脳卒中患者のやむを得ない転倒—やむを得ない転倒判定チェックシートの信頼性と予測的妥当性の検討

Beneficial Falls in Stroke Patients : Reliability and Predictive Validity of the Judgement Checklist

要旨

目的：脳卒中患者におけるやむを得ない転倒判定チェックシート（以下，判定シート）の，信頼性と予測的妥当性を検討した．

方法：検者5名で脳卒中転倒者20例に対し判定シートを評価，また2名は同様の対象に再評価を行い，検者間でのFleissのκ係数，検者内でのCohenのκ係数を算出した．予測的妥当性の検討は，対象の脳卒中転倒者123名の中から判定シートを用いてやむを得ない転倒者を抽出し，その他の転倒者との間で，再転倒割合，運動FIMを比較した．

結果：判定結果のFleissのκ係数は0.838，Cohenのκ係数は1.000であり，高い検者間・検者内信頼性を認めた．やむを得ない転倒者の再転倒割合は，その他の転倒者に比べ有意に低かった．運動FIMは有意に高く，やむを得ない転倒者は一定以上の能力回復を認める傾向にあった．

考察：判定シートの信頼性と予測的妥当性が高いことが示された．判定シートで転倒の質を評価することは，転倒後の患者指導などに使用できると考える．

Objective：The purpose of this study was to determine the reliability and predictive validity of the Judgement checklist for beneficial falls (hereafter called “Judgement checklist”) in stroke patients.

Methods：Five raters evaluated the Judgement checklist for 20 fallers with stroke, and two raters reevaluated the same patients. Fleiss' Kappa and Cohen's Kappa for examination of inter-rater and intra-rater reliability were calculated. For predictive validity, beneficial fallers were identified from among 123 fallers with stroke, using the Judgement checklist. We compared the incidence rate of recurrent falls and motor Functional Independence Measure (FIM) in beneficial fallers and other fallers.

Results：Fleiss' Kappa for Judgement was 0.838, and Cohen's Kappa was 1.000. Inter-rater and intra-rater reliability for the Judgement checklist was high. The rate of recurrent falls in beneficial fallers was significantly lower than that in other fallers. The motor FIM in beneficial fallers was significantly higher than that in other fallers, and beneficial fallers tended to have above average ability to recover.

Conclusion：The reliability and predictive validity of the Judgement checklist were shown to be high. The Judgment checklist was effective in evaluating the quality of falls and was useful for patient instruction after a fall.