12/28 NTUH clinical assessment

五字數值試(Five digit test, FDT):
作者：Manuel Sedo
出版社：TEAEDICIONES
中文翻譯者：Kar Ho Lau, a fantastic High School Senior in Boston, MA.
費用：Booklet-$10
Answer sheet-$25

http://www.sedo.net-a.googlepages.com/home

Non language bound low academic loaded alternative form of the stroop test that has been shown to be sensitive to automatic and controlled attention processes. The FDT test is used in children to measure reading ability and in clinical adults to measure brain damage from various causes.(Ages 6 to adult)

Second review:
I have questions regarding the Chinese version of FDT:
1. I’m confused about the stopping time that showed in the answer sheet at two different time?
2. How do I use the time and the numbers of correct items to interpret the patient’s function?
3. Can patients use their finger to point at each box to help them focus while counting numbers in each box?
4. Is the patient allowed to correct their answer during test?



複本就是類似原始量表的另一個施測版本 使用複本的目的主要是要避免使用原始量表產生的練習效應的影響 (e.g. 受測者可能會記得之前的題目及答案)

12/26 NTUH clinical & review IRB form

申請臨床試驗IRB
台大:要申請證明,則臨床試驗計畫送件核對單多印一張交給林淑芳蓋章後即可領回(需蓋申請者章)

1、臨床試驗計畫送件核對單(置於首頁)
2、臨床試驗計劃申請書--最末頁上需蓋申請者章及單位主管章(醫院-部主任章，醫學院-科主任章)
3、臨床試驗計劃書(首頁右上角需加上計畫申請人及蓋章)
4、臨床試驗快速審查範圍評檢表(背面需蓋申請者章及單位主管章)
5、臨床試驗受試者說明及同意書(首頁需蓋主要主持人章)
6、問卷
7、參考文獻
8、主持人及協同研究人員之學經歷、著作及所受訓練之背景資料(首頁需蓋申請者章)
9、檔案附光碟、隨身碟或email至NTUHRE011@yahoo.com.tw
10、以上申請時訂為一份合計共需2份,送至東址B4(AB棟)研究倫理委員會辦公室(門口有門禁)，分機3155申請
最好全部單面列印(除臨床試驗計劃書可雙面列印)--現沒規定
11、倫委會網頁台大醫院/文件表格/醫學研究部之表格下載
http://intra.mc.ntu.edu.tw/default_Ehospital.asp
e-mail: shuhwai@ha.mc.ntu.edu.tw

計劃時間更改變更
1.變更申請公文-簽一份
2.臨床試驗計畫申請書舊計劃時間第一,二張影本
3.新的臨床試驗計畫申請書,臨床試驗計畫書
高醫倫委會07-3121101-2396
國衛院02-26534401-23322

#因此需要檔案分開,在排版時較容易處理!

12/24 NTUH IRB(attention)

Mission:
1.Find out the prize of the FDT in english version.
2.Redesign the answer sheet in more easy exanmination way.
3.Need to pass up the IRB on Wednesday.

12/21 NTUH's clinical assessment & review article

Mission:
1.Today have finished 2 ADL and 1 BIB.
2.Next week may be will come on Monday 12/24,Wednesday12/26 and Thusday12/27.


FDT's Question:
I have questions regarding the Chinese version of FDT:
1. I’m confused about how to administer the test. In the instruction part, the stopping time isn’t mentioned anywhere. However, in the answer sheet ,stopping time is showed at two different time?
2. What is the instruction of the FDT scoring? How do I use the result (time and the numbers of correct items) to interpret the patient’s function?
3. Can patients use their finger to point at each box to help them focus while counting numbers in each box?
4. Is the patient allowed to correct their answer during test?

12/18 IRB form & NTUH's clinical assessment

Mission:
1.Today finished 2 ADL and1 BIB.
2.Use photoimpact correct the chinese numerals to Arabic Numerals.
3.Review the IRB form and article.
4.Disscuss the question of FDT with angie.(may be need to mail to the author)

12/17 IRB form & NTUH's clinical assessment

Mission:
1.Review IRB form of Wan Fang.
2.Today finished 1BIB and ADL,and 1 FDT.


Question about FDT:
1.patient will use their finger to point out the box of the test while answering the number,suitable or not?
2.what is the Criterion of this test?how to mention about the account of corret answer and the time?how to interpret p't ability?
3.patient will corret their answer while they fnd out the wrong answer,in that moment,what should I do ?

12/14 IRB form &NTUH's clinical assessment

萬芳IRB 需求:
1. 收件表單
2. 送審資料清單
3. 快速審查範圍勾選表 ( 視需要 )
4. 人體試驗計畫申請書
5. 審查意見表---一般
6. 主持人 / 共同主持人資料 ( 個人簡歷、臨床試驗 GCP 訓練資料等 )
7. 計畫書摘要 ( 若為查驗登記之試驗請另檢附衛生署之計畫書摘要格式 )
8. 計畫書 ( 計畫書參考範例 )
9. 受試者同意書 ( 一般試驗、基因、檢體 )、寫作建議
10. 醫療資源使用表
IRB 計畫
萬芳醫院 教研部
Tel: 02-29307930--轉機1467 or 1465陳嘉宏先生(IRB)
==>if get any question about IRB,can ask him.
寄件到此信箱96315@wanfang.gov.tw
相關表格，請至 http://www.wanfang.gov.tw/edu/06_irb/download.htm

if get any question about IRB,can ask him.
Mission:
1.Review the data of the IRB form
2.Today just finished 1 paper of BIB and ADL.
3.Next week will come on Monday, Tuesday and Fiday.

12/13 IRB form & NTUH's clinical assessment

Mission:
1.fill in all the form of Wan Fang.
2.Today i finished 1 ADL & BIB, and 2 FDT with stroke p't.

Tomorrow Mission:
1.call the 林嘉皇老師 about the plan will delay after Chinese New Year.
2.change the chinese number of FDT to Arab number e.g四-->4.
3.conclude the question about the FDT and article, tomorrow afternoon will discuss with sir.

寫作要點

1. 撰寫主題句：明確的主詞，完整明確的句意。若有可能，再精簡之！
(不是原句翻譯,而是擷取句子重點,然後以本身的句子表達出來)

2. 段落或章節內容，可先具體體會其意義，闔上書本後，再將段落或章節之重點，以自己的詞彙撰寫下來。（然而若有不懂或模糊不清之處，務必跟老師討論及澄清之！）

3.效率提問題:有任何問題,或者不明白的句子,應先釐清不明白的地方或者將問題以文字表達出來,再經由本身的思考,經過沉澱後再提出!

名詞解釋-網路篇 for 統計相關詞彙
「統計相關詞彙」可參考：http://ccms.ntu.edu.tw/~clhsieh/spss2003.htm 個人彙整。
研究方法及心理計量相關詞彙解釋：http://www.smithsrisca.demon.co.uk/research-methods-glossary.html
統計及心理計量詞彙：http://www.sportsci.org/resource/stats/ 2005-07-11
Logical Validity（邏輯效度）
Essentially the same as content validity, but, for a motor skills test. If the test assesses performance of what was taught without being confounded with other variables the test is logically valid. For further details, please take a visit at: http://www.geolog.com/msmnt/mval.htm

Future Plan:
資料庫查詢與彙整

學習 Endnote 軟體之使用 （詳：http://ccms.ntu.edu.tw/~clhsieh/EndNote/）
學習查詢 PubMed 資料庫建立簡易的 bibliography 於 Endnote以上

12/12 Reading & Revision

Mission:
Some questions about FDT:
1.why the answer beed to separate 2 stop timing,what is the meaning?
2.Figure out the instruction of evaluation and scoring !
3.If the tester said a wrong answer while having the examination,how to scoring or need to remind them that they couldn't change the answer?
4. The guidance of the assessment need to more profession,clear and understanding,or not they will spend much time to understanding and finish it.
5.some examination protocol need to figure out!
such like ,
指導語的目的是讓個案明白測驗作答方式，故在陳述指導語時，應隨時與個案保持視線接觸，並且視個案的反應而調整解釋的速度。而非將指導語通通唸完後，才看受試者。

一開始詢問個案是否有無老花或近視，若個案回答有，則應進一步主動詢問是否有帶來，若無，就拿出我們備用的眼鏡(如果我們自己有準備,目前還沒有)。而不是在個案測驗已經進行一半時，等到個案反應才拿出來。
6.是否應該先探討文字和算數這兩者對受試者那一者影響較多?為何要探討呢?

Five digit test(FDT):五字數值試

五字數值試(Five digit test, FDT):
作者：Manuel Sedo
出版社：TEAEDICIONES
中文翻譯者：Kar Ho Lau, a fantastic High School Senior in Boston, MA.
費用：booklet-$10
Answer sheet-$25

※2種不同評估方式：讀取或者數一數排列在圖卡上的一組數字或星星符號；或者不同數目和數字組合(1個4、2個5及3個1等等)。
※為中性語言，不要求讀出，可施測於無法在Stroop色字測驗回應的個案，比如年幼個案、文盲和色盲(無法分辨顏色的個案)。
※由於不同社會和文化背景下，最少為5個字句為最適合讓個案理解測驗的題目；及可跨文化和語言比較。(部分個案需要使用語音答案卷來回答以便能更清晰理解測驗的題目內容)
※分為4部分(閱讀一頁有50個項目)：
◎Rate of production(生理回應) of the subject反應：
=>檢測功能：言語速度（speeded verbal production）、流暢度（fluency）
＃Part1:Reading閱讀：讀出卡片上的數字
＃Part 2:Couting算數：數一數卡片上星星的數目
◎Cognitive controls of the subject適應：
=>檢測功能：認知結果（conscious effort）、計畫能力（planning）、適應性（flexibility）
【選擇性注意力和轉移性注意力】
＃Part 3:Selecting焦點：數一數卡片上數字的數目(選擇有矛盾的項目而不是讀取數
字)。比如數字為5但只有一個，答案為1。
＃Part 4:switching適應：在黑框中，所有項目之間從數數和讀取施測方式的轉移。
※嘗試用於和Stroop色字測驗(Stroop Color Word Test)比較直覺概念上的不一致(perceptual-conceptual conflict)
Stroop色字測驗為需個案讀出或命名出字的顏色，有時字的顏色會不一樣。

在非臨床狀況下，SCWT和FDT的相關為.71，.64，.66和.65（顯著水平p=.001）。
與較年老的中風患者比較，FDT能準確辨別97.5%的個案（隨意分類與測驗”沒有顯著差異”），但無法提供功能化。
FDT較少強調項目內容；但卻注重過程：控制順序結果和自我認知導向。
在臨床個案上，FDT為一般、控制、快速施測；分數無法與教育程度和受傷前能力呈現相關，及個案神經狀況表現負重。
FDT 為無特殊非閱讀測驗卻具有敏感的分辨腦部是否受損，尤其在多種文化個案上卻有著語言優勢或者不同教育程度、文盲或者色盲。

12/10 Reading article

Q&A
1.一旦在文章中得証信效度,有沒有一套方法或者其他方式可以知道這篇論文是否值得我們去參考或應用!
Ans:對於論文--價值==>研究設計或研究主題(多層面的,因有不同的issues需要確定)能不能夠回答探討的問題.因此我們才需要去懷疑這篇文章內容,將此篇的論文使用的方法和其他之前看過有類似ㄧ樣的做比較(comparison);也可以藉由文章內的討論,研究上的限制,介紹自己的優缺點以及前言對其他文章的討論來作為indicator.

2.另一個面向,則是如何知道工具是否可以證明這篇論文或如何去驗證?
Ans:就要看其研究的項目是那一種,如再測信度,施測者間信度等等,從它們的定義,統計指標,判讀標準以及臨床涵義或價值去推斷此篇論文的核心在告訴我們什麼事情!作者為何要以如此的研究工具去探討什麼議題?為何要利用某個項目來研究此目的的關係?

IRB 計畫
萬芳醫院 教研部 Tel: 02-29307930--1467(IRB)--96315@wanfang.gov.tw 1465陳嘉宏先生
相關表格，請至 http://www.wanfang.gov.tw/edu/06_irb/download.htm

12/7 Reading Article

P(probability):Inferential statistic =>estimate population 推母群體
=>characteristic of population
用sample 的特性去推population
@CI=confidence Interval 信賴區間
99%CI(α=0.05)={mean-2.57SD,mean+2.57SD}99%左右的樣本的平均值會落入U±2.58SE
95%CI(α=0.05)={mean-1.96SD,mean+1.96SD}95%左右的樣本的平均值會落入U±1.96SE
90%CI(α=0.05)={mean-1.645SD,mean+1.645SD} 90%左右的樣本的平均值會落入U±1.64 SE


當數值超過CI範圍==>表示不屬於此sample

Hypothesis testing: intervention 之後,看進步是因為by chance or sampling error
費雪爾（R.A.Fisher），把假設分為虛無假設（null hypothesis）與對立假設（alternative hypothesis）
兩種，且分別以符號Ho及H1表示之。
費雪爾建議：將實驗者心目中盼望得到的研究結果當作是對立假設H1 ；而將與對立假設完全相反的結果當作是虛無假設Ho。在兩種假設當中，只有虛無假設是直接受到統計檢定。費雪爾希望藉由統計測驗推翻虛無假設，從而間接的為對立假設的可信性提供支持。
1-4steps:
1.state null hypothesis: intervention 無效
Ho=Ua=Ub=Ua-Ub=0
#拒絕 虛無假設
#接受 虛無假設(介入無效)
evidence is too weak to support the effect (intervention 不一定無效)
2.state the alternative hypothesis:intervention 有效
H1=Ua≠Ub or Ua-Ub≠0 (nondirectional hypothesis)
H1=Ua>Ub(directional hypothesis)較常用
3.select level of significance (α)
error:decision to reject
Type 1 error(α)α=0.05(p<0.05)
type 2 error(β)β=0.2(power=0.8)

p=0.05 有5%的機率效果是by chance,有5%是Type 1error
p values: p<0.001 or p=0.001 在統計的意義=>都小於0.05,reject Ho
可以看出有進步或改變的差異
要看效果則要看effect size(ES)

null hypothesis(虛無假設）
「虛無假設」是母群體的變數。假設驗證是要根據實驗資料測試虛無假設的可行性，它可能被推翻或不被推翻。The null hypothesis is an hypothesis about a population parameter. The purpose of hypothesis testing is to test the viability of the null hypothesis in the light of experimental data. Depending on the data, the null hypothesis either will or will not be rejected as a viable possibility.
研究者想研究酒精和人對音調反應的影響。當µ1 表示喝酒者的平均反應時間，而µ2表未喝酒者的平均反應時間，則此虛無假設為µ1 - µ2 = 0。
Consider a researcher interested in whether the time to respond to a tone is affected by the consumption of alcohol. The null hypothesis is that µ1 - µ2 = 0 where µ1 is the mean time to respond after consuming alcohol and µ2 is the mean time to respond otherwise.
虛無假設通常和實驗者的預測結果相反，為的是要讓實驗資料將之推翻。此實驗中，實驗者認為酒精對反應力有不良的影響，若實驗資料亦顯示如此，則可以將虛無假設推翻。
The null hypothesis is often the reverse of what the experimenter actually believes; it is put forward to allow the data to contradict it. In the experiment on the effect of alcohol, the experimenter probably expects alcohol to have a harmful effect. If the experimental data show a sufficiently large effect of alcohol, then the null hypothesis that alcohol has no effect can be rejected.
http://www.ruf.rice.edu/~lane/hyperstat/A29337.html

null hypothesis：先假設和原本假設相反的假設，也就是「虛無假設」，再推翻它，進而證明原假設成立。（這麼做的原因是因為要直接證明一個假設成立很難，因為它可能在各種狀況下都成立，而只要所有情況中有任一個可以證明假設不成立，即可推翻此假設，但我們又不能保證已經找出所有的情況故最好的方法就是先假設和預期相反的虛無假設，再進一步推翻它，此方法較容易，且可間接證明原先預期成立。

12/6 NTUH's assessment & visit OT at Wan Fang Hospital

Mission:
1.2p't were out of croterion,one p't stroke because of falling floor,and the others' balance too poor to assessment his performance ,the score almost was zero.

2.Wan Fang Hospital:
林嘉皇老師 : 02-29307930轉1612, H.phone:09-26155910
Rush time :Mon,Wed,Fri---> 9-10a.m & 2-3p.m
Space: Have one bobath bed for us to assessment BIB,but if we have any interview or assessment in rush hour that the environment are crowed for us to do it.So ,we can use the corridor (the space of outside therapy room,still need time to observation).
Next Friday will go to contact with the 林嘉皇老師 for the next arrangement.

12/5 NTUH's assessment

Mission:
1.Today i finished 3ADL& BIB.
2.Tomorrow i will go to Wan Fang hospital for figure out the situation at there,such as how many CVA p't(name list),environment(bed,a room for cognition),how i reach the p't,and the detail of our plan need to interpretation!
3.Tomorrow morning plan to have meeting with sir!

Responsiveness（反應性）

1.反應性決定一工具是否夠敏感及可以偵測出臨床重要的變化。指評估工具可偵測出具臨床意義之改變的能力。(Responsiveness determines whether an instrument is sensitive to and can detect clinically important change.) (Hobart, 1996)

2.反應性是指一測量工具能在改變確實發生的情況下所檢測出表現改變的能力。(Responsiveness is the ability of an assessment to measure change in performance over time in situations where change truly occurs.) (Deusen. & Brunt, 1997)
【〝Assessment in Occupational Therapy and Physical Therapy〞by J.V. Deusen. & D. Brunt. (1997) p.432 、 Hobart, J.C. (1996). J. Neurol Neurosurg & Psychiatry, 60, 127-130. 】

3.指此量表偵測欲測量特質些微變化的能力。一個良好的量表，應能適當地反應病患或治療師所感受到或觀察到之功能變化。

effect size（效應值）

Effect size(ES)效應值：效應值是一群能測量治療成效大小的指標，而它們與樣本大小並不相關。效應值普遍使用在 "變化分析"的研究上，並從一特定的研究範圍內歸納出結果。例如Lipsey and Wilson(1993)中寫到，用於心理、教育和行為治療上。Effect size (ES) is a name given to a family of indices that measure the magnitude of a treatment effect. Unlike significance tests, these indices are independent of sample size. ES measures are the common currency of meta-analysis studies that summarize the findings from a specific area of research. See, for example, the influential meta-analysis of psychological, educational, and behavioral treatments by Lipsey and Wilson (1993).d = M1 - M2 / swheres = Ö[å(X - M)² / N] (X為原始分數；M表平均)(Ö表開根號；å表sigma加總)Cohen(1988)定義d為兩次測量平均差/兩者測量中任一個的標準差。(前提是兩者的變異數的數值相近)Cohen (1988) defined d as the difference between the means, M1 - M2, divided by standard deviation, s, of either group. Cohen argued that the standard deviation of either group could be used when the variances of the two groups are homogeneous. 若兩次測量的標準差數值相差很大，則用 s pooled = Ö[(s1²+ s2²) / 2] 代替。M1 - M2的值若為正，則表個案經過治療後有進步；M1 - M2若為負，則表退步。By convention the subtraction, M1 - M2, is done so that the difference is positive if it is in the direction of improvement or in the predicted direction and negative if in the direction of deterioration or opposite to the predicted direction.effect size d Percentage of Overlap ----------------------------------------------------- Small 0.20 85Medium 0.50 67Large 0.80 53David C. Howell (2001) Statistical methods for psychology 效應值可被解釋為兩次樣本分佈中(有接受治療和沒接受治療的個案族群)未重疊的部分。所以ES等於0就表示兩者全完重疊。(即治療前後沒有改變)Effect sizes can also be interpreted in terms of the percent of nonoverlap of the treated group's scores with those of the untreated group, see Cohen (1988, pp. 21-23) . An ES of 0.0 indicates that the distribution of scores for the treated group overlaps completely with the distribution of scores for the untreated group, there is 0% of nonoverlap.

12/4 NTUH's assessment

Mission:
1.i went to Renai branch Hospital for collecting the data of P't.
2.Recently only increased the number of CVA p't, today finished one BIB
3.Arrange a plan go to 萬芳Hospital for collecting data.

12/3 P> 5% or < 5%

P值指的是比較的兩者的差別是由機遇所致的可能性大小。
P值越小，越有理由認為對比事物間存在差異。
例如，P<0.05,就是說結果顯示的差別是由機遇所致的可能性不足5%，或者說，別人在同樣的條件下重複同樣的研究，得出相反結論的可能性不足5%。
P>0.05稱“不顯著”；P<=0.05稱“顯著”，P<=0.01稱“非常顯著”。
由於常用“顯著”來表示P值大小，所以P值最常見的誤用是把統計學上的顯著與臨床或實際中的顯著差異相混淆，即混淆“差異具有顯著性”和“具有顯著差異”二者的意思。其實，前者指的是p<=0.05，即說明有充分的理由認為比較的二者來自同一總體的可能性不足5%，因而認為二者確實有差異，下這個結論出錯的可能性<=5%。而後者的意思是二者的差別確實很大。舉例來說，4和40的差別很大，因而可以說是“有顯著差異”，而4和4.2差別不大，但如果計算得到的P值<=0.05，則認為二者“差別有顯著性”，但是不能說“有顯著差異”。

由於“有顯著差異”和“差異具有顯著性”容易混淆，因而現在有些期刊提倡用“差異有統計意義”來代替“差異有顯著性”，用“差異無統計意義”、“差異有高度統計意義”來代替“差異不顯著”和“差異有高度顯著性”。
如果P>5%，是否我們就可以下結論說比較的二者沒有差別呢？
不能。P>5%只能說明沒有充分的證據說明二者確有差別，但是也不能說二者沒有差別或差別很小。在這兩個極端之間還有一個過渡區間，即無論下有差別還是沒有差別或差別很小的證據都不足。要推斷二者沒有差別或差別很小，需要採用等效檢驗的統計推斷方法。
虛無假設（null　hypothesis)通常是表示沒有差異的假設，也叫原假設。
discussing the p-value related to the correlation coefficient. Of course, the p-value represents the probability of incorrectly rejecting the null hypothesis. If the p-value is less than some significance level, alpha, (typically practitioners use an alpha of 0.05) then we say that the result is statistically significant (at the 5% level) - i.e. the probability of incorrectly rejecting the null hypothesis is less than 5%.
"For the test I think you're alluding to, it would indicate that we would reject the null hypothesis that rho (the true correlation coeff) is equal to zero, hence there may be some evidence to suggest that a linear relation is present. Don't ignore a scatter diagram though, of course!"
...If the p-value for a correlation coefficient test is less than 0.05, it indicates that the correlation coefficient IS significantly different from zero (either positive or negative) at the alpha = 0.05 level. This means that there is some significant amount of linear relationship between your two variables of interest.
Imagine that there is a universe of points from the process you are studying. You take a sample of those to see if you can prove or disprove correlation. The truth that you are assuming is that there is no or null correlation.

"Now you develop some test or way to mathematically relate the sample to some statistic, in this case rho. You then compare it to some reference distribution. The probability (p) that you selected the sample in such a way that you got a sample that shows there is some correlation, i.e. that rho is not zero, when in fact it is zero, the truth you assumed; is the p value. In other words it is the probability that your sample indicates that the state of nature in the universe is different than the truth you assumed when your assumption was the correct one. In this case it is the probability that the rho or correlation is zero when your sample indicates that it is not zero.

"Usually if we have a one in twenty (0.05) chance of making the wrong decision, we are satisfied that there is a difference , i.e. statistical significence, and we reject the null hypothesis that there is no difference. You can set this level based on your need to be right. In drug testing work for instance, a p= 0.01 is often used since the consequences of being wrong are much more severe than being wrong about a knob for a radio."
referenced :http://www.isixsigma.com/library/content/c011119a.asp

做出是否拒絕虛無假設的決定，有四種拒絕虛無假設的方法
　（１）如果最終統計量落入拒絕域之內，則拒絕虛無假設
　（２）如果最終統計量大於臨界值，則拒絕虛無假設
　（３）如果ｐ－ｖａｌｕｅ值小於顯著水準，則拒絕虛無假設
　（４）如果虛無假設的值落在信賴區間之外，則拒絕虛無假設

如果減小了顯著水準α，那麼在檢驗一個實際上是真實的假設時，我們就減小了拒絕該假設的可能性；但是在另一方面，減小顯著水準卻可能增加了接受不真實的假設的可能性

12/1 Reading articles

Q&A
Q1:the standard error of measurement of the total score was calculated for both the test-retest and the interrater conditions to determine the consistency of scoring in absoloute terms and to evaluate the minimal detectable change.
Ans:DGI再測信度和施測者間條件檢驗總分的標準誤(SE of measurement, SEM)以判斷分數在絕對數值中的一致性，及評估最少偵測變化(Minimal Detectable Change)。

Q2:the Bland and Altman method of plotting the difference of scores against total scores of each participant of the 2 testing times //showed good realibility.

Q3:the mean differences in interrater scoring are plotted against the mean scores of the 2 raters for the same participant in figure 1B.
Ans: Q2 & Q3 are the same meaning of telling us the ICC scores of the interrater and test-retest have increased when we look in the Bland and & Alman plot and Table 2.e.g item 5:icc scores 0.56(test-retest )< icc scores 0.83 (interrater)
against difference(Y axis) vs mean (X axis)

Q4:for item 5,and for item 7 ,the realibility for the test-retest conditionwas lower than that of the interrater condition.
Ans:That is means the realibility

Q5:on item 8,there was total agreement in both test-retest and the interrater condition indicating that instructions for item 8 were specific enough to leave little doubt about scoring.
Ans:total agreement = 完全一致

Q6:the criterion for statistical significance was P less than .05.
Ans:
P值是論文中最常用的一個統計學指標，可是其誤用、解釋錯誤的現象卻很常見。因此，很有必要說明p值的意義、用法及常見錯誤。
釐清自己的觀念:
1.角色--
2.貢獻--對病患的成效有多少,能排除其他介入的因素來確定OTR 在臨床給予的治療?

11/30 reading and revise articles

敏感性(sensitivity)與特異性(specificity)
乃臨床診斷正確性之評價指標﹐亦可以引用到製造業對策之評價﹐以下表說明之：
sensitivity（敏感性）：疾病發現之能力﹐計算式：a/(a+c)　 最佳狀況為100%
specificity（特異性）：無病發現之能力﹐計算是：d/(b+d) 最佳狀況為100%

如上所示﹐乃健康者與罹患者之BioMark定量分布圖﹐圖中重疊區的上緣是疾病的指標﹐下緣則是健康的指標﹐一般而言均假設兩者間有重疊。

重疊區包括假陽性(False Positive)是誤判健康者為罹患者﹐假陰性(False Negative)則是誤判罹患者為健康者。
降低上緣值固可以提高診斷的敏感度﹐但此時診斷的特異性會降地（亦即假陽性增加）﹐兩者之間有取捨之關係。診斷之目的在於正確之判斷﹐通常在95%信賴區間外之情況﹐吾人視之為異常！
參考資料：http://homepage3.nifty.com/m_nw/dataac10j.htm

False positive rate (α) = FP / (FP + TN) = 18 / (18 + 182) = 9% = 1 - specificity
False negative rate (β) = FN / (TP + FN) = 1 / (2 + 1) = 33% = 1 - sensitivity
Power = 1 − β

sensitivity =number of true positives /(number of true positives +number of false positives )
@A sensitivity of 100% means that the test recognizes all sick people as such.
@Sensitivity alone does not tell us how well the test predicts other classes (that is, about the negative cases). In the binary classification, as illustrated above, this is the corresponding specificity test, or equivalently, the sensitivity for the other classes.
@Sensitivity is not the same as the positive predictive value (ratio of true positives to combined true and false positives), which is as much a statement about the proportion of actual positives in the population being tested as it is about the test.
@The calculation of sensitivity does not take into account indeterminate test results. If a test cannot be repeated, the options are to exclude indeterminate samples from analyses (but the number of exclusions should be stated when quoting sensitivity), or, alternatively, indeterminate samples can be treated as false negatives (which gives the worst-case value for sensitivity and may therefore underestimate it).

--------------------------------------------------------------------------------
一個診斷工具不會同時具有良好的Sensitivity & Specificity
通常Sensitivity好的工具Specificity會較差，而Specificity好的工具Sensitivity較差。
Sensitivity（以下簡稱Sen.）與Specificity（以下簡稱Spe.）是對診斷工具而言的。
然而對病人而言，重要的不是診斷工具的Sen.與Spe.
而是該診斷結果對病人的意義。亦即：
陽性預測值 Positive Predictive Value (PPV.) 與
陰性預測值 Negative Predictive Value (NPV.)
所謂的陽性預測值，就是檢查結果是陽性，而確實是得病而不是偽陽性的機率。
而陰性預測值，就是檢查結果是陰性，而確實沒有得病而不是偽陰性的機率。

11/29 revise the article(chinese)!

Mission:
1. revise the translation of the article,reading some chinese article to improve the writing skill with more qualify.
2. will go to Far Eastern Hospital for bringing back the data of p't!

11/28 NTUH assessment

Categorical variable, 分類變量

變數(variable)
在搜集資料時，首先要根據研究目的確定同質觀察單位，再對每個觀察單位的某項特徵進行測量或觀察，這種特徵稱為變數。如上述的“身高”、“體重”、“療效”就是變數。變數的觀察結果或測量值稱為變數值(variable value) ，變數按其值的性質可分為不同類型。

分類變數（categorical variable）：表現為互不相容的類別或屬性，亦稱定性變數。分類變數可分為無序與有序兩類。
無序分類變數（unordered categorical variable）是指所分類別或屬性之間無程度和順序的差別。又可分為二項分類和多項分類，如性別（男、女）；血型（O、A、B、AB）等。 無序分類變數的分析應先按類別分組，計各組的觀察單位數，編制分類資料的頻數表，所得資料稱為計數資料。
有序分類變數（ordinal categorical variable）是各類別之間有程度的差別。如尿糖化驗結果按－、±、+、++、+++分類；療效按治癒、好轉、無效、惡化分組。有序分類變數的分析應先按等級順序分組，計各組的觀察單位數，編制各等級的頻數表，所得資料稱為等級資料。


Mission:
1.Today i have finished 2ADL and 1BIB.
2.Tomorrow need to phone to Far eastern hospital for taking back the detail of p't

11/27 Reading & Translation article & figure out the basic concept of statistical

標準差standard deviation,SD:一組數值自平均值分散開來的程度
一個較大的標準差代表大部分的數值和其平均值之間差異較大;一個較小的標準差代表這些數值較接近平均值。

標準誤standard error,SE是一種 standard deviation
但通常的 standard deviation 是指原始資料的標準差;standard error 是指統計量或估計量的標準差
1.相當於統計母群的標準差。其公式隨統計項目不同而異。例如：樣本平均的標準誤＝樣本的標準差／根號（樣本大小）。The standard error is the estimated standard deviation of a statistic. The formula depends on what statistic you are talking about. For example, the standard error of a sample mean is just the sample standard deviation divided by the square root of the sample size.
http://www.cmh.edu/stats/definitions/stderr.htm

2.如果我們從同個母群中取出多個樣本，那我們必然可得到多個樣本數值的平均。若我們計算這些樣本數平均相對於未知母群平均的標準差，即稱為「標準誤」。標準誤是用來測量樣本平均的變異性。然而，我們可以用以下公式來計算標準誤：(即不需用到未知的母群平均) 標準誤 = 標準差/根號(樣本數-1)。Standard error. If we took several samples of the same thing we would, of course, be able to compute several means, one for each sample. If we computed the standard deviation of these sample means as an estimate of their variation around the true but unknown population mean, that standard deviation of means is called the standard error. Standard error measures the variability of sample means. However, since we normally have only one sample but still wish to assess its variability, we can compute estimated standard error by this formula:
SE = sd/SQRT(n - 1)
where sd is the standard deviation for a variable and n is sample size. Often estimated standard error is just called 'standard error.'
http://www2.chass.ncsu.edu/garson/pa765/normal.htm

測量標準誤(standard error of measurement,SEM):=測驗誤差的標準差
1.可以顯示對個別病患進行測量之誤差,也可計算95%信賴區間(confidence interval,CI)之SEM藉以表示個案之真實結果有95%的機會將落在此區間。
例:一個人接受某一測驗N 次 所得的分數應是以其真實分數為中心而構成的常態分配,這個分配的標準差就是測量標準誤。
2.另一個解釋-->:測驗分數之誤差程度的量數與其信度之間成反比的關係
亦即信度愈高 測量標準誤愈小;反之 信度愈低 測量標準誤愈大。
分數的分析理論，是比較「母群」的施測結果和預期結果，但在實行比較時，我們通常只能比較樣本的結果。（例如：我們記錄了100位個案的收縮壓，並計算其平均和標準差，我們就能知道單個個體數據離樣本平均的距離。但如果我們重複執行此測驗多次，就能了解單個個體數據離所有樣本平均的平均值的差距。)「所有樣本平均的平均值」的“標準差”就稱為 SEM。在正負一個測量標準誤之外的數據被解釋為和其它大部分數據(67%)有差異。
The theoretical (i.e. statistical) analysis of scores depends on comparisons between obtained scores (or statistics) and expected scores (or statistics) from the population based on happenstance (chance). But in practice our comparisons are based almost without exception on scores obtained from samples, not on populations. For example, if we record systolic blood pressure in a large number of volunteers (n=100) and calculate the mean and standard deviation of our sample scores, we would know on average how far away any particular individual's score was from the (sample) average. But now if we repeat the effort (i.e. the measurement of systolic blood pressure in multiple separate samples of 100 individuals) over and over again (say, 100 times) we would know on average how far away any particular sample's average score was from the mean of all the (100) samples tested. The "standard deviation" of the mean of all the sample means (i.e. the population mean) is the standard error of measurement (SEM). Scores that fall beyond ± 1 SEMs are interpreted as unlike most (~67%) of the other scores.
http://symptomresearch.nih.gov/chapter_23/sec29/cahs29pg1.htm

相關性分析correlation coefficient
若我們想知道兩個連續變數之間的關係,例如身高和體重,是不是兩個會一起變化,就要用相關性分析
相關就是兩個變數會一起變化,如果一起變大及變小,就是正相關,如果一個變大另一個就變小,則是負相關。例如體重和腰圍的關係。
低度相關就是兩個變數各變各的,例如血脂肪和血鈣濃度的關係。
表示相關程度的數字,就是相關係數,介於-1至1之間,愈接近-1(負相關) 或1(正相關),相關程度愈高;愈接近0,相關程度愈低。常用的有Pearson相關係數(母數方法)及Spearman相關係數(無母數方法).前者需要較大的樣本及較多數學假設,所以Spearman相關係數的適用範圍較廣。
MCID (最小臨床重要差異值)
Jaeschke最早定義「最小臨床重要差異值 MCID」為："在病人有獲利且執行上沒有困難或副作用的情況下，所得到臨床上最小的分數改變。" 而在那之後MCID的定義有些改變。例如："被認為有用或重要的最小分數差異"；"降低最小的風險，讓答應接受治療的病人事前知道不接受治療的風險"。這些定義顯示了MCID建構的多個層面；有些著重在潛在危險的改變，有些著重在治療決策的影響，有些則單純著重改變的大小。最常見的定義是：MCID為重要改變的最低界線。
Jaeschke first defined an MCID as being “the smallest difference in score in the domain of interest which patients perceive as beneficial and which would mandate, in the absence of troublesome side effects and excessive cost, a change in the patient's management” [6]. Since then the definition has varied. We see definitions such as “the smallest difference in a score that is considered to be worthwhile or important” [4], the “minimum absolute risk reduction for which patients would take a treatment given their understanding of the risk without that treatment” [7], or the mean score for patients with an optimal result minus the mean score for a group with a suboptimal result [8]. The definitions show the varied constructs with the common label of MCID; some weighing change against potential risks, others weighing the impact on treatment decision making, others weighing the impact on the magnitude of change alone. The common thread is that it is the lower boundary of change that has been defined, in some way, to be important.
MCID 的主要功能是協助研究及臨床人員解釋, 評量分數變化或差異之意義。
研究上，療效的判斷常以是否「統計顯著(statistical significance)」判定之，然而具有統計顯著之差異值，不一定具有「臨床意義(clinical significance)」。
MCID值可作為判斷群組分數改變/差異（組內(within-group)/組間(between-group)）是否具有臨床重要意義的最小閾值，決定評量工具的MCID值，可協助臨床及研究人員判斷研究結果所造成的差異是否具備「臨床意義」！MCID值的另一用途是判斷評估工具是否具備反應性(responsiveness)(within-group)。

11/26 Reading article & translation

Q & A
Q1:what is the meaning of 95% confidence intervals?
何謂信賴區間(confidence interval)？利用樣本抽樣,將抽出的樣本在一定可性度之下,利用抽樣分配建立一區間,採用此區間預測母體分配特性。
在了解了抽樣分配(sampling distribution)的概念及其兩個重要定理後，我們即可從事推論統計兩大任務之一：由樣本得到的統計值（statistic）來推估母群體之數值或母數(parameters)。在日常生活中常看到的民意調查或選舉調查，就是這種估計的運用。
估計的方法有兩種：一為點估計(a point estimate)，也就是從樣本得到的統計值來估計母群體的數值。如果您做了一個民意調查後，報告說全部選民中有 42%的人會投給某候選人，此即為點估計的例子(就是估計有 42%選民會投給此人)。另一為區間估計(an interval estimate)。此涉及信賴區間（confidence intervals）的估計步驟。信賴區間是估計在一個範圍內的數值，而非單一數值。
區間估計提供我們感興趣參數可能的範圍，例如：μ的 95%信賴區間（95% Confidence Interval, 95% CI）告訴我們此區間有 95%的機會會涵蓋真實母群體平均數。
影響區間大小的因素包括信心水準與母族群的變異數或標準偏差
意義：如為常態分布時,有95%的機會測量到的樣本數據會落在信賴區間範圍內
信賴區間 (Confidence Interval, CI) 有95%的信心確定，群體的正確數值會落在這個數值範圍內 Quantifies the uncertainty in measurement. It is usually reported as a 95% CI which is the range of values within which we can be 95% sure that the true value for the whole population lies.
95％信賴區間:95％信賴區間是從樣本數據計算出來的一個區間，保證在所有樣本當中，有95％會把真正的母體參數包含在區間之中。

Q2:How to decrease the different in the Bland and Altman method?
ANS:That will need to figure out the meaning of the difference in this paragragh at first,because it is too small variable that not so important to decrease the different.

Q3:some examples inside the article need all mention out or chose the most important one to explaination
ANS:main point(theme of article) <----> explain clearly ,if it is the main point ,you may need to make it clearly ,until the reader understand whart you mention!!

Q4:What is the means of positive correlation in concurrent validity?
同時效度(concurrent validity):自編的測驗與同時間的效標測驗，求其相關。目的在估計或診斷目前的實際情況。
Concurrent validity is a parameter used in sociology, psychology, and other psychometric or behavioral sciences. Concurrent validity is demonstrated where a test correlates well with a measure that has previously been validated. The two measures may be for the same construct, or for different, but presumably related, constructs.
positive correlation :An obvious concern relates to the validity of the test against which you are comparing your test.
http://allpsych.com/researchmethods/validityreliability.html

11/23 NTUH assessment & Translation reading paper

Mission:
1.Check the data base of the p't and help 蕙君invite p't to participate her cognition treatment!
2.translation about the second article,and find out some statistical method!


個人分數之正確性
測量標準誤(Standard error of measurement, SEM)之估計，來推估真實分數
測量標準誤之觀念，類似於統計之常態分配，即一個人之真實分數可透過許多次類似的測驗，以平均數代表其真實分數，而標準差就是每次測驗所得分數之誤差範圍。然而在實際應用上，我們並無法對每個受測者進行如此多次之測驗，所以需透過群體之標準差與信度係數來估計出測量標準誤。

Bland-Altman plot:
A scatterplot of variable means plotted on the horizontal axis and the differences plotted on the vertical axis which shows the amount of disagreement between the two measures (via the differences) and lets you see how this disagreement relates to the magnitude of the measurements. This plot includes approximate 95% limits (based on an assumption of normal differences). If differences observed in this plot are not deemed scientifically (or clinical) important (according to the researcher’s own expertise), this is a confirmation of agreement. (The decision as to what constitutes a clinically important difference should be made in advance of the analysis.)

11/22 Reading and translation articles

Question:
1.信度之間有2項種類1.test-retest & interrater reliability 之間的關連性,是否會是因2者分數高是否其關連性高,代表其信度越高.
老師的回答:基本上信度為看評量工具的穩定性,因此可以單獨分開解釋這兩者的功能:1.test-retest為看評估工具的經過再測後其穩定性是否會一樣.2.interrater reliability 則為不同施測者在施測工具後其兩者的一致性.
2.如何將評估工具發展成較客觀性的?需要的步驟以及考慮的面向為何?
老師的回答:考慮你要評估的目的是什麼!考慮其差別(沒聽得很清楚)以及測量的內容,以便變成更簡單和容易操作的評估工具.
3.Given a normal distribution and no change,68%of the time an observed score will fall within 1SE of measurement of a person 's true score, and 95%of the time it should fall within 1.96SE of measurement of the true score.



深藍色區域是距平均值小於一個標準差之內的數值範圍。在常態分佈中，此範圍所佔比率為全部數值之 68%。根據常態分佈，兩個標準差之內（藍，棕）的比率合起來為 95%。根據常態分佈，三個標準差之內（深藍，橙，黃）的比率合起來為 99% 。
常態分佈/常態分布/常態分配(Normal Distribution)又稱高斯分佈(Gauss Distribution)，一般研究變數常會呈現常態分佈或近似常態分佈，如身高、體重、收入、支出、意見程度、評量誤差(error of measurement)。常態分佈的特徵是以數值資料平均值(μ )為中心，分佈曲線呈鈴形(bell shape)，中心點位置其數值出現的頻率(次數)最多，離中心點位置左右(可延伸到無窮大± ∞ )的數值出現頻率漸少，曲線左右對稱，即大於平均值和小於平均值的出現頻率相等。

4.They used K coefficient values for the item analyses, which may have been influenced by the low variability of their subjects who were skewed toward the higher end of the scale.
老師的回答:利用kappa coefficient 去做個別項目一致性分析,較低的差異度代表有高的一致性或信度,因其評估的分數多集中在較高分數的範圍內.因此是由於他們所施測的族群不同,得到的分數也會不一樣,其他的可能會很高或者低的分數呈現出來.
Kappa 一致性係數（Kappa Coefficient of Agreement, K）是屬於無母數統計的範疇，適用於類別尺度變數，主要目的是探討不同測量者對一組不同物件分類結果的一致狀況。Kappa 一致性統計量的形成有一基本假設：判斷者在有意識的情況下所進行的判斷，其一致性不應低於隨機指派的結果。

慢性中風個案動態步態指標之信效度
Reliability and Validity of the Dynamic Gait Index in Persons with Chronic Stroke
論文各部分之重點：
前言：
I為何需要從事此研究（還有哪些問題未解決？其重要性為何？或此問題未解決，將導致哪些問題？）
大多數患者中風後，仍然在移動和步態活動中有平衡的問題；而這些問題通常在急性後期出現，以及限制一般功能和參與日常活動。因此在計畫治療和評估結果時，平衡的信賴程度和準確度是最基礎的。尤其中風病患評估動態平衡時非常重要的因素，因為他們時常在移動時跌倒。
雖然中風病患在動、靜態站姿上有良好的平衡表現以及感覺輸入的改變，但是在步態活動時評估個案的動態平衡仍然缺少的。Shumwa-Cook和Woollacout共同發展動態步態指標DGI以便評估老年人在步態活動的功能穩定性以及跌到的危機。
II研究目的（be specific，作者欲解決哪些問題？）
中風病患多數擁有感覺和神經動作組織性的問題以及動作中衝量的控制困難。DGI
此次的研究目的是要評量中風病患之施測者間信度(interrater reliability)、再測信度(test-retest
reiablity)以及同時建構效度(concurrent construct validity)。
方法（※需說明作者「如何設計研究」以驗證各「研究目的」）：
樣本：
25位中風病患，其中18位為男生和7位為女生。研究的平均年齡±標準誤差為61.6±13.1年(範圍26.6-75.4年)以及平均發病時間為4.2±7.5年(範圍0.5-35.3年)。19位病患在屋外是使用行走輔助器材，但只有6位在家裡使用。9位為左側偏癱,14位為右側偏癱。3為病患有使用三腳拐當作行動輔助器材以及剩餘的病患則是使用拐扙。所有病人都必須經過評量BI來判斷其功能獨立性，以及可以依照和明白治療師的指令。
※ 2位治療師(施測者1,JJ;施測者2,DC),兩者在評估神經性問題的病患都擁有十年的經驗以及曾有在其他病患族群使用DGI。
程序：
評估（測量）工具：
DGI含8個4點(0-1-2-3)量尺項目，滿分為24分， 8個行走項目為:（1）行走20呎；（2）改變行走速度，快變慢；（3）行走時同時頭轉向左和右；（4）行走時同時頭向上和向下；（5）行走時同時180度向後轉停；（6）行走時同時跨越鞋盒；（7）行走時同時繞過鞋盒；（8）上下4個樓梯。老年人若分數等於或小於19分者，有較高的機會發生跌倒。DGI總分數越低表示平衡失調越嚴重。
Berg平衡量表(Berg Balance Scale ,BBS)
BBS原先用來評估老年人的平衡能力以及跌到的危機率。其中Berg平衡量表共評估14 項功能性活動，且要求個案在一個姿勢下維持其平衡和同時項目的困難增加。BBS裡面特定的項目要素有相似的步態規定，如無支持獨立站姿和弓箭步站姿。其他的要素如從坐到站和無支持站姿。每項活動之評分為0 至4 分(最好表現為56 分)。BBS是ㄧ個證據充分以及在老年人、多發性硬化症和中風病患中擁有高的心理測量學特性。以中風病患為列，其研究的施測者間和施測者內信度顯示分數分別為.97和.98。分數愈高者表示受試者之平衡能力愈好，但分數為小於或等於44表示有很高的機率跌倒。
特定活動平衡信心量表(activities—specific balance confidence scale，ABC scale) ABC為16項自我報告問卷，詢問病患自己對於在日常生活活動上的平衡表現給予數值刻度(範圍0-100)評分。分數為0顯示在活動表現上為無信賴，分數100則表示完全信賴。Botner和其他專家表示在中風病患研究中，ABC有高的再測信度以及輕度到中度的線性相關係數與BBS和步態速度(分別為r =.36 ,r =.48)。在前庭失能病患中，介於DGI和ABC總分有中度的相關係數(r =.58)。
行走時間測量Timed walking test此項測驗個案需要在適當的速度下，在限定的時間內行走10公尺。行走時間測量發現在中風病患中有高的再測信度。步態速度反映出行走能力的要素以及用於評估神經性失能的個案的移動能力。
計時起走測驗(Timed Up and Go Test; TUG)
TUG為一簡易功能性的測驗，評估個案在行定的時間內起立、行走三公尺、向後轉身以及再次的坐下。此項測驗在中風病人中有良好的再測信度。
資料分析：各研究目的，以何種統計驗證之。
信度之中有兩種:施測者間信度(interrater reliability)和再測信度(test-retest
reliability)，是由組內相關系數-模式2，1(intraclass correlation coefficient , model 2 , 1)
計算出來。基於先前的參考文獻，他們建議組內相關系數的分數介於0.8-1.0顯示出良好的信度，0.6-0.8為可接受，0.4-0.6為中等以及少於0.4為較差。
同時建構效度(concurrent construct validity)
我們假設DGI與BBS、ABC有中度正相關；與行走時間測驗、TUG有中度的負相關

11/21 Far Eastern Hospital

Mission:
1.Today just have received 2 papers of BIB and ADL,because the Wednesday is the day of group therapy for stroke people!And the data of ICD cost one hour to figure out from thier computer!
The step are :1.病患就診查詢 2.任一病患 3.輸入病歷號碼 4.選擇2351 (復健門診)5.關閉F12 6.ICD碼 or with the step 5 we also can check the date that they begin come to rehabilitation!
2.Participant in the course about Introduction to memory by 顏乃欣主任!

intraclass correlation coefficient（組內相關係數）

intraclass correlation coefficient（組內相關係數）

Explain the use of intraclass correlation in relation to inter-rater reliability.

組內相關係數用來測量施測者間信度。ICC可被表示為組間的變異和總變異的比值。Intraclass correlation (ICC) is used to measure inter-rater reliability. ICC may be conceptualized as the ratio of between-groups variance to total variance.
資料建立：ICC的目的是用來評論施測者間的影響和受測族群間的關係。Data setup:The purpose of ICC is to assess the inter-rater (column) effect in relation to the grouping (row) effect, using two-way ANOVA.
解釋：當受測目標間沒有差異時，ICC的值會接近1，顯示總變異全來自受測者自身的不同。Interpretation: ICC will approach 1.0 when there is no variance within targets, indicating total variation in measurements on the Likert scale is due solely to the target (ex., subject, neighborhood) variable.
模型：ICC會隨著以下幾種原因而改變：評估者是包括所有施測者或是由可能的施測者中隨機抽來的；受測者是否包括所有受測者或是只是由隨機抽樣選出；信度的驗證是建立在個別的評估者上或是所有評者的平均。Models: ICC varies depending on whether the judges are all judges of interest or are conceived as a random sample of possible judges, and whether all targets are rated or only a random sample, and whether reliability is to be measured based on individual ratings or mean ratings of all judges. Shrout and Fleiss (1979).
ICC公式由來：令A代表個案真實的改變，令B代表由施測者間信度不良所造成的誤差，則ICC=A/(A+B)。B是個案間差異(一群施測者施測同樣個案時所給的不同分數)的均方(一組數的平方的平均值)，由ANOVA計算。個案間變異的均方則為(A的k倍+B)Derivation of the ICC formula, following Ebel (1951: 409-411): Let A be the true variance in subjects' ratings due to the normal expectation that different subjects will have true different scores on the rating variable. Let B be the error variance in subjects' ratings attributable to inter-rater unreliability. The intent of ICC is to form the ratio, ICC = A/(A + B). B is simply the mean-square estimate of within-subjects variance (variance in the ratings for a given subject by a group of raters), computed in ANOVA. The mean-square estimate of between-subjects variance equals k times A (the true component) plus B (the inter-rater error component), since each mean contains a true component and an error component.
將B用MSwithin、A用(MSbetween –B)/k表示(因為MSbetween = kA + B)，則公式就可化為：
　　　　　　ICC = rI = (MSbetween - MSwithin)/( MSbetween + [k - 1] MSwithin)。

此時MSbtween 反應了不同的個案的真實分數也就不同。MSwithin則表示由施測者間的誤差造成的分數不同。k代表了(施測者人數/受測者人數）。
Given B = MSwithin, and given MSbetween = kA + B, substituting these equalities into the intended equation (ICC = A/[A+B]), the equation for ICC reduces to the formula for the most-used version of intraclass correlation (Haggard, 1958: 60)　: ICC = rI = (MSbetween - MSwithin)/( MSbetween + [k - 1] MSwithin) where MSbetween is the mean-square estimate of between-subjects variance, reflecting the normal expectation that different subjects will have true different scores on the rating variable
MSwithin is the mean-square estimate of within-subjects variance, or error attributed to inter-rater unreliability in rating the same person or target (row). k is the number of raters/ratings per target (person, neighborhood, etc.) = number of columns.
當MSbetween 等於MSwithin時，ICC等於0，顯示此時分組方式不會對ICC造成影響。
ICC is 0 when within-groups variance equals between-groups variance, indicative of the grouping variable having no effect.
http://www2.chass.ncsu.edu/garson/pa765/reliab.htm#intraclass


(ICC)= 高≥ 0.8> 中≥ 0.6>低； Spearman’s ρ/Pearson’s γ= 高≥0.9>中≥0.7>低


(Reference：Volume 36 * Number 2 (Supplement) * April-June 2001 )

11/20 NTUH & Reading

Mission:
1.Today just finished one paper of BADL and BIB!
2.Read new paper that title is Reliability and validity of the Dynamic Gait Index in persons with chronic stroke!
3.Finding and recheck the number of ICD9 from the old files,but didnt have anyone matched with it.
4.Find out the meaning of the statistical method ,such as Bland and Altman method,concurrent construct validity!

The Bland & Altman plot (Bland & Altman, 1986 and 1999) is a statistical method to compare two measurements techniques. In this graphical method the differences (or alternatively the ratios) between the two techniques are plotted against the averages of the two techniques.

The Bland & Altman plot is useful to reveal a relationship between the differences and the averages (examples 1 & 2), to look for any systematic bias (example 3) and to identify possible outliers. If there is a consistent bias, it can be adjusted for by subtracting the mean difference from the new method.

If the differences within mean ± 1.96 SD are not clinically important, the two methods may be used interchangeably

Repeatability
The Bland and Altman plot may also be used to assess the repeatability of a method by comparing repeated measurements using one single method on a series of subjects. The graph can then also be used to check whether the variability or precision of a method is related to the size of the characteristic being measured.
Since for the repeated measurements the same method is used, the mean difference should be zero. Therefore the Coefficient of Repeatability (CR) can be calculated as 1.96 (or 2) times the standard deviations of the differences between the two measurements (d2 and d1):


This coefficient can be read from the Bland & Altman plot, but can also be calculated using Summary statistics. E.g. if the names of the variables for 2 repeated measurements for FSH concentration are FSH1 and FSH2, then you define a new variable as FSH2-FSH1 and calculate the summary statistics for it. By multiplying the calculated standard deviation by 2 you obtain the coefficient of repeatability.

Validity (效度) & Reliability(信度)

Validity (效度) has three kinds:
1.content validity(內容效度):the suitable degree of the assessment's content,such as the special characteristic is it suitable to the element of the assessment!
2.Criterion-related validity(效標關連效度):concurrent valididy & predictive validity
3.construct validity(建構效度):



Reliability(信度)has four types:
1.inter-rater reliability(施測者間信度):
2.test-retest reliability(再測信度):intra-rater reliability(施測者內信度):
3.split-half reliability(折半信度):
4.alternative form reliability(複本信度):

11/19 Key in data & revision the paper

Mission:
1.Key in data & revision the paper!
2.Arrange the definition of Validity and Reliability.

11/16 NTUH clinical assessment

Mission:
1.Recently the functional level of p't are so severe to let us testing ,such as OA,body weakness and others..
2. today i have finished 4ADL and 1 BIB

11/15 NTUH clinical assessment

Mission:
1. Today morning i have finished 3BIB and 4 ADL, afternoon have 2BIB and 3ADL.

11/14 Key in the data base

Mission:
1.Today have a course about Brain function and brain pathology that presented by 葉炳強教授.
2.Key in the databases.

11/13 Far eastern Memorial Hospital

Mission:
1.Today i have finished 18 papers (ADL & BIB).
2.Thusday(11/15) have 2 p't need to assess,930am and 11am!
3.Next week (11/21)wednesday go to Far eastern Hospital again!

11/12 Key in the data base & NTUH clinical assessment

Mission:
1.Today i have finished 4 ADL in NTUH clinical field, because new case are too weak to have an assessment!!
2.Tomorrow morning need to disscuss with Sir about the latest paper!
3.Tomorrow 11/13 afternoon and night will go to Far eastern Memorial Hospital!

11/9 Far Eastern Memorial hospital

Mission:
1.Today I have finished 7 papers(4 ADL & 3 BIB).
2.Next Tuesday (11/13)afternoon will go there again.
3.There(PT) have a group activity for CVA p't, so the department of OT will just have few CVA p't.

11/8 Check up the data of Utility

as the title,
Double checking the data of utility!

11/7 Check up with the data of utility

Just like the title ,
checking up almost 100 pieces of data

11/6 NTUH clinical assessment & Check up

As the tiltle,
1.Today have finished 3 BIB and 1 ADL.
2. And also finished the first check up list (3pieces).

11/5 Key in the data of the utility

As the title.

11/3 Key in the data base

Mission:
i have finished 20papers in 5 hours!

11/2 Key in the data of the utility

Mission:
1.As the title,i have finished key in 70database.

11/1 Far Eastern Hospital

Mission:
1.At Far Eastern Hospital have finished ADL and BIB each 5.
2.Next Friday(11/9) will plan to go there for whole day.
3.This week Saturday need to come here work for half day to key in data and tomorrow whole also need to key in data whole day.

Question:
1.The person who have ataxia also need to assess that also have difference in balance function.

10/31 NTUH clinical assessment

Mission:

1.key in the data base of utility.
2.The new case of the NTUH are just in ward.

10/30 Renai H clinical assessment & key in utility data base

Mission:
as title,
1.Renai H finished 1BIB ,because another p't didnt come that today weather became cool. And Write down the detail of other p't.
2.key in the data base of utility.

10/29 Key in data and reading articles

1.Key in the data!
2.arrange and modify the sentences of the article
※先快速瀏覽摘要，掌握論文重點<研究的目的/結果>。
※看內文之「方法」有無問題。
找老師討論！

論文各部分之重點：
前言：
I為何需要從事此研究（還有哪些問題未解決？其重要性為何？或此問題未解決，將導致哪些問題？）
多發行硬化症的個案常有平衡失調問題，原因是其神經元髓鞘脫失且會侵襲前庭神經或者在腦幹前庭核周圍的區域。如果前庭系統受到影響，症狀包括昏眩、視力不佳或者平衡問題出現。這些症狀跟週邊前庭失調的個案相似。Ｆrzovic等人報告出多發性硬化症的個案比控制組在腳跟接腳尖走直線、單腳站、功能性伸展測驗、上臂抬起測驗、登階測驗以及外部干擾的反應中表現較差。他們也表示透過此次的研究平衡失調的程度始終沒有改變，儘管個案自我報告疲勞有增加的現象。
目前並沒有功能性評估工具是用來評估多發性硬化症個案在行走時的平衡失調。Ms.Shumway-Cook等人發展動態步態指標（dynamic Gait Index, DGI），以評量週邊前庭疾病個案的平衡失調，因此也嘗試應用在測量多發性硬化症的平衡失調上。

II研究目的（be specific，作者欲解決哪些問題？）
本研究目的是探討DGI在多發性硬化症個案的施測者內信度(intrarater reliability)和施測者間信度(interrater reliability)以及利用比較行走時間測驗(6.1-m timed walk)以驗證DGI的效度(validity)。

方法（※需說明作者「如何設計研究」以驗證各「研究目的」）：
樣本：
10位來自醫院體系復健科的門診個案自願參加此研究，他們在殘疾狀況評分(expanded disability status scale)的分數介於2.0-6.0，以評量其殘疾的程度適合在施測範圍內。

程序：
在施測過程當中，個案可以使用輔助器材和踝足矯形器(ankle-foot orthosis，AFO)。
施測者間信度：物理治療師評量10位個案在間隔2禮拜之間的2次DGI的表現，並將施測過程中個案的表現用錄影機記錄下來。由於多發性硬化症的功能會惡化，會造成個案在行走能力會受到影響；因此我們錄影以免個案之功能變化影響研究結果。為了要驗證DGI的效度，個案在時間行走測驗錄製的時間需要跟DGI的總分做比較。
施測者間信度：11物理治療師經過第一次評量的2週後再一次觀看錄影帶和記錄10位個案的分數。這2週期間再做評量紀錄的理由是因為臨床評估工具介於施測和再施測之間要有合理的時間間隔。
所有治療師都有治療多發性硬化症個案的經驗，只有其中5位是有治療過前庭失能的個案。在此研究之前，有2位治療師使用過DGI和其他功能性評估工具。這11位治療師再臨床的服務時間介於4.5-13.5年。

評估（測量）工具：
DGI含8個4點(0-1-2-3)量尺項目，滿分為24分， 8個行走項目為:（1）行走20呎（2）改變行走速度，快變慢（3）行走時同時頭轉向左和右（4）行走時同時頭向上和向下（5）行走時同時180度向後轉停（6）行走時同時跨越鞋盒（7）行走時同時繞過鞋盒（8）上下4個樓梯。老年人若分數等於或小於19分者，有較高的機會發生跌倒。DGI總分數越低表示平衡失調越嚴重。


資料分析：各研究目的，以何種統計驗證之。
此研究在評量多發性硬化症個案的平衡步態失調中並沒有標準的準則存在。為了要探討DGI在此族群的同時效度(concurrent validity)，利用兩變項相關分析(Pearson bivariate)驗證DGI總分數和6.1呎行走時間之相關程度。
利用組內相關係數（intraclass correlation coefficient, ICC）來檢驗施測者間信度。施測者間信度則在訓練後才使用兩變項相關分析評估之。
結果：
#說明樣本之特性
#說明各研究目的之數據
效度(validity)
6.1呎行走時間和DGI總分數呈高度負相關（r =－0.8）。個案行走速度愈快，DGI總分數愈高(圖表1)。行走最快所需要的時間為5.27秒，相對的DGI分數為22分；行走最慢所需要的時間為13.23秒,相對的DGI分數為10分。

施測者內信度(intrarater reliability)
這11位治療師的施測者內信度的分數ICC介於.760-.986(圖表3)。第7項目的兩變項相關分析無法驗證是因為個案並沒有表現出適當的效度。在治療師對個案步態的認知中只有少許的差異，個案的分數相當類似。

施測者間信度 (interrater reliability)
ICC的係數為.983以及8個行走項目ICC介於.910-.976
討論：
※說明研究結果之重要性<學術/臨床意義為何>
由於多發性硬化症在年輕的成人越來越多，且平衡失調常會影響其行動能力。本篇文章是首位將DGI應用在多發性硬化症個案身上。DGI的總分介於10到20分中，有8個分數是低於19分，表示參與本研究的個案有80%較高的機會發生跌倒，因為其平衡失調以及緩慢步態速度是與他們的DGI總分呈負相關的。DGI的行走時間測驗在臨床評估行動和功能上是很常見的，且在神經功能障礙個案，緩慢行走速度與平衡失調有關。Brown 和其同事表示紀錄接受物理治療後步態改變的速度來當作其進步的原則。
DGI的同時效度在6.1呎行走時間和DGI總分數呈高度負相關（－0.801）。DGI總分的施測者間信度為.983以及施測者內信度介於.760和.986。因此從結果得到，DGI可以發展為評估週邊前庭疾病的平衡失調外，也是應用在多發性硬化症個案上一個有信度的功能性評估工具。

※ 研究限制
DGI「行走時同時繞過障礙物」項目比較不敏感，以致未能分辨一些個案的平衡障礙。施測者內信度在第2項「改變行走速度，快變慢」和第5項「行走時同時180度向後轉停」兩者分數較低。治療師在評分的過程中，有2個項目之評分不易，即第2項「改變行走速度」很難去辨別個案的程度是落於中度或輕度障礙以及介於中度和重度障礙。而在第5項「行走時同時180度向後轉停」很難在一些個案中三秒的原則下去做判斷。在步態分析中，在功能性活動中比如上下台階，評估單腳站立姿勢是非常重要的。在第6項「行走時同時跨越障礙物」的指導語並沒有清楚的說明是否為雙腳同時跨越還是單腳跨越障礙物。對於此項目需要有更明確的指導語，例如：雙腳同時跨越障礙物。其他治療師比較關心的問題是與「最少步態偏向」和「明顯步態偏向」的定義有關，因為步態改變的程度並沒有提供清楚的描述。

10/27 reading article論文閱讀-彙整重點

論文閱讀-彙整重點


※先快速瀏覽摘要，掌握論文重點<研究的目的/結果>。
※看內文之「方法」有無問題。
找老師討論！

論文各部分之重點：
前言：
I為何需要從事此研究（還有哪些問題未解決？其重要性為何？或此問題未解決，將導致哪些問題？）
II研究目的（be specific，作者欲解決哪些問題？）

方法（※需說明作者「如何設計研究」以驗證各「研究目的」）：
樣本：
程序：
評估（測量）工具：
資料分析：各研究目的，以何種統計驗證之。

結果：
說明樣本之特性
說明各研究目的之數據

討論：
※說明研究結果之重要性<學術/臨床意義為何><針對研究目的所得數據之解釋>
※研究限制

*************************************************************************************
論文各部分之重點：
前言：
I為何需要從事此研究（還有哪些問題未解決？其重要性為何？或此問題未解決，將導致哪些問題？）
多發行硬化症的個案常有平衡失調問題，原因是其神經元髓鞘脫失且會侵襲前庭神經或者在腦幹前庭核周圍的區域。如果前庭系統受到影響，症狀包括昏眩、視力不佳或者平衡問題出現。這些症狀跟周邊前庭失調的個案相似。Ｆrzovic等人報告出多發性硬化症的個案比控制組在腳跟接腳尖走直線、單腳站、功能性伸展測驗、上臂抬起測驗、登階測驗以及外部干擾的反應中表現較差。他們也表示透過目前平衡失能的程度始終並沒有改變，儘管個案自我報告疲勞有增加的現象。
目前並沒有功能性評估工具是用來評估多發性硬化症個案在行走時的平衡失能。動態步態指標（dynamic Gait Index, DGI）是由Ms.Shumway-Cook等人發展的，他們將之應用在週邊前庭疾病的個案，因此嘗試應用在測量多發性硬化症的步態失能上。

II研究目的（be specific，作者欲解決哪些問題？）
此次的研究目的是要探討DGI在測試多發性硬化症個案平衡的施測者內信度(intrarater reliability)和施測者間信度(interrater reliability)以及利用比較行走時間測驗(6.1-m timed walk)來檢查DGI的效度(validity)。

方法（※需說明作者「如何設計研究」以驗證各「研究目的」）：
樣本：
10位來自醫院體系復健診所的門診個案自願參加，在殘疾狀況評分(expanded disability status scale)的分數介於2.0-6.0。

程序：
在施測過程當中可以使用輔助器材和踝足矯形器(ankle-foot orthosis，AFO)。
檢查評分者之間信度，物理治療師紀錄10位個案在間隔2禮拜之間的2次DGI的表現，並且會將個案的表現用錄影機錄下來。由於多發性硬化症的功能會惡化，會造成個案在行走項目的能力會受到影響；因此我們要控制這一個變項，故使用錄影帶將表現錄製成永久的紀錄。其時間行走測驗的錄製的時間需要跟DGI的總分做比較。
檢查同一施測者測量信度，11物理治療師經過第一次觀察的2個禮拜後再一次觀看錄影帶和記錄10位個案的分數。第2次觀察紀錄的理由是因為臨床評估工具介於施測和在施測之間要有合理的時間間隔。所有治療師都有治療多發性硬化症個案的經驗，除了其中5位是有治療過前庭失能的個案。在此研究之前,有2位治療師是有使用過DGI和功能性評估工具。這11位治療師接受訓練的時間介於4.5-13.5年。
評估（測量）工具：
動態步態指標滿分為24分，有8個行走項目:（1）行走20呎（2）改變行走速度，快變慢（3）行走時同時頭轉向左和右（4）行走時同時頭向上和向下（5）行走時同時180度向後轉停（6）行走時同時跨越鞋盒（7）行走時同時繞過鞋盒（8）上下4個樓梯。老年人若分數等於或小於19分者，有較高的機會發生跌到意外。DGI總分數越低表示平衡失能越高。


資料分析：各研究目的，以何種統計驗證之。
此研究在檢驗多發性硬化症個案的平衡失能並沒有標準的效標存在。為了要探討DGI在此族群的同時效度(concurrent validity)，利用兩變量相關分析(Pearson bivariate)比較介於DGI總分數和6.1呎行走時間測驗的秒數。
利用組內相關係數（intraclass correlation coefficient, ICC）來檢驗施測者間信度。施測者內信度則在訓練使用兩變量相關分析後才評估之。
結果：
#說明樣本之特性
#說明各研究目的之數據
效度
有負相關系數(-.801)是介於6.1呎行走時間測驗的秒數和DGI總分數（兩變量相關分析, P<.01）。即個案行走的時間減短，以及DGI總分數增加(圖表1)。行走最快所需要的時間為5.27秒，相對的DGI分數為22分；行走最慢所需要的時間為13.23秒,相對的DGI分數為10分。

施測者內信度(intrarater reliability)
這11位治療師的施測者內信度的分數是介於.760-.986(兩變量相關分析, P<.05)。

施測者間信度 (interrater reliability)
組內相關係數（intraclass correlation coefficient, ICC）的分數為.983(P<.05)以及8個行走項目分數介於.910-.976
討論：
※說明研究結果之重要性<學術/臨床意義為何>
由於多發性硬化症在年輕的成人越來越多，且平衡失能常在他們身上可以發現以及會影響其行動能力。再加上DGI的行走時間測驗在臨床評估行動和功能上是很普遍性的，且在神經功能障礙個案，緩慢行走速度與平衡失能有關。Brown 和其同事表示紀錄接受物理治療後步態改變的速度來當作其進步的原則。因此從結果得到，DGI可以發展為評估週邊前庭疾病的平衡失能,也是一個有信度的功能性評估工具應用在多發性硬化症的個案上。

※ 研究限制
目前行走時同時繞過障礙物比較不夠敏感來分辨一些有多發想硬化症個案的平衡障礙。施測者內信度(intrarater reliability)在第2項的改變行走速度，快變慢和第5項行走時同時180度向後轉停分數較低治療是在評分的過程中，在第2項的改變行走速度很難去選擇個案的程度是介於中度或輕度障礙以及介於中度和重度障礙。而在第5項行走時同時180度向後轉停很難在三秒的原則下去判斷。
在第6項行走時同時跨越障礙物的指導與並沒有清楚的說明是否為雙腳同時跨越還是單腳跨越障礙物。其他治療師比較關心和問題是跟「最少步態偏向」和「明顯步態偏向」的定義有關，因為步態改變的程度並沒有提供。

10/26 NTUH clinical assessment

Mission:
1.Today finished 2BADL and BIB.
2.Tomorrow i will come to office.


question:
1.由於研究的樣本來源都會受到限制在某一個範圍內,當我們要利用研究中的評估工具時候,是否能夠全面性的應用在臨床上的病人,再加上病人的疾病種類或者類型都會因此不一樣,施測的結過應該如何去詮釋?是否有解決的方法?
ANS:當我們在遇到病人時,要視情況來或者經過自己本身的經驗判斷,對於評估後的結果要有一些保留.

10/25 NTUH clinical assessment

Mission:
1.Today have finished 3ADL and 2BIB.
2.Next tuesday morning will go to Renai Hospital,Thusday will go to Yadong Hospital for whole day.


Question:
1.One p't who have apraxia and aphasia diseases will not allow to include in our databese, but how about the p't have old stroke,he get in ward because of pool passage problem,is she need to assess?

10/24 NTUH clinical assessment

Mission:
1.Today finished 3ADL,1BIB.One BIB paper didnt complete successful because the p't thought that is too easily for him,so he don't want to finish and go back.
2.Next week Thusday (11/1) will go to YaDong hospital with Hui Shan and i will taken the BIB and BADL assessment.
3.Today afternoon went to a course named Introduction of attention that leaded by 陳之昭心理師.
4.Tomorrow afternoon also need to go to NTUH 'clinical field helping Sir.


Question:
1.If the p't had ICH is because of lyphoma,and it ICD number have mention in criterion but not the major,this kind of patient can we assess?
2.If the p't who have bilateral himeparesis,is he need to include in?

10/23 Renai branch Hospital clinical assessment

Mission:
1.Today have finished one FAI because p't need to go home after cognition assessment,next week (10/30)tuesday will have the Balance assessment.
2.To work out the missing data of p't that had already taken before.

Question:
1.The detail of p't such as the area of stroke is difficult to find out because they are OPD,this kinds of detail not so usual will mention on the treatment card.Just will mention brief information like ICH ,cerebral infarction or CVA.
Ans:ICH ,Cerebral infarction can write it down,others will need to find out from the chart.

10/22 NTUH clinical assessment

Mission:
1.Just now contact with MR.歐(a chief of MHH PT department ),he said that they didnt have any p't namelist because p't(OPD) just come here for treament ,and then they just left;so they no need to detain any informations.
2. 近期可至板橋亞東蒐集資料，聯絡對象 陳晶瑜主任 (02)89667000-6200轉1516.
i will be arrange it recently!
Transportation :MRT will directly reach there.
3.Today have finished 3BADL and one BIB.

Question:
1.i know that some p't with severe OA,amputation,or malignant tumor will influence the performance of balance,but how about the ADL,is it will influence too?

10/19 NTUH clinical assessment

Mission:
1.Today i have finished 3 BIB and ADL papers.
2.Monday remember remind sir to phone to YaDong hospital and BeiYi hospital.
3.Monday morning I will go to MHH,Tuesday morning will go to Renai Hospital.
4.Next week(10/27) i will come here for half day that substitute with absent on Wednesday(10/17).

10/18 Renai and NTUH clinical assessment

Mission:
1.Remember Monday to remind Sir about phoning to 亞東醫院和北醫's Therapist.
2.The Stream server is functioning now ,but the problem of data still need time to figure out.
3.Today i have finished 3BIB and 2ADL.
4.Next week will need to stop assessment at Renai branch hospital,because the number of p't are lower down,and need to wait about 1 month,only can go there again.
5.Make a decision and phone to MHH therapist about go there on Monday;Tuesday will go to Renai for last time!

10/17 MHH clinical assessment

Mission:
1. Today weather is cool that make a few p't come to hospital!so, i just have finished 2 BIB and 1BADL.
2.Next week 10/22morning,10/23afternoon or after 10AM that we can go there for assessment;except Wednesday,Thusday and Friday.
3.Tomorrow morning i will go to Renai Branch hospital.
4.Today afternoon go to attend one lecture about Basic concepts in cognitive assessment2.
5.Next Monday need to remind Sir about phone to 亞東醫院或者北醫.

10/15 Renai clinical assessment

Mission:
1.Today i have finished 2 BI,1 FAI.
2.tomorrow morning will go to Renai H again.
3.remember to phone MHH PT therapist that i will go there on Wednesday and Hui shan will go there on Thusday.
4.Tomorrow Morning 8.30 will have meeting with Sir.

Minimum detectable difference (MDD)

The minimum detectable difference represents the smallest difference or change that would be statistically significant when comparing different samples. Results depend on the type of statistical model you intend to use to make comparisons, e.g., a t-test, ANOVA, etc. Estimates of variance drive the analysis once you select the level of uncertainty (that is, Type I and II error) that you are willing to live with.

10/13 NTUH clinical assessment

Mission:
1.Today i have finished 3BIB and BADL.
2.Stream-cat server crashing down again.i have written a mail to yehtai.
Question:
BIB
1.item28/29:the p't back leg some p't will hip deviation to outside only then he could stand stable.
i will give them they can do it,1 mark.Because they can do it.
2.item19,20,21:A lot of p't will need to squat only then he could reach to pick up pen.
I think they are afraid to doing forward motion because that will easy fallen!

3.If i have a wrong detail that include the personal detail of p't ,how i destroy it?
The way i did is tearing off it become small pieces!

10/12 Renai H & NTUH clinical assessment

Mission:
1.Today i have completed 4 BIB and 3 ADL.
2.write email to yettai for PDA problem.
3.the step of find out ICD-9 from the portal website!

Menu->治療師輸入->病歷號碼(查詢)->身分證(複製再查詢)->勾選醫令序號->該身份證號下之帳號(選擇一筆紀錄再查詢)---->下方出現診斷,按進入即可查詢到!

4.Next Thusday(10/18) afternoon will go to NTUH clinical for help!

10/9 MHH clinical assessment

Mission:
1.Next week Wednesday(10/17),Thusday(10/18),Friday(10/19) morning are suitable to us to go MHH PT field for assessment.Planning go there for Wednesday and Friday.
2.Key in database.
3.Reading article.

Question:
BADL
1.If p't still need to use 軟便劑,i think that is include in NA ,because it's compare with general people is abnormal .

BIB
1.item 28,29:one p't are having hip deviation to outside that his two step can't be one line.
2.item19,20,21:most p't couldn't bend their waist to pick up but they will compensate with knee flexion.

10/8 NTUH clinical assessment

Mission:
1.Find out how to key in the detail of Stream-cat!
2.PDA problem not yet solved!
3.tomorrow will go to MHH for whole day!

# 不適用(N/A)：當個案從事活動之方式未在項目範圍內，即不符合一般人從事該活動之表現時，則該項目評為不適用，評量者須在備註欄上紀錄N/A。例如「洗澡」活動以擦澡方式取代；以使用便盆、尿壺代替至廁所大、小便。

#item 18 : add MRT and mark myself.

#(1)Set up部分不列入此活動之評分考量的：如：健康照護 18.按時服藥：由家人掀開好藥包，個案可自行服藥，計為完全獨立。
(2)參與社交活動時，與家人一同前往，個案有主動去參與，計為完全獨立。
(3)若是個案只是”陪”別人/家人去從事這項活動，計為部分獨立。
(4)若此活動需要先經運輸或移動，此運輸或移動過程不計入此活動計分之考量，如第17項需先由家人開車載個案到定點，不列入評分。

10/5 NTUH clinical assessment

Mission:
1.Analysis the details of BIB for a p't who have treatment in MHH.
2.Tuesday will go to MHH whole day!

Question:
1.Today i used PDA assessed p't about stream-cat but after that the detail of thep't didnt mention in there?what's going on? i didn't know how to assess it ?
2.And it cant make me add new one detail! and have some error come out!

10/4 MHH clinical assessment

Mission:
1.Today finished about 11 papers (including 2BIB,9IADL).


Question:
1.The therapist has mention about the detail of ICD-9 difficult to know about it in the chart,may be there didn't mention.
2.p't need the BIB result analysis,isn't just tell her about her performance?
3.Because of the detail of ICD-9 difficult to find out ,so how i determine some p't is it the true stroke or recurrent ,or TIB caused stroke?
4.item 18(transportation):there have some p't are taking MRT go anywhere!should i include in or NA.

10/3 NTUH clinical assessment

mission :
1.Today completed 5 papers 3BADL,2BIB.

Question:
1.clinical and statistical fields,how they combine or what they concern with?

10/2 Renai H & NTUH clinical assessment

Mission:
1.Today completed 1BI,2BADL,2BIB assessments.
2.Thursday will go to MHH.
3.Friday will go to NTUH.

Question:
1.what is the means of the categorical variable?
2.Find out the meaning of "the range of analysis"?
3."Bookmark method"how it function? =Bookmark Standard Setting Methods

10/1 Renai Branch & NTUH clinical assessment

Mission:
1.Renai today completed 3BI,3FAI.
2.NTUH today also completed 3BADL.

Dicussion:
1.Arrange the time to go to MHH with hui shan ,we decided to assess p't together in a certain time.Only p't will not feel bother to our assessment

9/29 Reading & Key in database

Reading:Interpreting rehabilitation outcome Measurement
Objective:with the increased use of Standardized outcome instrument (this article use AM-PAC dor example)in rehabilitation field,question frequently arise as to how to interpret the scores that are derived from these standardized outcome instruments.There are illustrate 4 different data analysis and presentation strategiesthan can used to yield meaning ful outcome.
1.Interpreting a single scale score :SEE, SD,CI,95%confidence band

2.interpreting clinical significance of score change :clinical significance(MCID), statistical significance(MDC,SD,SEM)

3.a percentile ranking method:PR(%)
4.a functional staging approach :IRT (MCID)

9/28 Renai branch clinical assessment & Discussion article

Mission:
1.Today finished 2 BIB.
2.Next MOnday & Tuesday morning will go there, afternoon will plan to go to NTUH.
3.Next Monday will contact to the MHH PT therapist


Discussion:
1.Likert Scale -Multipoint ratings scale:
Multipoint Ratings: use a linear scale to give responses on a gradual basis.

Likert Scale: multipoint ratings where strength of agreement is identified against a clear statement.
順序尺度：此尺度資料可表示事物間的等級或順序，但不能衡量不同等級間的距離。只有大小沒有距離，例如Likert五點計分量表所得數據，可能是１～５分，亦可能是-2～+2分，且若5>4，但5-4≠1。

9/27 Renai branch clinical assessment

Mission:
1.Today completed 4FAI,3BI&5BIB,but failure assessing 2 BIB because one p't have dizzy(HTN) another who are easy fatigue.They have just done one motion or position change such as sit -->lie down and pick up the pen in sitting balance.Next time will depend of his health condition.
2.Tomorrow will go to Renai branch in the morning.
3.phone to MHH's PT therapist to arrange next time assessment.

9/26 Renai branch clinical assessment

Mission:
1.today completed one assessment because some p't had forgotten the appointment!Next time remember to give him a slip of paper to remind him.
2.Tomorrow will go there for whole day to conpleted afternoon p't who can accept assessment.
3.Future plan: arrange time table for going three places such as NTUH,Renai Branch,MHH. May be i will arrange up to the number of the p't of Renai.

9/21 Renai Branch clinical assessment

Mission:
1.Future plan:next week i will go to NTUH on Friday afternoon,Wednesday noon will take lift,and Wednesday &Thursday &Friday morning will go to Renai branch.
2.Today completed 2FAI,1BI.


Question:
1.how i want to conclusion after assessed the FAI & BI to P't?

9/20 Taipei city hospital, Renai branch

i will have to take lift for one and half hours today afternoon.
Mission:
1.Today completed 2BIB,2FAI,1BI.
2.Today also had one p't reject to continue the BIB or BADL assessment.There are few reason of he rejected because he felt tired after testing Cognition assessment , he didnt have enough time to continue that he have to go to other treatment, and he felt boring on this kinds of assessment.He didnt finish listening my explaination,and he immediately said "No".

9/19 Taipei City Hospital,Renai Branch clinical assessment

9/18 typhonic vacation
9/19
Mission:
1.Future plan:After this week, begin next week i will arrange some time(may be i will go there in afternoon) go to NTUH.

2.Go to taipei city hospital,Renai branch for assess BI,FAI,ans most important is BIB.
3.Today i have completed 4 BIB,1 BI, 1 BADL.

Question:
BIB
1.Most of the p't couldn't squat down totally,or maintain the position for longly.Besides this, most of the p't can't complete the items after item 34-41
2.when p't in standing position, and need to pick up the pen up,but they always need to squat down.

9/17 仁愛醫院clinical assessment

Mission:
1.Today completed 3 papers of BI and 1 FAI
2.Tomorrow i will also go to 仁愛醫院.
3.Remind the therapists about the concern to the p't's inner feeling after the test.

Question:(FAI)
1.If the p't who have 小兒麻痺症（Poliomyelitis) and had stroke ,is he include in our protocol?If his disease not influenced by stroke,may be he can received.
2.And this p't is using wheelchair is the item of waliking outside>15mins &Driving car/bus travel,can i give him about NA. NA,his disability not affected by stroke,but is the Poliomyelitis.

9/14 仁愛醫院 clinical assessment

Mission:
1.today had completed 5 papers of BI
2.Next Monday also will go for whole day
3.I had already built 仁愛醫院's data base bank.
4.Plan: next Monday(9/17) also will go there for whole day!
5.Remember to console the idea of p't who had retest of cognition assessment
6.Console about p't feeling after taken the cognition assessment or we can get this information through their therapists.

Question:
1.If p't who have psychotic nerosis diseases eg.depression,and he also a stroke p't ,is that ok to accept them? I think that is ok for the psychotic syndrome didn't imfluence his cognition or representation.
特別註明在資料
2.For item 3(individual hygiene bathing):got one p't that his mother help him to tie up his hairs.Others activities he can completed by himslef.

9/13 仁愛醫院 clinical assessment

Question:
1.Because if we do too many assessment at p't, that will make the p't felt uncomfortable,tired or bother to continue finishing it.So the therepist of 仁愛醫院 suggested that my assessment will seprate for two times (15mins/per time)and continue do the assessment after the Cognition Assessment.Besides this, the cognition assessment also had taken so much time for assessed p't!
2.The p't who had already tested may be better to have a assessment again after 2 weeks later, that means may be they will forget about this matter,and their emotion will better than now .
3.The agreement still need to give them sign another one(mine one)?

Solution:
1.the suggestion of the therepist of 仁愛醫院,that will also make to gather the p't's data will decrease because their criteria more higher than mine!!!
2.Or i will go there on the other time for assess p't again!

Mission:
1.Tomorrow i will also go there for whole day!
2.Today completed 3 BI paper.


#Mr.周already had fixed the stream-cat server,below is the message that he gave me yesterday!
問題應該出在更改了Server的名字
以上供你參考

#仁愛醫院地址 : 台北市大安區仁愛路四段 10 號
公車：
1. 大安路口： 36,37,261,263,270,311 藍 ,621,630,仁愛 - 公車 ,仁愛 - 大有
2. 仁愛醫院： 41, 74, 204, 278
3. 仁愛國中： 33, 52, 275, 278, 285, 292, 626, 630

#捷運忠孝復興站右轉尊龍客運直走後到達福華飯店左轉就可以看到了!

9/12 clinical assessment

Mission:
1.Tomorrow or the next day will plan to go to 仁愛醫院! otherwise will also need to plan go to 榮總
2.contact to the 湘萍(薛老師's assistant),discuss about the plan
3.Completed 3 ADL assessment
4.Tomorrow(9/13) will go to 仁愛醫院 for whole day.

9/11 Clinical assessment

Mission:
1.Arrange the time go to MMH again.(about p't 's details and others thinngs)
2.contact with MMH PT therepist

9/10 Discussion & Key in data

Discussion:
Question:
1.BADL :
-->item 1:always will choke with water will give mark with 1 ,but not always will give it to 2? yes,of course
-->item 7,8,9,10 : if he just can't did one matter is the tie shoelaces, or unbutton. if p't is wear a shoe that have shoelaces or wear clothes
-->**compare the different ADL between before and after stroke!

2.IADL:
-->item 40 :健身跑步車 ,if their house didnt have such instrument, the can give it with NA or just put zero. NA
-->item 43,44: where did the housewife include in? in got job with salary or another one? In without salary blank or you can state it at blank.
-->item 18:if he come out with the 康護車,can i include in and give it one because he need medium assisst? NA
--> item 32,33,34 ,some p't have presbyopia 遠視眼;老花眼 or cataract 白內障 ,they couldn't reading ,is that we will give him zero or NA? That need to figure out that is this kind of disease influenced his/her ADL after stroke or not?If not ,NA.
--> If they will not do a activities recently,but he can do it ,may we give them 3?how to different the two kinds of this ? First, u just determine that p't didn't do this week, give zero. In other hand , we can ask him/her next week again same question! Second, you can use common sense to determine that he/she can do such activities!

The website below is about how to learn basic excel skills!!
http://www.peboking.com/modules/booklists/viewcat.php?cid=180&amp;min=0&orderby=titleA&show=15#class1616

9/7 MHH clinical

Mission:
1.check out the p't's diagnosis and other details such as the date of his/her went to Hospital and began the PT.
2.photocopy ADL assessment about 50 .
3.Today had assessed about 18.

Question:
1.BADL :
-->item 1:always will choke with water will give mark with 1 ,but not always will give it to 2?
-->item 7,8,9,10 : if he just can't did one matter is the tie shoelaces, or unbutton.


2.IADL:
-->item 40 :健身跑步車 ,if their house didnt have such instrument, the can give it with NA or just put zero.
-->item 43,44: where did the housewife include in? in got job with salary or another one?
-->item 18:if he come out with the 康護車,can i include in and give it one because he need medium assisst?
--> item 32,33,34 ,some p't have presbyopia 遠視眼;老花眼 or cataract 白內障 ,they couldn't reading ,is that we will give him zero or NA?
--> If they will not do a activities recently,but he can do it ,may we give them 3?how to different the two kinds of this ?

9/6 Reading &key in data

Improving Patient Reported Outcomes using item respone theory and computerized adaptive testing.
PRO (include physical function or disability,side effects,medical care costs, pain, and other content areas) are easier to administer and less expensive than physician-observed health status measures.But in this time, have a limitation of these standard measurement is pricision.Besides this, there also have a major limitation is the "one size fits all", that will makes a standard questionaire contain many items that are irrelevant and uninformative for the particular patient.
So we have planned to develop a comprehensive bank of questionaire items to measure the latent trait of interrest(e.g.,physical function/disability),use of a psychometric technique called item response theory(IRT) and use of computerized adaptive testing(CAT)to administer the items.
First step,the development of a comprehensive item bank -construct a domain hierarchy--from global constructs(health) to more specific domains(physical,mental ,and social health).

Clinical Question:
1.One p't had a history of old stroke(2007/7/3), but this time is due to left side weakness caused by his abdominal hit the bathroom closet and had a spleen hemorrhage.Besides, his left side motion more badly than first time and have sublaxution . Is this p't still can in clude in our data base again?The onset time of stroke are too close?
ANS: if he has other truama that will make more complicated,that will not include in.
2. Another p't has left caudate head infarct and residual AcomaA aneurysm, in the chart stated this p't right side weakness,but the p't complaint about left hand side and ring leg side have weakness.How i want to determine/compare about this two different information?
ANS: we need to examine her whether p't complaintment isn't right
3.If p't has wound in abdominal, then should the item of bathing will give it NA or zero! ANS :NA and check out the different kind of bathing, which one is the general one?(to take a sponge bath or use water bathing?)

Discussion:
1.rememner to prepare the papers(ADL) and clothes!
2.Ask the Mr.歐 what need to be caused when take assess to p't
3.Need to ask about he would like the data after asessment? If yes , we will give it(photocopies)
to him next week.
4.Arrange the next assessment time with him

9/5 clinical assessment

Question:
1. One p't who had Moyamoya disease with IVH and bilateral ischemic frontal stroke status post bilateralEC-IC bypass,but her upper extremities didn't have effect and just influence on her right lower extremities with weakness developed.This such case i had included into the item bank,did i do wrong?
ANS: That kind of case can include in our data bank, and write down the affected side is the right side.

2. One p't who is deaf and she also include as CVA,she can't heard and speak clearly,but she can understand what you talking; if i want to interview her , can i interview on her caregiver ?
ANS: yes, of course.But we need to comsider about how long the time is the caregiver has take care to the p't, it must more than half month,if we want to interview the item of IADL ! If we just interviewed with BADL ,and the caregiver was take care of her whole day,that's fine.
3. If i couldn't find out the inpatient ICF number from chart,where i can find in other ways? to outpatient is the only way i can do just lend the chart and look through it or the website of NTUH ,have any other ways to solve this problem?
ANS:There is only the way is,may have others efficient ways ,but need to disscuss with Angie.


Remind:
1.Remember to ask sir some information about MHH.
--what do i need to prepare like papers of assessment (BADL,BIB,Stream-CAT),PDA
##歐育志 0930669163 ---ADL

#Transportation to Taipei MMH :take the metro arrive at staion of ShuangLian,entrance one,turn left can see the Hi-life convenience store and turn to the right,go straight end of the corner ,then you will see the MHH on your left hand side.
Bus station:
C. 馬偕醫院站 - 226,518,42,46,613,紅1
D. 馬偕醫院站 - 42,209,518,紅1

9/4 clinical assessment(future plan)

Remind:
1. Next time use email or phone to early inform sir about take lift for one day ,not to use skype!
2.Future plan in MHH that i will arrange is Monday,TuesdayThursday whole day will be at MHH for collect the data,others day like Wednesday,and Friday will go to NTUH on morning.
#MHH (Whole day):Monday,TuesdayThursday
#NTUH(half or whole day):Wednesday, Friday morning or afternoon
@after two weeks may be i will reverse the arrangement ,is that suitable?
3.Because of take lift on Monday,so i will have come on Friday with whole day!
4.Friday(9/7) i will go to MHH whole day for clinical assessment,begin on 9AM.

Question:
1.If p't have bradykinesia, and he also include in CVA criterion,does he will include in our data bank?

8/31 Mission

Mission
1.key in the data of new cases.
2.go through the latest articles

QUESTION:
1.if the p't retest again in BADL & have new data of IADL, is it can receive and save it to another new detail

8/30 clinical assessment

* stream management server still crashing down,the website show the information just like below :

'/stream' 應用程式中發生伺服器錯誤。
在建立連接至伺服器時發生錯誤。當連接至 SQL Server 2005 時，失敗的原因可能是，在預設設定下，SQL Server 不允許遠端連接。 (provider: 具名的管線提供者, error: 40 - 無法開啟至 SQL Server 的連接) 描述: 在執行目前 Web 要求的過程中發生未處理的例外情形。請檢閱堆疊追蹤以取得錯誤的詳細資訊，以及在程式碼中產生的位置。 例外詳細資訊: System.Data.SqlClient.SqlException: 在建立連接至伺服器時發生錯誤。當連接至 SQL Server 2005 時，失敗的原因可能是，在預設設定下，SQL Server 不允許遠端連接。 (provider: 具名的管線提供者, error: 40 - 無法開啟至 SQL Server 的連接)原始程式錯誤:
在執行目前 Web 要求期間，產生未處理的例外狀況。如需有關例外狀況來源與位置的資訊，可以使用下列的例外狀況堆疊追蹤取得。 堆疊追蹤:
[SqlException (0x80131904): 在建立連接至伺服器時發生錯誤。當連接至 SQL Server 2005 時，失敗的原因可能是，在預設設定下，SQL Server 不允許遠端連接。 (provider: 具名的管線提供者, error: 40 - 無法開啟至 SQL Server 的連接)]
System.Data.SqlClient.SqlInternalConnection.OnError(SqlException exception, Boolean breakConnection) +739123
System.Data.SqlClient.TdsParser.ThrowExceptionAndWarning(TdsParserStateObject stateObj) +188
System.Data.SqlClient.TdsParser.Connect(ServerInfo serverInfo, SqlInternalConnectionTds connHandler, Boolean ignoreSniOpenTimeout, Int64 timerExpire, Boolean encrypt, Boolean trustServerCert, Boolean integratedSecurity, SqlConnection owningObject) +685966
System.Data.SqlClient.SqlInternalConnectionTds.AttemptOneLogin(ServerInfo serverInfo, String newPassword, Boolean ignoreSniOpenTimeout, Int64 timerExpire, SqlConnection owningObject) +109
System.Data.SqlClient.SqlInternalConnectionTds.LoginNoFailover(String host, String newPassword, Boolean redirectedUserInstance, SqlConnection owningObject, SqlConnectionString connectionOptions, Int64 timerStart) +383
System.Data.SqlClient.SqlInternalConnectionTds.OpenLoginEnlist(SqlConnection owningObject, SqlConnectionString connectionOptions, String newPassword, Boolean redirectedUserInstance) +181
System.Data.SqlClient.SqlInternalConnectionTds..ctor(DbConnectionPoolIdentity identity, SqlConnectionString connectionOptions, Object providerInfo, String newPassword, SqlConnection owningObject, Boolean redirectedUserInstance) +170
System.Data.SqlClient.SqlConnectionFactory.CreateConnection(DbConnectionOptions options, Object poolGroupProviderInfo, DbConnectionPool pool, DbConnection owningConnection) +359
System.Data.ProviderBase.DbConnectionFactory.CreatePooledConnection(DbConnection owningConnection, DbConnectionPool pool, DbConnectionOptions options) +28
System.Data.ProviderBase.DbConnectionPool.CreateObject(DbConnection owningObject) +424
System.Data.ProviderBase.DbConnectionPool.UserCreateRequest(DbConnection owningObject) +66
System.Data.ProviderBase.DbConnectionPool.GetConnection(DbConnection owningObject) +496
System.Data.ProviderBase.DbConnectionFactory.GetConnection(DbConnection owningConnection) +82
System.Data.ProviderBase.DbConnectionClosed.OpenConnection(DbConnection outerConnection, DbConnectionFactory connectionFactory) +105
System.Data.SqlClient.SqlConnection.Open() +111
ASP.global_asax.Application_Start(Object sender, EventArgs e) +150
版本資訊: Microsoft .NET Framework 版本:2.0.50727.832; ASP.NET 版本:2.0.50727.832

Mission:
1.connect to Mr周業太 for cencern about the stream management server
2.key in the p't's data
3.tomorrow i will coming whole day!

8/29 mission

Mission
1.the server of stream management still can;t function, they also couldn't find out the problem is!
2.remind sir about the 主持人.
3.not yet key in the data of 3 new p't

8/28 mission

mission:
1.arrange the time table of going to NTUH ,my plan may be will arrange monday and friday morning will go , and Tuesday to Thusday is afternoon only go there!
#NTUH(half day): --Monday and friday morning
--Tuesday to Thusday is afternoon
2.try out the main point of the new article
3.人體試驗送審資料及排列清單裡面:need to phone there and find out what is the meaning !
4.The MMH just need :審核表,申請表,中英文計畫書摘要,詳細計畫書以及受試者同意書(自己設計)
5.need to confirm some detail with sir Tomorrow(8/29):
-->主持人是謝老師或馬偕PT 老師(歐育志),協同主持人
-->詳細計畫書的設計
-->同意書裡面的主持人資料
-->英文計畫書摘要

8/24 clinical & mission

1.look through國立臺灣大學醫學院附設醫院臨床試驗計畫書,get attention on what will need to approach to MMH,and compare to the component of MMH proposal
the component of NTUH proposal include臨床試驗計劃書,申請書,受試者型態概述,快速審查範圍評檢表,受試者說明及同意書,參考文獻.There are six subtitle. Monday(8/27) will disscuss with sir.
2.2 p't are take in assessment(BI,BADL,BIB) ,not yet key in the data,not yet write down the data of the p't!
3. i sent an email to Mr.周業太 on wednesday(8/22)to tell him about stream management server was crashing down,and phone to him again today morning to concern the situation about the server.He will let me now about the situation on today works. But he didn't call me at last.
4.Monday i have arrange 2 P't to accept the asessement about BIB,BADL ,may be have Stream -cat .
5.go through the article!

8/23 clinical

1.2p't have take in the assessment,both of them have a same problem is the function just has a little bit different between affected side and unaffected side,but still can consider to accept them
2. NOT yet key in the data!!
3.look through MMH 研究相關流程
來院收病患的公文。要含以下資料
> 1. 要由系上或是醫學院發文
> 2. 附上研究計畫
> 3. 研究計畫的主旨
> 4. 病患類別與收取哪些類的資料
> 5. 收案時間可以盡量寫寬一點
> 6. 院內所需要附上的資料和流程，如下
http://www.mmh.org.tw/taitam/irb/
看看能不能進去下載
find out what and how the process go through with?
4.continue yesterday articles
5.tomorrow morning go to the clinical !

8/22 reading & mission

1.Arrange 1-2 p't to take in the assessment of stream-cat within a week---check is it the server is still function or not?
2.find out the main point of the latest article
3. find out the future challenges of the first article
4.think out how to arrange the time table(when i suppose go to Mackay Memorial Hospital or NTUH? )

8/21 reading & misison

Mission:
1.arrange p't to take in assessment(BI,BIB,BADL or stream-cat)
2.consider about the arrangement of the schedule that when will go to NTUH or other hospitals
3.Find out the mainpoint of another article!

8/20 reading & discussion

In the first article, how CAT combined IRT method to improve the functional outcome become more precision and effecience!
First step,we need to choose a specified item pool(specified outcome domain).
2nd step , item selection: use IRT to select an initial item to provide good discrimination over a wide range that all p't answer as the first question.
3rd step, patient respone:according to p't respone, we can have an initial score estimate and the score of confidence interval.
-IRT have 2 methods (Rasch modeling & CI).
These two methods can help the CAT to improve the functional outcome become more precision and effecience!
-->got three parameter:1,2,3-parameter;1-parameter is for difficult,2-parameter is for discrimination,3-parameter is for guessing.Now,it has assumption that item have equal dicrimination parameter and that guessing not a factor in the date.
-->Rash modeling :it can provide an index of each item's difficult-easy level, that will let us to determine if this items of the measurement need to modify or make shorten to become more comprehensive measurement or not.Besides,it also can make the item and p't's ability on the same metric. It can provide information about p't's abilities are fit with the specific component outcome domain.

-->confidence interval: it relative to the probabilities of patients, it can determine the suitable place of individual along functional dimension.
IRT can develop measure scale that are comprised of items with a known relationshipbetween item responses and position on an underlying functional domain.,called item characteristic curve. Using this approach,probabilities of patients scoring a particular response on an item at various funtional ability levels can be modeled.These probability can used to determine the individual's most like ly position along the functional dimension.

Both methods will develop the measurement become more precise and faster with effeicient!Because they make the possible area/range/distribution of p't abilities will become more smaller and that will faster let we determine where the p't abilities is!

4th step, score calculation: after the 3rd steo-the basis of the patient's response,then can estimate initial score and confidence interval.
5th step, stop rules or recontinue to step 2: that are based either the size of the pre-programmed confidence Interval are satisfied or the maximum number of items that used to test.
6th step,functional outcome: If there are not satisfied,a new item from the item pool is continued to administer, untilthe stop rule is satisfied.


Question:future challenges
1.why difficult to construct item bank? is the items too much? or other else?
2.why so few expert use CAT instrument
3.advertisement?!

8/17 reading & dicussion

1. what is the logic of the CAT assessment ?how can it possible reach precision and faster?
2. Find out the meaning of confidence interval ?
3. breadth(兩個極端,例如一端為簡單,另一端為困難) vs. depth (解析度)
4. Find out the main point of the new article?(Improving patient reported outcomes using item response theory and computerized adaptive testing)
5. what is the limitation of CAT in the future?

8/16 BADL & mission

Tomorrow mission: photostep the assessment of BADL,BI, agreement of stream-cat and BADL. Second, look through the flims of BIB (part one & two), if get some problem from there , write it down and ask angie about the solvent! Third, need to prepare the assessement for next week!

IRT & CAT

why we use IRT & CAT in this moment? It is because we didnt have clear definition of functional outcome or delineation between intrusments that assess functional outcomes. In the field of rehabilitation have many,different types of intrusments are overlapping with same function. So ,the contemporary measurement techniques have some functions better than traditional measurement such as it can unity,completeness and consistency issues.Following the last discription, it also can saves time in busy clinical settings. Question :how to achieve the functions that mention in the above sentences. Or how to prove that the CAT &IRThave such function?

8/15 BADL & BIB

BIB: when p't failed approaching one or two of the items like item 26 & 24(both feet beat time by turns &墊腳尖 ), but he can succed on item28 & 29(維持跨步). On the item of standing to squat, p't couldn't maintain his stability when he squated in the end of the motion. So, the mark will give is 0. if he can maintain,but he will backwards, the mark will give is 1.

8/14 practice BI , BIB &paper sheet of Stream-cat

BI: the p't felt boring about asking him same question as other assisstant or student had done it before. but we still need to explain to him about we have different item we have to comfortable ,then only let you continue . BIB: Need to pay attention on the safety of p't,for example mobility of item 23-25 . STREAM-CAT: the item of lying on bed knee flexion,when the affected limb knee flexion,the foot need to get close to the bed surface.item of 23(L8),p't usually can't have full range of it or eversion when abduction.

8/13practice Stream-CAT &PDA

Stream-CAT &PDA :safety ;the motion of p't is it completed in the UE/LE extremities' item ? For example, 17(L4)knee flexion :when pts' knee flexion ,but his ankle will slightly eversion about 10 degree , will give him 1 mark. No matter the motion is , if the p't couldn't reach the normal motion, then we will give him 1 mark in the UE/LE extremities' item or 2 mark in the mobility item . I have arrange some p't this few days ,tommorow (Tuesday,8/14) have two (inpatient ward) p't can have assessment about stream-CAT and BIB or ADL on 2.40pm and 4pm. Wednesday 8/15 one OPD p't about 2.30pm can take part in Stream-CAT and IADL . Thusday also have 1 inpatient ward p't (aging women) can have a BI asseseement to her caregiver.

8/10 practice Stream-CAT &BIB

Stream-CAT: Mobility can't have any assissstant for example quatrican,walker and etc. then others subject can use the assisstant to support p't ,prevent fallen. 3 mark is mean all independent. BIB :If pt's easily fatigue,can let him rest first and he /she need more times to finish his motion. Appointment : Monday 8/13 from 2.30pm to 3.30 pm,i have arrange 2 OPD p't to assess Stream-CAT(include PDA) ,BADL or IADL and BIB. Tuesday8/14 4pm, inpatient.

8/9 pratice BI & BIB

BI : need to remind the p't or caregiver the item of activities in BI are relevant to the ability of p't do in this two days!they will always mention about other days or other function. And they also mention about his Affected Limb that couldn't do the examination ,therefore we need to make a clarify with them .
BIB : pay attention on p't position ,for example when p't sit to stand, we need to make sure his leg didnt lean against the bedside,and make sure he is safety and comfortable. Angie and i have two items to debate about sit to lying and stand to sit.Angie give them zero, and i give them one.Why suppose this will happen ,because of the environment and the diffirent role (audience and tester,what we recept are different.).tomorrow afternoon 230pm also had one to two p't can test about STREAM-CAT&PDA ,BI

8/8 pratice strean-cat & BI

STREAM-CAT
1.item 5(M2 raise up hip) :p't just can raise up alittle bit range(about 20), it makes me difficult to determine is it full range or not!And the marks i need to give hime is 1 or 2. Answer is 1 .
2.item 15(L2 hip flexion in sitting): p't need to use both hand to support the bedside, only can hip flexion like his right leg. Because this item not include in mobility, means no matter what situation also can use any assisstant to support p't to do the motion.
3. if p't just had a little movement on his motion, how we determine it if his movement are different direction ,answer give him zero mark, or not (right direction) will give him 1 mark. for example,standing position then flexion knee ,if he doing the knee flexion are direct the leg behind(knee flexion), g ive it 1 marks. Just a little bit of range or leg is direct to front will give zero.
BI
1. item 3( personal hygiene) : if p't can't do all of items(include comb hair, brush teeth,wash face and shave)or 2 items of all, just can include to zero.


Apointment: tomorrow thusday (8/9)3 pm to 4pm: have 2 p't can have assessment for BADL,BI,STREAM-CAT PDA and BIB.

8/6 practice BIB

if i know the p't abilities of sitting balance with observation, then can skip the item of sitting balance ,go through to the item of position change or standing balance.

• the item of 19,20&21, when p't flexion his waist to get up a pen, make sure his buttock mustn't have touched the bed, means that knee mustn't flexion too much,but need to use trunk flexion more than knee flexion.
• the item of 26,27 the p't can flexion or extension his ankle, if the angle of ankle as same as his another foot
• iteme of th30,31 need to cautions:

1 the heel of front leg need to go close to the tiptoe

2. two legs must be a line(sometimes p't will deviate out of midline to compensate his balance ,mark will be zero.)

Stream-CAT
the items of mobility can't have any assisstant when p't have assessment.

8/3 pratice BIB

one patient that have intention tremor, without consider the expand of time, just determine if he could do it and we will give him 1 mark. Because his tremor make him couldn't take up or touch the pen precisely,need to give him chances, is it wouldn't influence this or others assessment like STREAM-CAT & PDA.

reference from: http://www.merck.com/mmhe/sec06/ch091/ch091c.html
Intention (Cerebellar) Tremor: This relatively slow, broad tremor occurs at the end of a purposeful movement, such as trying to press a button. Intention tremor may result from a damage to the cerebellum or its connections. Multiple sclerosis and stroke are common causes. Wilson's disease, alcoholism, and overuse of sedatives or anticonvulsants can cause the cerebellum to malfunction, resulting in intention tremor.

practice BIB,BI,BADL,IADL,Stream-CAT

Today PDA was crash down,had fixed it ,just need press the button below the PDA, it means reset the network card's detail,but it didnt influence our detail.
BADL(BIB) : need to ask more precise ,for example one item about personal hygiene include bruhes teeth,bathing used and others.
If some patientjust finished one activity , just give 0 mark. Another 1 mark is means that p't need to finish three four of the activites.

8/1 practice IADL &Stream-CAT

IADL
-before disease still have the limitation of time?
if yes,how long before disease?
because this p't have two part of his life, one was stayed at Thailand alone ,another is come back staying here!
Stream-CAT
-item5 :
p't no need to help for stable him legs buthis hips has alittle bit unsymmetric
-item23:
how broad of the range of motion that p't need abduction his leg?

Conclusion :
The assessment need to exam :
Outpatient:
-BADL & IADL
-BIB (over standing item ,like squat more difficult)
-Stream-cat & PDA (Safety & fatigue)

Inpatient:
-BADL
-BIB
-Stream-CAT &PDA (depend to p't)
(fatigue or not enough endurance)

Tomorrow(8/2,Thusday)
Mr.江(OPD) 3:00pm --BIB (BADL) have OT treatment after 3pm
Mr.游(OPD) 2:00pm --Stream-CAT& PDA have OT treatment on 2:30pm
Mr.黃1(Inpatient) 3:30pm -- BADL & BIB have OT treatment on 4pm
subtitution :Mr.黃2(OPD ,W1,2,4) have OT treatment on 2.30, he can accept after treatment

7/31 pratice daily

周業太 yehtai.office@gmail.com
if PDA connection didnt have any problems,but still can't access Stream Management or Stream-CAT , just call the name above sentences.

IADL
The patient who is total dependent in his daily activities, he didn't do activities that he like after stroke because of depression mood.According to the p't mood, make him didn't have any mood to do meaningful activities. It doubt me that this situation of patient had change totally after stroke .how we can do to change his quality of life.
Item 41 others: p't do said he 隨意欣賞風景,散步


Thusday 8/2
From 2 pm to 4pm have patient to practice some assessment, for example BI,BIB,Stream-cat and others.

7/30 pratice BI,Stream-CAT,BADL

BADL:
IADL need to plan to take examination on patient in other days.
Stream-CAT(paper sheet) :
in the item of M2(hip elevation on lying ),her leg are deviated from midline,need one people to hold it.if someone help her ,is it the point will given 1 or 2?
And the hip are not symmetrical (no assisstant at her foot), and also cant maintain longer.
-U10 thumb and index finger tipinch,use the thumb nail to touch the pad of index-->wrong ,just can give with one mark!
-M4(sit to stand) can use hand to support on the bed.
BI : need to exclude the patient who has aphasia syndrome?
if we met some patient who are total independent, still need to consider in? or just exclude from our examination.
next plan: find OPD for training stream -cat with PDA and include paper sheet.

7/27 pratice BIB and BI (morning)

BIB
1.Before assess patient's sit to lay, need to remember remove their shoes ,and wear it back before exam the item of standing(sitting).
-must lying straight in midline
2. If the patient is prone(wrong position), this result that may be her concious not clear about our commands, and too many commands will confuse her.
-at the item of taking a pen infront of him, if the p't can't recognize the direction(left or right), that's fine ,we can give them a sign where the pen need to put on.
-at the ietm of taking a pen from floor ,never mind with her leg move back !
3.Arteriovenous malformation( 動靜脈畸形) s/p op(AVM) is include in CVA criterion?
Answer:

• 747.81 Anomalies of cerebrovascular system
  - Arteriovenous malformation of brain
  - Cerebral arteriovenous aneurysm, congenital
  -Congenital anomalies of cerebral vessels
  Excludes:ruptured cerebral (arteriovenous) aneurysm (430)
• reference from: http://icd9cm.chrisendres.com/

4. The mark of BI is a little bit large to determine p't ability in their meaningful daylife, for example bathing, hygiene,wearing and etc. even though, we are difficult to judge the independence level of client.

7/26 pratice BIB & BI

In BI assessment ,when we met some patient who are talking not so fluent , or aphasia ,is it we won't choose them for a exam ? In my opinion,if the patient doesn't understand or comman ,that's difficult for determine which answer he give is right, there have too wide indefinite rank to consider.

BIB, got one item that tip to toe and two legs be a line, but if the line is not so straight, are this item going to give him a point or 0. There are too many item need to remember comman ,so need some time to remember it.

tuberculosis meningocephalitis(結核症狀腦膜炎) can include in CVA criterion?
Answer :not include in CVA criterion.
reference from: http://icd9cm.chrisendres.com/