The Preliminary Study Of The Traumatic Brain Injury ICF Reliability And Validity

Background and ObjectiveTraumatic brain injury (traumatic brain injury, TBI) is a common clinical injury, accounting for systemic trauma incidence, mortality and disability rate, has become a major health and economic problem worldwide. Different degrees of traumatic brain injury left the body structure and function, social activity, mental disorders, to the family, the community brought a great deal of pain and heavy burden. The modern rehabilitation theory considers that nerve tissue damage after the function is not completely lost, can promote the rehabilitation the lesions surrounding tissue or contra lateral reorganization of brain cells or compensatory, play brain plasticity. Therefore, the degree of functional recovery and rehabilitation training has the close relation, clinical experience has shown that early rehabilitation training can improve self-care ability, improve sequela of life of patients with traumatic brain injury. Targeted treatment decides the rehabilitation effect of the success or failure, functional rating scale can provide guidance for rehabilitation, and rehabilitation therapy in evaluating therapeutic effect of one of the important methods. Brain injury rehabilitation evaluation including the conscious state evaluation, function evaluation, comprehensive evaluation and assessment of cognitive function and so on. Method scope limitation, however these dizzying, lack of comprehensive internationally recognized rating scale traumatic brain injury.International Classification of Functioning, Disability and Health is the World Health Organization’s internationally accepted framework to describe and measure the health of the individual and social level theoretical structure, a comprehensive assessment of the patient’s overall level. ICF components of body functions (physiological and psychological functions), body structures (anatomical parts of the body), activities (individuals perform actions and tasks) and participation (life situations), involving both environmental factors and personal factors on health promote or hinder the role, is a description of the health and functional comprehensive assessment scale.ICF of stroke, chronic ischemic heart disease has been prepared since the WHO issued by ICF. However, traumatic brain injury ICF is still under study and formulation, assessment of entry has no consensus at domestic and abroad.Our group participating in discussions traumatic brain injury ICF core set and joint in the first ICF China rehabilitation clinical application of advanced training courses and read related literatures about foreign traumatic brain injury ICF, select the assessment of entry were significantly associated with traumatic brain injury patients function and health, to assess domestic patients with traumatic brain injury and analyze the reliability and validity whether it applies to domestic patients with traumatic brain injury, providing certain reference significance for the establishment of China traumatic brain injury ICF, in order to better guide the rehabilitation of patients with traumatic brain injury.Methods1. Traumatic brain injury ICFTraumatic brain injury ICF including physical function, the four components of the body structure, activities and participation, and environmental factors,12 categories of body functions, body structure of a category, activities and participate in11categories, environmental factors6categories. Quantify the size of each category by ICF limit value (0-4,8, and9).0represents no damage0-4%, on behalf of the minor injury5-24%the2represent moderate damage to25-49%,50-95%of the3represents severe damage,4represents96-100%complete injury,8representatives unspecified "do not have sufficient information to determine the severity of the injury;9represents" not applicable "indicates that this category does not apply to the patients; environmental factors with a positive or negative value to quantify its obstacles or promote the role of level.2. Fugl-Meyer motor function assessmentEvolved on the basis of the evaluation method of Brunnstrom movement by the Swedish doctor Fugl-Meyer et al is widely recognized as the most widely used method of evaluation. Assessment of upper limb function is divided into10major items,33items, each of a maximum score of2points,66points; lower extremity7major items,17items, maximum score of2points each, a total of34points, the upper and lower extremities total divided into100cents. Upper limb large joint assessment include:flexor-extensor cooperative motion of the shoulder, elbow, wrist, wrist stability, whether hyper reflex, etc. Small joints include:grip, finger side of the hand pinch on pinch mode of motion, including coordination and speed assessment. This scale reaction more comprehensive upper extremity function. Integrals of motion expressed clinical significance:I grade severe dyskinesia, points out50%, II grade for obvious dyskinesia score was50%-84%of the total score, grade Ⅲmoderate dyskinesia Credits for85%-95%of the total score, IVgrade mild movement disorders, integrator for more than96%of the total.3. Modified Barthel Index, MBIModified Barthel index table is divided into totally dependent on a lot of help medium to help small amount of help and is completely independent of the five levels, each of the scores of each level is different, the project personal hygiene, bathing freedom scores0,1,2,3,4,5points; stool control, bladder control, eating, dressing, going to the toilet, the scores of the six projects on the stairs0,2,5,8,10; transfer, walking two projects scores for0,3,8,12,15points.10projects total score of100points, the independent capacity was positively correlated with the score.4. SubjectChoose from March2011to July2012,100cases of Nan fang Hospital Rehabilitation consecutive hospitalized patients with traumatic brain injury. Inclusion criteria:①by CT or magnetic resonance imaging (MRI) and other imaging diagnosed patients with traumatic brain injury;②injured three months to15years;(3) signed an informed consent form;④patients are informed and understand the research purposes. Exclusion criteria:①GCS score<8points;(2) existence of the severe aphasia affect the information collection, mental disorders and severe dementia patients.5. IndexBody functions calculation the traumatic brain injury ICF Rating Scale and the Fugl-Meyer assessment form, the activities involved in the Pearson correlation coefficient between the aspects of improved Barthel index table to review the validity of the finished version of traumatic brain injury ICF Rating Scale. Using Kendall’s Wto test interrater reliability and Cronbach’s Alpha to test consistency. All evaluation with the patient’s consent before testing, operator must take training, clear principle of Scale, rating standards and precautions.6. Data analysisUsing spss13.0statistical software to deal with the results, Using Kendall’s W value to examine the reliability between two reviewers; Content uniformity test Cronbach alpha value analysis; Criterion validity using Pearson correlation.Results1. Reliability between different assessors:The correlation coefficients between two assessors have good consistency. Kendall’s W value of0.700, P=0.000.2. Internal consistency:the Cronbach’s alpha coefficient of traumatic brain injury ICF is0.883, with high internal consistency; the Cronbach’s alpha coefficient of activities and participation is0.927, with high internal consistency; the Cronbach’s alpha coefficient of body functions is0.739, good internal consistency; the Cronbach’s alpha coefficient of environmental factors is0.616; body structural components due to only one category, cannot calculate the value of Cronbach’s Alpha.3. Criterion validity:Showed a good negative correlation between body function in the traumatic brain injury ICF and Fugl-Meyer assessment form, its Pearson coefficient of0.754(P<0.01); the traumatic brain injury ICF in the activities and participation modified Barthel Index (MBI) rating scale showed good negative correlation between the Pearson coefficient of0.785(P<001).Conclusion1. Traumatic brain injury ICF has certain reliability and validity.2. Traumatic brain injury ICF can better reflect the limb motor function and daily life activities.