目的 评价经口摄食功能评估量表(FOIS)和洼田饮水试验应用于急性脑卒中患者中的信效度,为急性脑卒中患者的吞咽功能评估提供更为有效的评估工具.方法 采用便利抽样法,选取2016年4—9月南方医科大学南方医院神经内科收治的急性脑卒中患者304例为研究对象.采用FOIS、洼田饮水试验对其进行评估,记录其发病初期第1、2次评估结果 及发病1、3个月评估结果.结果量表的评定者信度:发病初期第1次FOIS评估结果与发病初期第2次FOIS评估结果的Kappa值为0.862,rs=0.934,P值均<0.001;发病初期第1次洼田饮水试验评估结果与发病初期第2次洼田饮水试验评估结果的Kappa值为0.923,rs=0.976,P值均<0.001.量表的效标效度:发病初期第1次FOIS评估结果与改良Barthel指数评分结果的χ2值为118.21,rs=0.397,Cramer's V=0.624,P<0.001;发病初期第1次FOIS评估结果与美国国立卫生研究院卒中量表(NIHSS)评分结果的χ2值为78.50,rs=-0.461,Cramer's V=0.508,P<0.001;发病初期第1次洼田饮水试验评估结果与改良Barthel指数评分结果的χ2值为123.93,rs=-0.574,Cramer's V=0.638,P<0.001;发病初期第1次洼田饮水试验评估结果与NIHSS评分结果的χ2值为75.56,rs=0.464,Cramer's V=0.499,P<0.001.发病初期第1次FOIS评估结果与发病初期第1次洼田饮水试验评估结果的rs=-0.933,P<0.001.FOIS评估结果与洼田饮水试验评估结果均显示,患者发病3个月后的吞咽障碍症状明显减轻,经口摄食功能也有所改善.结论 FOIS与洼田饮水试验均具有良好的信效度,且在评估急性脑卒中患者的吞咽功能方面具有密切的相关性,其联合使用可使急性脑卒中患者的吞咽功能评估更全面、更具体.%Objective To investigate the reliability and validity of the Functional Oral Intake Scale (FOIS) versus the water swallow test in acute stroke patients, in order to provide a more effective tool for measuring the dysphagia in these patients. Methods A total of 304 patients with acute stroke receiving treatment in Department of Neurology, Nanfang Hospital, Southern Medical University from April to September 2016, were enrolled by using the convenient sampling. The swallowing function of them was evaluated two times at the initial period after acute stroke, and was evaluated at 1 month, 3 months after the onset of acute stroke by both FOIS and the water swallow test.Results Rater reliability: the overall rater agreement between the first and the second evaluation was excellent with aKappa statistic of 0.862 (FOIS) and of 0.923 (the water swallow test),rs=0.934 and 0.976, respectively, allP<0.001. Criterion validity: the chi square values of the first evaluation results of the FOIS and water swallow test, compared with the Modified Barthel index scores, were 118.21 (rs=0.397,Cramer's V=0.624,P<0.001) and 123.93 (rs=-0.574,Cramer's V=0.638,P<0.001), respectively. The chi square values of the first evaluation results of the FOIS and water swallow test were 78.50 (rs=-0.461,Cramer's V=0.508,P<0.001) and 75.56 (rs=0.464,Cramer's V=0.499,P<0.001) respectively, compared with the NIHSS scores. In addition, there was a significantly negative correlation between the first evaluated results of FOIS and the water swallow test (rs=-0.933,P<0.001). Both the results of FOIS and water swallow test showed that the symptoms of dysphagia were significantly alleviated and the oral feeding function was improved at three months after stroke onset.Conclusion Both FOIS and the water swallow test are reliable and valid for evaluating the swallowing function in patients with acute stroke, with a significant correlation with each other. The combined use of the two tests can make the swallowing function evaluation in these patients more comprehensive and specific.
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