腦中風患者吞嚥障礙的相關因素 , 定義性特徵 , 及護理措施之臨床效度測試

1. 腦中風患者吞嚥障礙的相關因素,定義性特徵,及護理措施之臨床效度測試腦中風患者吞嚥障礙的相關因素,定義性特徵,及護理措施之臨床效度測試 • 中文摘要 • 本研究的目的在探討腦中風患者「吞嚥障礙」的相關因素、定義性特徵及護理措施的臨床效度測試；分別以診斷內容效度法(DCV method)及臨床診斷效度法(CDV method)進行分析。收集的資料以SPSS for windows 6.0版進行資料的統計分析。個案基本資料以Frequency瞭解分佈，並以t-test及2檢定兩組個案之基本屬性是否有差異。定義性特徵以Cronbach‘s alpha 驗證信度，並採因素分析法測定次概念以建立建構效度，最後以邏輯性迴歸進行區辨效度測定，找出必要性定義特徵，以作為臨床評估吞嚥障礙快速、有效的指標。 • 本研究為探索性研究，利用本研究者所發展出來的「吞嚥障礙相關因素評量表」、「吞嚥障礙定義性特徵評量表」、及「吞嚥障礙護理措施評量表」，進行臨床信、效度測試。研究對象主要有二：一為研究相關因素及定義性特徵的診斷內容效度(DCV)之臨床神經內科護理人員共52名；另一為研究相關因素及定義性特徵臨床診斷效度(CDV)的腦中風患者共計107名，經布氏吞嚥障礙篩檢(BDST)結果分為兩組；無異狀組計56名，有異狀組計51名，其中51位吞嚥障礙者的主要照顧者和負責護士並針對吞嚥障礙的吸入防範及吞嚥促進兩項護理措施進行資料填寫。 • 研究結果顯示，吞嚥障礙相關因素依診斷內容效度及臨床診斷效度研究法，雖然CDV score部份得分低於0.5，但十七項相關因素DCV score得分皆高於0.5，因此最後十七項皆保留為吞嚥障礙的相關因素。十六項定義性特徵依診斷內容效度及臨床診斷效度研究法，雖CDV score部份分數偏低，但並未發現兩種量表特徵比值皆低於0.5者，經相關矩陣後則刪除四項，保留十二項，經因素分析萃取出兩個因素為：因素I「高危險性吸入暨語言障礙表徵」計有七項，其alpha值為0.81，項間平均相關係數為0.38，每個項目的矯正單項/總項相關係數均>0.30，顯示每一個項目具有內在一致性；因素II「無效的進食表徵」共有五項，其alpha值亦為0.81，項間平均相關係數為0.46，每個項目的矯正單項/總項相關係數亦均>0.30，亦顯示每一個項目具有內在一致性。而十二項定義性特徵的alpha 係數為0.89，項間相關係數平均值為0.39，顯示項間關係良好。矯正單項/總項相關係數介於0.45至0.72間；因此，十二項定義性特徵全數保留。 • 為能有效區辨吞嚥障礙，兩組個案經邏輯式迴歸分析找出五項主要定義性特徵：第1項口腔內食物滯留、第3項急性食物吸入的跡象、第5項後咽部燒灼感或癢刺感、第9項食物掉出或漏出嘴唇外、及第15項咳嗽力量變小等。 • 主要照顧者和負責護士在「吞嚥障礙護理措施---吸入防範及吞嚥促進」執行成效上，除吞嚥促進的第8、9項兩項有差異外，其餘皆無顯著差異。十九項吸入防範措施的alpha係數為0.81，而二十五項吞嚥促進療法的alpha係數為0.80，表示兩種評量表具有不錯的內在一致性。 • 根據以上研究結果，三種量表可作為臨床腦中風患者吞嚥障礙快速、有效、正確的評估工具及作為評量護理服務的指標。

2. Clinical Validation of the related Factor, Defining Characteristic,and Nursing Interventions of Swallowing Disorder among Stroke Patients • 英文摘要 • The purpose of this study was to explore the clinical validation of the related factors, defining characteristics, and nursing interventions of swallowing disorder among stroke patients. There were two study methods for clinical validation: (1) the diagnostic content validity (DCV) model, (2) the clinical diagnostic validity (CDV) model. Data were analyzed by using t-test, 2 test, factor analysis, and logistic regression.An explore study was used to examine the reliability and validity of three scales which include the scale of swallowing disorder for related factors, the scale of swallowing disorder for defining characteristics, and the scale of swallowing disorder for nursing interventions. The samples of this study included 52 neurological nurses for DCV of related factors and defining characteristics, and 107stroke patients who were divided into a swallowing impairment group (BDST-Positive, N=51) or a normal swallowing group (BDST-Negative, N=56) by the Burk Dysphagia Screening Test (BDST) . The knowledge, attitude, and effectiveness of nursing interventions related to aspiration precaution and swallowing enhancement were evaluated by means of examining caregivers and primary nurses.Results of this study showed that the DCV scores of 17 related factors and 16 defining characteristics were greater than 0.5, but parts of CDV scores were less than 0.5. Four items of defining characteristics were deleted based on the spearman correlation matrix. A cronbach‘s alpha coefficient for the rest items (12 items) was 0.89 and the average interitem correlation was 0.39. All of corrected item / total correlation were over 0.30 (0.45-0.72). Based on factor loading greater than 0.40, two factors were extracted from 12 Defining characteristics. The two factors were labeled “ high risk of aspiration with speech disorder” and “ineffectiveness of swallowing”. Five major Defining characteristics were determined by logistic regression based on the data of 51 BDST-positive patients and 56 BDST-negative patients. The cronbach’s alpha coefficient for nursing interventions related to aspiration precaution and swallowing enhancement were 0.81 and 0.80, respectively.The findings of these study support three scales are reliable and valid in diagnosing and providing nursing interventions for the health problem of swallowing disorder among stroke patients.