言語聴覚士による聴覚印象評価の信頼性について：『〈発語失行症〉話しことばの評価票』を用いた検討

The reliability of auditory perceptual evaluation in speech-language-hearing therapists : An investigation using the Speech Dimension Rating for Apraxia of Speech

　『〈発語失行症〉話しことばの評価票』の聴覚印象評価の信頼性について，臨床経験年数の異なる言語聴覚士(ST)グループを対象に検討した．

　臨床年数5年以上のSTⅠ群(10名)と同5年未満のSTⅡ群(13名)が7症例(発語失行主体型3例，Broca失語2例，伝導失語2例)の発話サンプルを用いて，『〈発語失行症〉話しことばの評価票』を2週間の間隔をおいて2回実施した．評価者内信頼性は再テスト法による級内相関係数ICCを算出し，評価者間信頼性は両群から無作為に抽出した4組のペアにおける初回評価についてのICCを算出した．その結果，評価者内信頼性のICC値0.6以上は両群ともに16項目(64％)であった．一方，評価者間信頼性のICC値0.6以上はSTⅠ群が4～7項目，Ⅱ群が3～5項目であり，両群ともに評価者間の一致度は低かった．

　本評価票の臨床的有用性を高めるためには，評価者は評価項目の十分な理解と評価基準および評価方法の統一化，評価技能の均質化が必要である．

　The purpose of this study was to assess the reliability of auditory perceptual evaluation by speech-language-hearing therapists (SLHT) using the Speech Dimension Rating for Apraxia of Speech.　Twenty-three SLHTs evaluated speech samples of seven patients with apraxia of speech, Broca's aphasia, or conduction aphasia.　The intra-person reliability was then analyzed using the intra-class correlation coefficient (ICC) for each evaluator, and the inter-rater reliabilities between four sets of pairs randomly extracted from both groups were analyzed using ICC for the first time evaluation.　The results showed that 16 out of 25 items (64%) had an ICC of over 0.6 for the intra-person reliability of each evaluator.　However, the inter-rater reliability between evaluators showed significant differences.　We conclude that in order to utilize the Speech Dimension Rating for Apraxia of Speech for clinical examinations, a thorough understanding of the evaluation items with their evaluation criteria, and homogenous evaluation skills of the SLHTs are required.