张萍萍,周亮,施加加,等.中文版Ohkuma问卷在脑卒中后吞咽功能筛查中的信度及其应用价值[J].中华物理医学与康复杂志,2026,48(1):8-13
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| 中文版Ohkuma问卷在脑卒中后吞咽功能筛查中的信度及其应用价值 |
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| DOI：10.3760/cma.j.cn421666-20230827-00674 |
| 中文关键词: 吞咽障碍 筛查 问卷 信度 诊断价值 |
| 英文关键词: Dysphagia Screening Questionnaires Reliability Diagnostic value |
| 基金项目:上海市2025年度高水平机构建设运行计划“软科学计划”项目（25692104500）;上海市2023-2025年第六轮公共卫生体系建设三年行动计划（GWVI-6）；上海市2023-2025年公共卫生重点学科建设（GWVI-11.1-49） |
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| 中文摘要: |
| 目的 明确中文版Ohkuma问卷在脑卒中患者应用中的信度及其诊断价值。 方法 选取2021年9月至2022年12月在潍坊医学院附属医院、潍坊市中医院康复科住院的脑卒中患者185例，所有受试者均完成1次中文版Ohkuma问卷的填写，并行电视荧光吞咽检查（VFSS）和Rosenbek渗透-误吸分级量表（PAS）分级。首次问卷调查结束1周后，再随机抽取60例受试者再次填写中文版Ohkuma问卷。计算中文版Ohkuma问卷的克朗巴哈系数(Cronbach′s α)和组内相关系数（ICC），以反应其信度。以VFSS为金标准，计算中文版Ohkuma问卷的灵敏度（Sen）、特异度(Spe)、阳性似然比(PLR)、阴性似然比(NLR)和诊断比值比（DOR），以反应该问卷的诊断效能。绘制受试者工作特征曲线（ROC）并计算ROC曲线下面积（AUC）以评估中文版Ohkuma问卷的预测能力，并采用逐步线性回归模型分析中文版Ohkuma问卷与PAS的相关性。 结果 185例受试者中文版Ohkuma问卷的平均完成时间为216 s，中文版Ohkuma问卷的Cronbach′s α值为0.918，ICC为0.956［(95%CI(0.909,0.979)］（n=60）。中文版Ohkuma问卷的Sen、Spe分别为0.943［95%CI(0.860，0.984)］、0.878［95%CI(0.804,0.932)］，PLR和NLR分别为7.745［95%CI(4.724,12.696)］和0.065［95%CI(0.025,0.169)］，DOR为119.04［95%CI(37.552～337.33)］，绘制中文版Ohkuma问卷区分吞咽障碍的ROC曲线，AUC=0.946［(95%CI(0.914～0.977)］，P<0.001。经逐步多元回归调整混杂因素年龄和性别后，中文版Ohkuma问卷评分与PAS分级仍显著相关(β=0.692，P<0.001)。 结论 中文版Ohkuma问卷是一种快速、可靠、有效的吞咽障碍筛查工具，不仅具有较高的信度和诊断准确性，还可预测吞咽障碍的严重程度。 |
| 英文摘要: |
| Objective To determine the reliability and diagnostic value of the Chinese version of the Ohkuma questionnaire in screening for post-stroke dysphagia. Methods A total of 185 hospitalized stroke survivors were the study′s subjects. They were surveyed using the Chinese version of the Ohkuma questionnaire and underwent videofluoroscopic observation of their swallowing. Grading using Rosenbek′s Penetration-Aspiration Scale (PAS) was also applied. One week after the first survey, 60 of the participants were randomly selected to complete the Chinese version of the Ohkuma questionnaire again. Cronbach′s α was computed to quantify intraclass correlation and assess the reliability of the questionnaire. Sensitivity (Sen), specificity (Spe), the positive likelihood ratio (PLR), the negative likelihood ratio (NLR), and the diagnostic odds ratio (DOR) of the questionnaire were calculated to evaluate its diagnostic performance using the videofluoroscopy results as the gold standard. The receiver operating characteristics (ROC) curve was plotted and the area under the curve was calculated to evaluate the questionnaire′s predictive power. A stepwise linear regression model was used to analyze the correlation between the questionnaire scores and the PAS grades. Results The average completion time for the Chinese version of the Ohkuma questionnaire among the 185 participants was 216s. The Cronbach′s α for the questionnaire was 0.918 with an intraclass correlation coefficient of 0.956 ［95%CI (0.909, 0.979)］(n=60). The Sen was 0.943 ［95%CI (0.860, 0.984)］ with an Spe of 0.878 ［95%CI (0.804, 0.932)］. The instrument′s PLR was determined as 7.745 ［95%CI (4.724, 12.696)］, with an NLR of 0.065 ［95% CI (0.025, 0.169)］ and a DOR of 119.04 ［95%CI (37.552, 337.33)］. The area under the instrument′s ROC curve was 0.946 ［95%CI (0.914, 0.977)］, demonstrating significant power in distinguishing dysphagia (P≤0.001). After adjusting for confounding factors (age and gender) using stepwise multiple regression, the scores on the Chinese version of the Ohkuma questionnaire remained significantly correlated with the PAS grades (β=0.692, P≤0.001). Conclusions The Chinese version of the Ohkuma questionnaire is a rapid, reliable, and effective screening tool for dysphagia, demonstrating high reliability and diagnostic accuracy, and it is capable of predicting the severity of dysphagia. |
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