日本語版粗大運動能力分類システムの信頼性の検討およびデルフィ法によるこのシステムの臨床使用に対する専門家の意見調査

Reliability Study of Gross Motor Function Classification System and Delphi Survey of Expert Opinion for Clinical Use of this System in Japan

要旨：日本語版GMFCSの信頼性の検討とDelphi調査を使った臨床使用における専門家の意見を明らかにする目的でこの検討を行った．信頼性の検討は334名の脳性麻痺児（男児191名，女児143名），8カ月から12歳（平均5歳7カ月，標準偏差3歳1カ月）を対象として行った．181名の評価者がこの研究に参加し，2名一組でそれぞれ独立にGMFCSによる重症度の判定を行った. Delphi調査には質問紙を使い，各施設でこの研究を主導した協力者20名から回答を得た．信頼性の検討から，レベルⅢおよびⅣの4～6歳の年齢帯のKappaが0.40を下回っていた．Delphi調査の結果でも，レベルⅢに対してだけは支持的な回答の比率が80％を超えなかった．GMFCSの信頼性はレベルⅢの4～6歳の年齢帯における記載が実際の発達より低めに設定されていることによって部分的に低下している可能性が示唆された．

Abstract : The purpose of this study was to examine the reliability of the Japanese version of the Gross Motor Function Classification System (GMFCS) and to determine expert opinions on clinical use of this system using a Delphi survey. The reliability study was performed with 334 children (191 boys, 143 girls) with cerebral palsy, ranging in age from 8 months to 12 years (mean, 5 years 7 months ; standard deviation, 3 years 1 month). A total of 181 assessors participated in the study. Two assessors classified each child's level of gross motor function independently using a revised version of the GMFCS (Japanese version 1.1). This revision of the GMFCS was based on the results of previous pilot studies performed in Japan. A questionnaire was used for the Delphi survey, and the rate of positive response was calculated from the answers of 20 assessors at each institute that conducted the reliability study. In the reliability study, overall kappa was 0.67, but specific kappas ＜0.40 were found at level Ⅲ and Ⅳ in the 4-6 year age group. In the Delphi survey, the rate of positive responses was not ≧80％ only for the description of level Ⅲ among the five levels. These findings and structural analysis of descriptions for level Ⅲ and Ⅳ according to the results reported by Rosenbaum and coworkers suggest that reliability of the GMFCS was partly lowered because of the level Ⅲ description for the age of 4-6 years, which might be set at a relatively lower level than actual development.