目的 通过Alberta婴儿运动量表(AIMS)与Gesell发育诊断量表(GDDS)平行效度的研究,以初步探讨AIMS判断高危婴幼儿运动发育异常的百分位参考值。
方法 选取2017年1月-2018年2月在常州市妇幼保健院儿童保健高危儿门诊定期体检的268例高危儿为研究对象,均接受AIMS和GDDS评估。AIMS的百分位与GDDS粗大运动发育商(DQ)用于检测平行效度。将所有的高危儿分为足月组和早产组,并将早产组分为3个月龄组。再将GDDS粗大运动DQ<76分别与AIMS百分位<P
5,<P
10和<P
25进行分析,分别计算各组别的Spearman相关系数和
Kappa值。
结果 在3种标准下,当AIMS判定足月高危儿运动发育异常的百分位取<P
10时,与GDDS粗大运动DQ平行效度最好,呈高度一致(
Kappa＝0.759,
P<0.001);对于≤6月龄的早产高危儿组,在任何标准下二者相关性和一致性均差;对于7~12月龄的早产高危儿组,当AIMS判定运动发育异常的百分位取<P
25时,二者的相关系数和
Kappa值分别为0.779和0.766,呈较好相关和高度一致,而取<P
5和<P
10时仅呈中度相关和一致;对于>12月龄的早产高危儿组,当AIMS百分位异常取<P
10,二者的相关系数和
Kappa值最高,均为1,呈高度相关和完全一致。
结论 AIMS和北京版GDDS在定量和定性方面为高度一致和相关,对于足月儿和1岁以上早产高危儿可取<P
10作为判断运动发育异常的参考值,对于1岁内早产高危儿,AIMS可更敏感地发现运动发育异常,运用其结果判定运动发育异常时仍需综合考虑以决定早期干预时机。
Abstract
Objective To analyze the parallel validity of the Alberta Infant Motor Scale(AIMS) and Gesell Development Diagnosis Scale(GDDS), and to primarily set the percentile reference value of AIMS in judging motor developmental abnormalities of high-risk infants.
Methods From January 2017 to February 2018, a total of 268 high-risk infants who underwent physical examination in Department of Child Health, Changzhou Maternal and Child Health Care Hospital were enrolled in this study, and were assessed by AIMS and GDDS.The percentile of AIMS and gross movement development quotient(DQ) in GDDS were used to test the parallel validity.All the high-risk infants were divided into full-term group and premature group, and the premature group was then divided into three groups according to month of age.Then the Spearman correlation coefficient and
Kappa value of GDDS and AIMS in determining motor developmental abnormalities among each group were calculated.
Results When taking P
10 as the value for determining motor developmental abnormalities in full-term high-risk infants, the parallel validity with GDDS was the best, showing a high consistency between AIMS and GDDS(
Kappa＝0.759,
P<0.001).For high-risk infants aged 6 months or younger, the correlation and consistency between AIMS and GDDS were poor under any criteria.For preterm high-risk infants aged 7—12 months, when the AIMS percentile was＜P
25 for the motor developmental abnormalities, the correlation coefficient and
Kappa value were 0.779 and 0.766, respectively, showing a good correlation and high consistency.However, it was only moderately correlated and consistent when taking AIMS＜P
5 and ＜P
10 as the value of the developmental abnormalities.For preterm high-risk infants over 12 months old, when taking AIMS ＜P
10 as the value of the developmental abnormalities, the correlation coefficient and
Kappa value were the highest.
Conclusions AIMS and Beijing version of GDDS are highly consistent and correlated quantitatively and qualitatively.For full-term high-risk infants and premature high-risk infants over 1 year old, <P
10 can be taken as the reference value for judging motor developmental abnormalities.AIMS can more sensitively detect motor developmental abnormalities for premature high-risk infants within 1 year old.When using the percentile of AIMS to determine motor developmental abnormalities, it is still necessary to comprehensively consider for determining the appropriate time of early intervention.
关键词
高危儿 /
Alberta婴儿运动量表 /
Gesell发育诊断量表 /
运动发育
Key words
high-risk infants /
Alberta Infant Motor Scale /
Gesell Development Diagnosis Scale /
motor development
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参考文献
[1] 黄真,杨红,陈翔,等.中国脑性瘫痪康复指南(2015):第二部分[J].中国康复医学杂志,2015,30(8):858-866.
[2] Chawla S, NatarajanG,Shankaran S,et al.Association of neurodevelopment outcomes and neonatal morbidities of extremely premature infants with differential exposure to antenatal steroids[J].JAMA Pediatr, 2016, 170(12):1164-1172.
[3] McLean N, Trotman H.Outcome of late preterm infants at the University Hospital of the West Indies [J].Am J Perinatol, 2016, 33(14):1365-1370.
[4] Dagvadorj A, Takehara K, Bavuusuren B, et al.The quick and easy Mongolian Rapid Baby Scale shows good concurrent validity and sensitivity[J].Acta Paediatr,2015,104(3) :e94-e99.
[5] 段志娴,白华.Alberta婴儿运动量表在早产儿与足月儿早期干预中的应用比较[J].中国儿童保健杂志,2020,28(7):820-826.
[6] 陈文霞.婴幼儿发育商评分在高危儿随访中的应用研究[J].中国妇幼保健,2017,32(22):5645-5647.
[7] Tian Y, Zhang CC, Yu GJ, et al.Influencing factors of the neurodevelopment of high-risk infants[J].General Psychiatry,2018,31(3): e100034.
[8] 吕攀攀,高文婷,赵娜,等.高危儿神经系统发育的评估:236例报道[J].中国康复理论与实践,2019,25(6):714-717.
[9] Fleuren KMW, Smit LS, Stijnen Th, et al.New reference values for the Alberta Infant Motor Scale need to be established[J].Acta Paediatr,2007,96(3):424-427.
[10] 林传家,李寄平,张秀珍,等.婴幼儿发育检测手册[M].北京:北京市儿童保健所,1986:31-34.
[11] 张秀玲,李寄平,秦明镜,等.Gesell发展诊断量表3.5～6岁北京修订本的制定[J].中国临床心理学杂志,1994,2(3):148-150.
[12] Piper MC, Darrah J.发育中婴儿的运动评估[M].黄真,李明,译.北京:北京大学医学出版社,2009.
[13] Piper MC, Pinnell LE, Darrah J, et al.Construction and validation of the Alberta Infant Motor Scale(AIMS)[J].Can J Public Health, 1992, 83(Suppl 2): 46-50.
[14] 王翠,黄真.Alberta婴儿运动量表[J].中国康复医学杂志,2009,24(9):858-861.
[15] 王慧,李海峰,王江平,等.Alberta婴儿运动量表在脑损伤高危儿康复随访中的应用[J].中华物理医学与康复杂志,2018,40(2):115-117.
[16] 程冰梅,肖华,何璐,等.Alberta婴儿运动量表与Gesell发育量表在高危儿运动评估中的一致性[J].广东医学,2017,38(20):3158-3159,3163.
[17] Piper MC, Darrah J.Motor assessment of the developing infant [M].Alberta: Saunders, 1994.
[18] Campos D, Santos DC, Goncalves VM, et al.Agreement between scales for screening and diagnosis of motor development at 6 months[J].J Pediatr,2006,82(6) :470-474.
[19] Suir I, Boonzaaijer M, Nijmolen P, et al.Cross-cultural validity: canadian norm values of the Alberta Infant Motor Scale evaluated for Dutch infants[J].Pediatr Phy Ther, 2019,31(4):354-358.
[20] Saccani R, Valentini NC, Pereira KRG.New Brazilian developmental curves and reference values for the Alberta Infant Motor Scale[J].Infant Behav Dev,2016,45(Pt A): 38-46.
[21] 王翠,李一芳,黄真,等.Alberta婴儿运动量表的效度研究[J].中国康复医学杂志,2018,33(1):55-58.
[22] 林碧云,危曼,邵肖梅,等.Alberta婴儿运动量表对新生儿重症监护室高危儿出院后筛查运动发育落后的准确性研究[J].中国循证儿科杂志,2015,10(2):81-84.
[23] 漆明霞,张鸣鹤,张娟,等.Alberta婴儿运动量表在高危儿运动发育监测中的应用研究[J].当代医学,2017,23(24):65-67.
[24] 石琳,卞广波,魏勤,等.高危儿Gesell发育量表评估情况分析[J].宁夏医学杂志,2018,40(2):114-116.
[25] Liao PJM, Campbell SK.Examination of the item structure of the Alberta Infant Motor Scale[J].Pediatr Phys Ther, 2004, 16(1):31-38.
[26] 黄真,王翠.目标性活动优化早期发育[J].中国实用儿科杂志,2017,32(11):830-833.
基金
江苏省妇幼健康科研资助项目(F201816);南京医科大学科技发展基金面上项目(NMUB2018069);南京医科大学科技发展基金—一般项目(NMUB2018069)
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