要介護者のためのBedside Mobility Scaleの開発

• Published in: 理学療法学 Vol. 35; no. 3; pp. 81 - 88
• Main Authors: 牧迫 飛雄馬, ABE Tsutomu, 島田 裕之, 阿部 恵一郎, 小林 聖美, 小口 理恵, 大沼 剛, 木村 英生, 中村 好男
• Format: Journal Article
• Language: Japanese
• Published: 日本理学療法士学会 20.06.2008; Japanese Society of Physical Therapy
• Subjects: 信頼性; 妥当性; 評価
• ISSN: 0289-3770; 2189-602X
• DOI: 10.15063/rigaku.kj00004963350

This study was intended to develop a Bedside Mobility Scale (BMS) and evaluate its reliability and validity for community-dwelling physically handicapped people. This preliminary study used a consensus exercise with five physical therapists to verify the BMS items that are essential to mobility assessment in a bed and indoors. The BMS was developed with 10 items with established face/content validity. The ten BMS items are rolling, changing to a preferred position on a bed, lying to sitting (plus sitting to lying), holding a sitting position, picking up something, sitting to standing, holding a standing position, transfers, locomotion inside (walking or handling a wheelchair independently). For each item, the BMS score is 0-4. Consequently, the maximum BMS score is 40. A physical therapist (A) evaluated its test-retest reliability by assessing 13 patients (5 males, 8 females; mean age 80.0 ± 10.5 years). Inter-rater reliability was examined by assessing 10 patients (3 males, 7 females; mean age 84.8 ± 7.7 years) by independent raters (physical therapist B and nurse C). Results indicate that BMS has high inter-rater (ICC = 0.97; p < 0.01) and test-retest (ICC = 0.97; p < 0.01) reliability. The second phase of this study was conducted at three home-visit nursing stations. Participants in the study were 163 physically handicapped patients who practiced home-based rehabilitation with a physical therapist or occupational therapist. For each patient, one assessor (a physical therapist or occupational therapist in charge) administered the BMS at a patient's residence. Patients were assessed through direct observation of their performance at their bedside and indoors. The total BMS score was related significantly to the Barthel Index (r = 0.88, p < 0.01), the certified care levels (Government-Certified Disability Index) (r = -0.70, p < 0.01) and the criterion of independence degree of daily living in the handicapped elderly (bed-ridden degree) (r = -0.85, p < 0.01). Moreover, the BMS score showed a significant difference between groups classified by the certified care levels and ADL of disabled elderly persons. These findings indicate that, when using the BMS to assess physically handicapped people, similar results are obtainable by different raters. These results support the use of the BMS, which is demonstrably reliable and valid. The BMS might enable classification of mobility and examination of physical therapy outcomes. Especially, findings in this study indicate that the BMS might be a valuable outcome in severely handicapped patients. 本研究では，重度要介護者を対象としたベッド上，ベッド周囲，居室内での動作および移動能力を定量的に評価する指標を開発し，その信頼性と妥当性を検証した。内容妥当性を満たした10項目からなるBedside Mobility Scale（BMS）を作成し，在宅にて理学療法士または作業療法士の訪問によるリハビリテーションを実施している163名（男性83名，女性80名，平均年齢76.4歳）を対象として，BMSによる動作・移動能力評価を行った。分析の結果，BMSには高い検者内および検者間信頼性が得られた。また，BMSは日常生活活動能力や日常生活自立度と有意な関連を持ち，特に重度要介護者および日常生活自立度の重度低下者の動作能力評価に適しており，臨床的意義が高いと考えられた。