結論：MABC-2三年齡層於學齡兒童，總分之再測信度與評分者間信度佳，隨機測量誤差可接受，混齡分析以及年齡層二之總分具備區辨效度；年齡層二、年齡層三之總分與MABC-2 Checklist有良好之收斂效度；年齡層一之總分具備自我照顧以及家庭生活功能之預測效度；三年齡層之團體層級反應性佳，年齡層一與年齡層三總分具備個別層級反應性。因此，MABC-2總分可提供穩定與正確之動作技巧評估結果，並可反應兒童之動作技巧改變。然而，於向度層級，再測信度為低至佳，隨機測量誤差為中等至大；獨立分析僅於年齡層二與年三之MD與Bal向度具備區辨效度；三年齡層僅MD與Bal向度具備團體層級反應性。因此，使用單一向度結果解釋兒童動作技巧表現時，建議施測二次以上較能提供穩定、可信、精確之結果，以及反應兒童之改變。

Background: The Movement Assessment Battery for Children-Second Edition (MABC-2) is widely used to assess motor skills in school-aged children, offering several merits, such as age-specific contents in three age bands, inclusion of fine and gross motor skills encompassing three dimensions: manual dexterity (MD), aiming and catching (AC), and balance (Bal), applicability to all school-aged children, and short administration time with good psychometric properties. However, limited evidence of responsiveness exists as well as reliability and validity for Age Bands 2 and 3. Objective: To examine the reliability (test-retest reliability, inter-rater reliability, and random measurement error), validity (discriminant, convergent, and predictive validity), and responsiveness (group- and individual-level) of MABC-2 in school-aged children. Methods: Children were administered with the MABC-2 three times (initial, retest within 14 days, and at a 6-month follow-up). Parents completed the MABC-2 Checklist during the first evaluation and the Self-Care and Family Living Scales of the Vineland Adaptive Behavior Scale-Third Edition during the follow-up. Intraclass correlation coefficients (ICC) was used for test-retest and inter-rater reliability, and minimum detectable change percentage (MDC%) quantified random measurement error. For validity, independent t-tests or Mann-Whitney U tests was used for discriminant validity and correlation coefficients was used for convergent and predictive validity with the MABC-2 checklist and the Self-Care and Family Living Scales, respectively. Group-level responsiveness was determined with paired t-tests and effect sizes (ES). For individual-level responsiveness, children were categorized into four groups based on MDC, calculating the group proportion of all children. Results: Our study included 32-71 participants in initial and retest evaluations across the three age bands (males: 44-66%), with the follow-up involving 9-42 participants. Test-retest reliability revealed moderate to high ICCs for total scores (0.65-0.81) and low to high ICCs for dimension scores (0.47-0.83). Inter-rater reliability showed high ICCs for both total and dimension scores. Random measurement errors were moderate to large (MDC%=12.73–66.98%). Regarding validity, significant differences in total, MD, and Bal scores were found between two groups of children of all ages combined (p = 0.001-0.039). In Age Band 2, significant differences were found in total, MD, and Bal scores, and in Age Band 3, significant differences were found in MD and Bal scores (p = 0.001-0.040). Convergent validity was established in Age Bands 2 and 3 (r = (-0.42)-(-0.35), p = 0.001-0.021), and predictive validity was confirmed in Age Band 1 (r = 0.43, p = 0.033-0.034). For responsiveness, significant changes in total, MD, and Bal scores were of found between initial and follow-up evaluations, with moderate ES (0.47 to 0.56). At the individual level, 5-36% of children across age bands showed significant score improvement. Conclusion: The total score of MABC-2 demonstrates good test-retest and inter-rater reliability, acceptable random measurement error, adequate validity, and responsiveness. It provides accurate and pricise results of motor skills and reflects changes. However, at the dimension level, test-retest reliability varies, random measurement error is moderate to large, and weak validity is observed. Group-level responsiveness was found only in the MD and Bal dimensions across all three age bands. Therefore, when using dimension scores as indicators of motor skills, we recommend assessing more than once to ensure stable, reliable, and accurate results.