燒燙傷用台灣版自覺徒手功能評量之發展

Abstract

背景：以適當的評估工具評估手部燒燙傷病患之手功能是極為重要的。然而，當今用於評估手部燒燙傷病患之數種評估工具心理計量上及臨床實用性上皆有其不適切之處，也並沒有專門適用於燒燙傷病患之評估工具；可能因而導致遺漏了重要的資訊，而影響手功能評估的準確性及後續的臨床治療。自覺徒手功能評量乃用於評估個案的自覺手功能狀況，可協助了解個案主觀最欲改善的問題，且在臨床之使用亦較便利，但其心理計量等相關特性並未在燒燙傷族群中經過驗證。 目的：本研究乃以自覺徒手功能評量(MAM-36)為基礎，欲針對手部燒燙傷病患發展出「燒燙傷用台灣版自覺徒手功能評量」(T-MAM for Burns)並驗證其心理計量特性，用以評估燒燙傷病患之自覺手功能。 方法：原始版 MAM-36問卷先進行翻譯並作文化上之調整，隨後加入針對燒燙傷設計之題項形成初始版「燒燙傷用台灣版自覺徒手功能評量」問卷。將初始版問卷於45名有復健需求之手部燒燙傷病患，並追蹤三個月。正式版問卷之題項乃依據心裡計量分析結果自初始版篩選出，且同時分析其心理計量特質(如信效度)及其於第一個月與第三個月追蹤時之反應性。 結果：最後被選入正式版「燒燙傷用台灣版自覺徒手功能評量」問卷者共20題，並附加三題用作臨床參考(不列入計分)。本問卷具有良好之內部一致性與再測信度(Cronbach’s α = 0.947; ICC = 0.987)。同時效度結果顯示「燒燙傷用台灣版自覺徒手功能評量」之分數與QuickDASH高度相關(r = -0.786)，並與傑布森─泰勒手功能測驗(JTHFT)及握�指力中度相關(r值分別為-0.487、0.660及0.631)。第一個月及第三個月追蹤之效果值分別為0.24及0.44，顯示本評量具有小至中等之反應性。區辨效度部份，以燒燙傷面積(TBSA) 25%切分為兩組之總分並無顯著差異，但「燒燙傷用台灣版自覺徒手功能評量」高分組及低分組則具顯著差異。 結論：「燒燙傷用台灣版自覺徒手功能評量」為一具信效度、針對燒燙傷族群使用的自覺徒手功能評估工具，且可反應出燒燙傷患者不同時間點時的徒手功能改變情形，可用作燒燙傷復健之結果評估。

Background: To evaluate hand function of hand-burn patients with adequate tools is essential. However, it seems that no burn-specific hand function measurement tools are available, while common-used tools lack validation in burn population. The quality of hand function evaluation and the following rehabilitation intervention might therefore be jeopardized. The Manual Ability Measure (MAM-36) is a questionnaire evaluates self-perceived manual ability. It can help to recognize clients’ subjective first-priority problems and is clinically more convenient to administer, but has not been validated in burn population. Objectives: This study aimed to develop and validate Taiwanese Version of the Manual Ability Measure for Burns (T-MAM for Burns), an evaluation tool adapted from the MAM-36, to assess self-perceived manual ability of burn patients. Methods: The original MAM-36 was translated and cultural-adapted first and burn-specific items were added, forming a preliminary version of the T-MAM for Burns. The preliminary T-MAM for Burns was field-tested in a consecutive sample of 45 hand-burn patients with rehabilitation needs, and a three-month follow-up was done. Items of the final T-MAM for Burns were selected based on the results of psychometric analysis. Psychometric properties such as reliability and validity of the T-MAM for Burns were investigated, as well as its responsiveness at the first and third month follow-ups. Results: Twenty items were selected into the final T-MAM for Burns, with three additional items as clinical reference (not to be counted into the total score). The T-MAM for Burns was found to have excellent internal consistency and test-retest reliability (Cronbach’s α = 0.947; ICC = 0.987). Concurrent validity results showed that the T-MAM for Burns score was highly correlated to the short form Disabilities of the Arm, Shoulder and Hand (QuickDASH) (r = -0.786) and moderately correlated to the Jebsen-Taylor Hand Function Test (r = -0.487) and grip/pinch power (r = 0.660 and 0.631, respectively). The effect sizes at the first and third month follow-ups were 0.24 and 0.44, respectively, showing a small to moderate responsiveness. Regarding the discriminant validity, no significant difference in total score was found between two groups divided by TBSA = 25%, but the scoring was significantly different between the high and low T-MAM for Burns score groups. Conclusions: The T-MAM for Burns is a valid and reliable tool to assess the perceived manual ability among burn patients. It can reflect the changes of manual ability over time, and can be used as an outcome measure in burns rehabilitation.