頚髄損傷者に特化した上肢機能評価Capabilities of Upper Extremity Test（CUE-T）の信頼性，妥当性，反応性の検証

Reliability, Validity, and Responsiveness of the Upper Extremity Test for Spinal Cord Injury

要旨

はじめに：頚髄損傷（cervical spinal cord injury：CSCI）者の詳細な上肢機能評価は数が少ない．Capabilities of Upper Extremity Test（CUE-T）はCSCI者に特化した上肢機能評価であるが，本邦での報告は乏しい．本研究はCUE-Tの信頼性，妥当性，反応性を検証した．

方法：回復期，慢性期CSCI者に対して信頼性（評価者間信頼性，内的一貫性）の指標（weighted kappa係数，級内相関係数，Cronbachのα係数）を算出した．また，他の上肢機能評価や日常生活活動評価との相関係数を算出し，妥当性を検証した．さらには，一定期間の間隔で2度評価を行い，CUE-Tと他の評価の変化量の相関関係による反応性とstandardized response mean（SRM）を用いた変化の敏捷性の検証を行った．

結果：Weighted kappa係数は0.61〜1.00，級内相関係数は0.9以上，Cronbachのα係数は0.9以上となった．CUE-Tと他の評価法は中等度から強い相関関係を示した．また，CUE-Tと他の評価法の変化量は有意な相関関係を示し，SRMは0.8以上となった．

考察：本邦においてCUE-TはCSCI者の上肢機能評価としての良好な信頼性，妥当性，反応性が示された．今後は，CUE-Tの解釈可能性を検証し，本邦における普及を検討していきたい．

Abstract

Introduction：There are few detailed evaluations of upper extremity function in Japan, especially for cervical spinal cord injury (CSCI). The capabilities of upper extremity test (CUE-T) evaluates upper extremity function, is specialized for CSCI, and is internationally used；however, there are few reports from Japan. This study verified the reliability, validity, and responsiveness of the CUE-T in Japan.

Methods：We determined the interrater reliability, internal consistency, weighted kappa coefficient, intraclass correlation coefficient, and Cronbach's α coefficient for acute and chronic CSCI. The correlation coefficient with other evaluations was calculated and validated. Furthermore, the evaluation was performed twice at regular intervals, and the correlation between the change in CUE-T and other evaluations and the sensitivity to change using the standardized response mean (SRM) were verified.

Results：The weighted kappa coefficient was 0.61-1.00, intraclass correlation coefficient was ≥0.9, and Cronbach's α coefficient were ≥0.9. The CUE-T and other evaluation methods showed moderate to strong correlations. In addition, the amount of change between CUE-T and the other evaluations were significantly correlated, and the SRM was ≥0.8.

Discussion：In Japan, the CUE-T has been suggested to have good reliability, validity, responsiveness, and interpretability as an evaluation of upper extremity function in patients with CSCI. We will continue to verify the interpretability of the CUE-T and consider its dissemination in Japan.