摘要：
目的 确定复旦中文版沟通功能分级系统(CFCS)的信度和效度.方法 以2017年5月至2017年10月在复旦大学附属儿科医院康复中心和上海董李凤美康健学校中2～18岁脑瘫和具有沟通障碍的学龄前儿童(PCCD)为研究对象,排除具有严重听力和视力障碍者和非汉语沟通的家庭.由研究小组多名儿童康复医师和治疗师根据英语版CFCS翻译、回译和集体讨论形成复旦中文版CFCS.在言语语言治疗师(SLP)进行现场CFCS评级的同时,照顾者根据CFCS提供的评估流程行回顾性评估,相对照顾较多的为第一照顾者,较少的为第二照顾者.通过分析SLP和照顾者、照顾者之间的评估结果的相关性,确定CFCS的评估者间信度.以能力低下儿童评定量表(PEDI)作为校标行效度检验,PEDI评估者为儿童照顾者或儿童在校的主要任课老师,通过分析SLP的CFCS分级与PEDI社会功能项目的尺度化分之间的相关性,确定CFCS的效度.结果 符合本文纳入和排除标准的研究对象139名儿童,男91例,年龄2.0～ 15.8 (4.7±3.2)岁,2～4岁74例(53.2％),～16岁65例.脑瘫儿童80例均行粗大运动功能分级系统(GMFCS)评估,行手功能分级系统(MACS)评估47例;PCCD儿童59例.同1名SLP对139个纳入对象行CFCS评估.102/139(73.4％)个家庭至少有1名照顾者参与了CFCS评估,48/102(47.1％)个家庭有2名照顾者参与了CFCS评估,总体信度SLP与照顾者、第一和二照顾者间CFCS评级Kw分别为0.83和0.85.102个参与了CFCS评估家庭中55例脑瘫儿童,其中20例有2名照顾者参与了CFCS评级,SLP与照顾者、第一和二照顾者间CFCS评级Kw分别为0.88和0.86;PCCD 47例儿童,其中28例有2名照顾者参与了CFCS评级,SLP与照顾者、第一和二照顾者间CFCS评级Kw分别为0.85和0.82.2～4岁儿童的CFCS评价在SLP和照顾者间的信度为Kw=0.77,照顾者间的信度为Kw=0.90;～ 16岁儿童的CFCS评级在SLP和照顾者间的信度为Kw=0.87,照顾者间的信度为Kw=0.74.139例纳入对象SLP的CFCS级别与PEDI社会功能项目的尺度化分之间的相关系数为-0.81.结论 复旦中文版CFCS在脑瘫儿童和PCCD中均具有良好的评价者间信度和平行效度,可以有效地对这些儿童进行沟通功能分级.%Objective To determine the reliability and validity of Chinese Communication Function Classification System (CFCS,Fudan).Methods Inclusion criteria:Children diagnosed as cerebral palsy aged from 2 to 18 years and preschool children with communication disorders(PCCD) in Children's Hospital of Fudan University and Shanghai Dong Li Feng Mei Health School from May to October 2017.Exclusion criteria:Children with severe hearing and visual impairments and families with non-Chinese communication.Several pediatricians and rehabilitation therapists in the study group translated,re-translated,collectively discussed and formed the Chinese CFCS(Fudan) according to the English original translation.While the SLP was performing on-site CFCS,the caregivers who were given the process retrospectively assessed CFCS,relatively the one who took more care was the first caregiver and less for the second caregiver.The inter-rater reliability of the CFCS was determined by analyzing the correlation between the results of a SLP and a caregiver and the results of a caregiver and a caregiver.Pediatric Evaluation of Disability Inventory (PEDI) as a parallel validity test was assessed by the caregivers for children or children's main teachers at school.By analyzing the correlation of the SLP's CFCS levels and the scales of the PEDI social function items,the validity of CFCS was determined.Results 139 Children were involved in the research,91 males and 48 females,aged between 2.0 and 15.8 (4.7 ±3.2) years,74 cases (53.2％) were from 2 to 4 years old and 65 cases were from 4 to 16 years old.80 children with cerebral palsy were assessed by GMFCS,47 were assessed by MACS,and 59 of 139 children were PCCD.The SLP assessed the all 139 children involved in the research.At least one caregiver in 102/139 (73.4％) families participated in the CFCS assessments,2 caregivers in 48/102 (47.1％) families participated in the CFCS assessments.Overall reliability:Kw values between a SLP and a caregiver,the first and second caregiver were 0.83,0.85.55 children of 102 participants involved in CFCS assessments were cerebral palsy,of them 2 caregivers in 20 families participated in the CFCS assessments,Kw values between a SLP and a caregiver,the first and second caregiver were 0.88,0.86.47 children were PCCD,of them 2 caregivers in 28 families participated in the CFCS assessments,Kw values between a SLP and a caregiver,the first and second caregiver were 0.85,0.82.As to the CFCS of Children aged 2 to 4 years,Kw value between a SLP and a caregiver was 0.77,and the first and second caregiver was 0.90.The CFCS of Children aged 4 to 16 years,Kw value between a SLP and a caregiver was 0.87,and the first and second caregiver was 0.74.139 participants' correlation coefficient between the SLP's CFCS levels and the scales of the PEDI social function items was-0.81.Conclusion The Chinese CFCS(Fudan) has good reliability and parallel validity among children with cerebral palsy and PCCD,and can effectively classify the communication function of these children.
