最近，在《神经学、神经外科及精神病学杂志》（Journal of Neurology, Neurosurgery, and Psychiatry ）（影响因子: 3.63）杂志上发表的文章中，中科院心理所陈楚侨研究员提出了一种高级统计方法——Rasch模型，来研究在临床大脑损伤病人中使用执行困难问卷测量的自知力缺损问题。研究结果表明在对执行功能症状的报告上，病人和监护人没有显著差异，这证实了前人的研究。然而，这种发现仅在总的分数上一致。自我与监护人报告的中等相关的结果表明，尽管在总分上相当，但监护人报告并不能提供与病人相同的评价。病人与监护人评价的项目区分性证实了他们在评价执行困难问卷频率上的差异性。通过对两个版本的执行功能问卷的项目分析，他们发现不同项目间存在小到中等程度的差异，这些结果也证明了以前的研究结果。对20个执行功能项目中5个项目区分功能的确认，表明了病人与他们的监护人在评价执行功能行为的频率上是存在差异的，同时也表明这些评价是不可互换的。
这些发现立即吸引了该杂志编委会的注意。编委Trevor Bond教授评价说，“这些发现的前提是明显的，直截了当的。监护人和病人报告的显著差异传统上被认为是失调的首要证据，也是这些病人康复方面的一个关键证据……对于这个群体来说，如果这篇文章的发现具有普遍性，临床医生或许需要重新考虑监护人与病人报告执行功能差异的理论、实践以及诊断的重要性。”
自知力受损病人的主观报告是临床医生以及研究人员最关心的问题之一。它是一个非常值得研究的问题。传统上，研究人员采取一种简单的提取法(例如，检测表中病人报告的分数减去他人评价的分数)来反映临床病人的自知力缺损。尽管对病人以及监护人之间的多视角的比较在临床实践中很有趣， 然而，这种方法有一些心理测量学方面的局限，比如把称名数据当作连续数据使用，对项目进行简单相加求总分等。此外，病人以及其他人可能对问卷上相同的项目有不同看法，结果，对日常生活中执行困难行为的频率的报告可能会有很大不同。这种现象被认为是某种类型的测量误差或者项目的区分功能有关。在解释临床被试自知力缺损的结果上，这是非常关键但又常被忽略的问题。（来源：中科院）
生物谷推荐原始出处：
（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.
