[논문]뇌졸중 환자의 운전재활 시기 결정을 위한 K-MBI의 임상적 유용성: 예비 연구

박명옥

doi:10.21288/resko.2017.11.2.91

뇌졸중 환자의 운전재활 시기 결정을 위한 K-MBI의 임상적 유용성: 예비 연구
Clinical Usefulness on K-MBI for Decision of Driving Rehabilitation Period in Patients with Stroke: A pilot study 원문보기

재활복지공학회논문지 = Journal of rehabilitation welfare engineering & assistive technology, v.11 no.2, 2017년, pp.91 - 98

초록
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연구배경 및 목적: 수정된 바델지수(MBI)는 지역사회 재활세팅 및 재활 병원에서 흔히 사용되어지는 기본적인 일상생활 평가 도구이다. 선행 연구들에 의하면 노인 혹은 뇌졸중 환자들의 운전 능력과 일상생활활동의 수준은 유의미한 상관성이 있음을 보고된 바 있다. 그러나, 뇌졸중 환자의 운전능력을 예측함에 있어 임상에서 흔히 사용되는 일상생활 활동 기본 평가인 수정된 바델지수의 유용성을 밝힌 연구는 미비하다. 본 연구에서는 한국형 수정된 바델 지수(K-MBI)룰 활용하여 뇌졸중 환자의 운전 가능성을 알아봄으로서 운전 수행 능력을 예측함에 있어 한국형 수정된 바델 지수의 임상적 유용성을 알아보고자 하였다. 연구방법: 서울 소재 재활병원에서 재활치료를 받고 있는 뇌졸중 환자 48명이 연구에 참여하였다. 모든 연구 대상자에게 K-MBI 검사를 통해 기본적인 일상생활 활동 수준을 측정하였고 가상현실 운전시뮬레이터를 이용하여 운전 수행능력을 측정하였다. 운전 시뮬레이터상의 운전 수행 검사의 합격/불합격에 따른 K-MBI 점수의 예측 타당도를 ROC curve를 이용하여 검증하였다. 결과: 뇌졸중 이후 운전재활을 권고할 만한 기본적인 일상생활 활동 수준은 K-MBI 점수가 최소 86.5점인 경우가 적절한 것으로 나타났다. 결론: 본 연구는 뇌졸중 환자의 운전 재활을 권고하는 시기를 예측함에 있어 유용한 기초 자료가 될 것으로 판단된다.

Abstract ▼ AI-Helper

Background & Object: Basic daily activity screening tool such as the Modified Barthel Index (MBI) has been used commonly in rehabilitation clinic and community based rehabilitation setting. Previous studies have shown the significant relations between the level of daily activities and driving ability on stroke or elderly people. However, there is a lack of studies to investigate the usefulness of MBI on prediction of driving ability for stroke patient. This study was to predict driving abilities of stroke survivor using Korean version Modified Barthel Index (K-MBI). Methods: A sample of 48 patients with stroke in rehabilitation hospital was recruited. All participants were tested level of basic daily activities using K-MBI. The driving ability of participants was tested using virtual reality driving simulator. The predictive validity was calculated of the K-MBI among pass or fail group of driving simulator test using receiver operating characteristics curves. Results: The cut-off score of >86.5 on the K-MBI is proper sensitivity to predict on driving performance ability. Conclusion: This pilot result offers clinical reference to therapists and caregivers for reasoning on driving recommendation period during rehabilitation stage of stroke survivors. Further studies need to identify prediction using real on-road test in a large population group.

주제어

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문제 정의

Therefore, next study will be have to investigate on-road conditions. In addition, in this study was showed the significant mean difference on driving performance between men and women. This result is similar the previous study that the women older has lower self-regulation on driving performance than the men[30-31].
This study established the predictive validity of the K-MBI for measuring driving ability of patient with stroke. Although, K-MBI is a screening tool to measure for basic daily activities, its accuracy in predicting driving ability is closure to moderate exact.
Despite some limitations, this study has some clinical significance. This study provided the cut-off value of K-MBI score to predict driving skill of patient with stroke. It means K-MBI is usefulness to anticipate passing or failing value of driving ability.

제안 방법

Driving aptitude tests are assessment for essential driving ability based on motor and cognitive function for safe driving and it is consist of four sub-items: reaction time, judgment, speed anticipant and steering wheel-pedal operation test. Also, on-road course tests in the simulator were composed of various road course scenarios. In this study, specific two courses: exercise mode & test mode were used for evaluating driving ability.
An occupational therapist assessed all of the participants. First, the occupational therapist assessed basic activities of daily living status of participants using K-MBI. And then, there were checked driving performance ability using the simulator.
In order to perform an evaluation that can predict whether or not to resume driving of the patient, therapist apply several physical, visual-perceptual, cognitive evaluation such as Useful Field of View (UFOV), Motor-free Visual Perception Test (MVPT), Trail Making Test A & B (TMT A&B), Optical Vision Test and driving simulation.
In this study, specific two courses: exercise mode & test mode were used for evaluating driving ability.
In most cases, whether their client resuming driving after a stroke it depends on the clinical reasoning of the occupational therapist. In this study, using the K-MBI, which is most commonly used in the clinical order to examine the training point of driving ability to perform post-stroke, it was you want to select a sorting reference value by executing the operation acceptance. Of the more patient 6 months after stroke onset, after measuring the current K-MBI score was judged whether the operation or performance acceptance with driving simulator.
In this the study was used virtual reality simulator for measuring client’s driving ability.
The receiver operation characteristic curve (ROC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were analyzed to know the cutoff-value between the K-MBI scores and the driving ability score. All data analyzed using the IBM SPSS software version 20.
Therefore, this study aimed to know cut-off score of Korean version Modified Barthel Index (K-MBI) to decide a suitable point for recommendation of driving rehabilitation for stroke patients.

대상 데이터

This study was a cross-sectional design and a total of 48 stroke patients participated in the study. The participants were recruited from among patient being admitted at a rehabilitation hospital in Seoul.

데이터처리

Descriptive statistics were used to describe the demographic characteristics of all the participants. The Chi-square test and the independent t-test were used to compare the demographic characteristics and functional performance ability between pass and fail group in the driving test results.

이론/모형

The participants were recruited from among patient being admitted at a rehabilitation hospital in Seoul. The sampling was used convenience method. All participants were diagnosed as having stroke.

성능/효과

Although, K-MBI is a screening tool to measure for basic daily activities, its accuracy in predicting driving ability is closure to moderate exact. Clinically, this findings means when the therapists recommend driving rehabilitation to their client, the right period is 86.5 point of K-MBI scores. Even though, this study is pilot research, it provide evidence of clinical reasoning using K-MBI as widely used test for right period to recommend driving rehabilitation of stroke survivors in clinical setting.
The results of the independent t-test indicated that there were no significant difference in the age or driving experience among driving test result (p>.05).
As their daily activities scores were higher, driving performance skills were appeared more higher in older driver[27]. The results of this study, when the K-MBI score was showed upwards of than 86.5, participants successful drove on simulator. In other words, this result means when therapists whom in the rehabilitative hospital suggest training for driving to their patient with stroke, the appropriative period is predicted among upward of 86.
Of the more patient 6 months after stroke onset, after measuring the current K-MBI score was judged whether the operation or performance acceptance with driving simulator. The results to analyze whether pass reference point to operation run through the curve of the ROC curve, was the cut-off score when K-MBI score is 86.50 points. In this case, the under area of ROC curve is shown in 0.

후속연구

In spite of this result, this study has some limitation. Because this study was preliminary research, the further study will have to progress using cohort design through large group. In this the study was used virtual reality simulator for measuring client’s driving ability.
However, there is a study that the driving errors on the driving simulator is different with on-road driving performance. Therefore, next study will be have to investigate on-road conditions. In addition, in this study was showed the significant mean difference on driving performance between men and women.

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