日常注意力測驗應用於中風個案之心理計量特性驗證

Abstract

研究背景與目的：注意力缺損為中風後常見的問題，且影響個案後續的功能恢復。日常注意力測驗（Test of Everyday Attention, TEA）乃根據Posner等人提出的注意力模型發展出，具備強力的理論基礎。TEA具備三種平行複本，可交替使用以降低練習效應。當使用TEA作為評量中風個案治療成效的工具時，TEA應具備良好的複本信度、建構效度及反應性。然而，過去研究並未提供足夠的證據支持。因此，本研究目的為驗證TEA應用於中風個案的複本信度、收斂效度及反應性。 方法：本研究分為以下二部份進行。複本信度研究：參加者為來自台北市三家醫院的中風門診個案，年滿18歲，診斷為出血性或缺血性中風。若個案有影響認知的重大傷病史、無法遵從口語指令等情況，則排除之。參加者各需接受TEA任二種版本的評量，時間間隔三至七日。效度與反應性研究：參加者為連續住進臺大醫院復健部的中風住院個案。參加者需於住院時完成初次評量，包括TEA、其他三項注意力測驗及巴氏量表；並於出院前接受TEA的追蹤評量。 結果：共40位門診個案參與複本信度研究；效度及反應性研究中，共27位住院個案接受初次評量，其中10位完成追蹤評量。結果顯示，地圖搜尋（Map Search）、數電梯樓層（Elevator Counting）、看圖數電梯樓層（Visual Elevator）、電話簿搜尋（Telephone Search）及樂透（Lottery）五子測驗，皆具備良好的複本信度（ICC=.60-.96; SRD%=22.3%-45.4%）及適當至良好的收斂效度（r=.34-.80）。電話簿搜尋、雙重任務（Telephone Search while Counting）及樂透三子測驗具有中等至良好的反應性（SRM=.69-.86）。 討論與結論：本研究首次驗證TEA任二種版本應用於中風門診個案的複本信度，且致力於探討TEA與其他注意力測驗的收斂效度，及TEA的反應性。本研究結果顯示，TEA中評量持續性注意力、選擇性注意力及轉移注意力之子測驗為精確有效的注意力評量，並可能具備良好的反應性。因此建議未來研究繼續從事反應性的驗證研究，以期完整建立TEA應用於中風個案作為療效評量型工具的科學特性。

Background and purposes: Attention impairment, one of the common problems in persons with stroke, often impedes recovery of functions following stroke. The Test of Everyday Attention (TEA), developed on the basis of Posner’s model of attention, is a measure with theoretical basis. The TEA has three parallel versions, which allow it to be administered on successive occasions to reduce the practice effect from one occasion to the next. The parallel-form reliability, construct validity, and responsiveness are critical psychometric properties when the TEA is applied to evaluate the efficacy of attention rehabilitation. Nevertheless, these critical properties of the TEA in stroke have not been well established. Therefore, we aimed to evaluate the parallel-forms reliability, convergent validity, and responsiveness for persons with stroke. Methods: This study was separated into two sections. For the parallel-form study, we recruited outpatients with stroke aged over 18 from the three hospitals in Taipei City. The patients were excluded if they met the exclusion criteria, such as pre-existing major diseases, presence of unilateral neglect and aphasia, inability to follow oral commands, etc. The eligible participants were thereafter assigned to one of the three groups (Groups AB, BC, and AC) and all were evaluated twice with the TEA by a trained examiner. The interval between the two administrations of the TEA ranged from 3 to 7 days. For the validity and responsiveness study, we recruited consecutive admissions with stroke to the rehabilitation wards at National Taiwan University Hospital. To examine the convergent validity of the TEA, the TEA, three additional tests of attention, and Barthel Index were then given to the participants. Before the participants were discharged from the wards, they would accomplish the follow-up administration of the TEA. Results: In the parallel-form reliability study, 40 participants were recruited. In the validity and responsiveness study, 27 participants were enrolled for the convergent validity. Of these, 10 accomplished the follow-up administration of the TEA. The results showed the five subtests of the TEA (i.e., Map Search, Elevator Counting, Visual Elevator, Telephone Search, and Lottery) had good to excellent parallel-form reliability (ICC=.60 to .96; SRD%=22.3% to 45.4%) and adequate to excellent convergent validity (r=.34 to .80). Furthermore, the Telephone Search, Telephone Search while Counting, and Lottery subtests were the higher responsive measures of attention in comparison with the other subtests (SRM=.69 to .86). Discussion and Conclusion: This study is the first to assess the alternate-form reliability between any two versions of the TEA, to examine the convergent validity of the TEA with the additional tests of attention, and to investigate the responsiveness of the TEA. Our findings suggest that the TEA had satisfactory parallel-form reliability and convergent validity to measure sustained, selective, and switching attention for persons with stroke. If the evidence of the responsiveness is well established, the use of the TEA as an evaluative measure for the persons with stroke can be suggested.