最近,，在《神經(jīng)學,、神經(jīng)外科及精神病學雜志》（Journal of Neurology, Neurosurgery, and Psychiatry ）（影響因子: 3.63）雜志上發(fā)表的文章中，中科院心理所陳楚僑研究員提出了一種高級統(tǒng)計方法——Rasch模型,，來研究在臨床大腦損傷病人中使用執(zhí)行困難問卷測量的自知力缺損問題,。研究結果表明在對執(zhí)行功能癥狀的報告上，病人和監(jiān)護人沒有顯著差異,，這證實了前人的研究,。然而，這種發(fā)現(xiàn)僅在總的分數(shù)上一致,。自我與監(jiān)護人報告的中等相關的結果表明,，盡管在總分上相當，但監(jiān)護人報告并不能提供與病人相同的評價,。病人與監(jiān)護人評價的項目區(qū)分性證實了他們在評價執(zhí)行困難問卷頻率上的差異性,。通過對兩個版本的執(zhí)行功能問卷的項目分析，他們發(fā)現(xiàn)不同項目間存在小到中等程度的差異,，這些結果也證明了以前的研究結果,。對20個執(zhí)行功能項目中5個項目區(qū)分功能的確認，表明了病人與他們的監(jiān)護人在評價執(zhí)行功能行為的頻率上是存在差異的,，同時也表明這些評價是不可互換的,。
這些發(fā)現(xiàn)立即吸引了該雜志編委會的注意,。編委Trevor Bond教授評價說，“這些發(fā)現(xiàn)的前提是明顯的,，直截了當?shù)?。監(jiān)護人和病人報告的顯著差異傳統(tǒng)上被認為是失調(diào)的首要證據(jù)，也是這些病人康復方面的一個關鍵證據(jù)……對于這個群體來說,，如果這篇文章的發(fā)現(xiàn)具有普遍性,，臨床醫(yī)生或許需要重新考慮監(jiān)護人與病人報告執(zhí)行功能差異的理論、實踐以及診斷的重要性,。”
自知力受損病人的主觀報告是臨床醫(yī)生以及研究人員最關心的問題之一,。它是一個非常值得研究的問題。傳統(tǒng)上,，研究人員采取一種簡單的提取法(例如,，檢測表中病人報告的分數(shù)減去他人評價的分數(shù))來反映臨床病人的自知力缺損。盡管對病人以及監(jiān)護人之間的多視角的比較在臨床實踐中很有趣,， 然而,，這種方法有一些心理測量學方面的局限，比如把稱名數(shù)據(jù)當作連續(xù)數(shù)據(jù)使用,，對項目進行簡單相加求總分等,。此外，病人以及其他人可能對問卷上相同的項目有不同看法,，結果,，對日常生活中執(zhí)行困難行為的頻率的報告可能會有很大不同。這種現(xiàn)象被認為是某種類型的測量誤差或者項目的區(qū)分功能有關,。在解釋臨床被試自知力缺損的結果上,，這是非常關鍵但又常被忽略的問題。（來源：中科院）
生物谷推薦原始出處：
（Journal of Neurology, Neurosurgery, and Psychiatry ）,，79:86-88,，R C K Chan，R K Bode
Analysis of patient and proxy ratings on the Dysexecutive Questionnaire: an application of Rasch analysis
R C K Chan1, R K Bode3
1 Neuropsychology and Applied Cognitive Neuroscience Laboratory, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
2 Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
3 Centre for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, Illinois, USA
Correspondence to:
Professor R Chan, Institute of Psychology, Chinese Academy of Sciences, Beijing 100101, China; rckchan@psych.ac.cn
Background: We provide an alternate method of analysing self-report and proxy-report data on subjective complaints of dysexecutive symptoms among a group of patients with traumatic brain injury.
Objective: The purpose of this study was to examine differences in the ratings of patients and proxies on a measure of the dysexecutive syndrome and further explore the insight impairment problem in patients with traumatic brain injury.
Methods: Rasch analysis was conducted on the ratings of the Dysexecutive Questionnaire (DEX) by a sample of patients and their proxies.
Results: While the average scores based on patient and proxy ratings were approximately the same (mean patient raw score = 30.12 and mean proxy raw score = 31.32), differential item functioning was found in five DEX items. As a result, the relationship between measures obtained from patient and proxy ratings was only in the moderate range (intraclass correlation = 0.46).
Conclusions: Identification of differential item functioning in five of the 20 DEX items reflected the different perspectives of patients and their proxies in reporting the frequency of dysexecutive behaviour and suggests that these ratings are not interchangeable.
