背景與目的：中風復健動作評估量表（Stroke Rehabilitation Assessment of Movement, STREAM）能夠快速與準確的測量出中風病人的能力程度，且許多研究顯示此評估工具有良好的信效度。近代有學者提出不能只以信效度等觀點來檢驗、確認評估工具的有效性與一致性，其提出最小重要差異值（Minimal Important Difference, MID）的概念。另外，也有學者認為經驗與年資會影響判斷的準確性。因此，本研究擬探討STREAM的MID值在不同資歷治療師間之差異。
研究方法：本研究邀請四位職能治療師，依照工作年資區分成資淺治療師組與資深治療師組。四位治療師觀看預先錄製的80位中風病人使用STREAM評估的影片後，分別使用覺類比量尺（Visual Analogue Scale, VAS）和15點李克特量表(15-point Likert scale)以自評方式估計 STREAM量表的MID值。運用Weighted kappa檢測不同資歷治療師使用VAS和15點李克特量表評分之分組的一致性。為瞭解資淺組與資深組之間的評分差異性，研究者以配對t檢定來探討。最後，再將兩組的MID值進行比較，瞭解不同工作資歷治療師在判斷STREAM之MID差異性。
結果：結果發現不同資歷治療師在使用VAS、15點李克特量表進行評分具有中低度一致性；進一步於差異性比較結果得知，資深組使用VAS、15點李克特量表進行評分的分數平均值幾乎皆大於資淺組的分數平均值，且有部分量表的資淺與資深兩組評分，彼此間具顯著性差異；比較資淺組與資深組治療師的STREAM表MID值，資深組的MID值大多小於資淺組。
結論：本研究證實STREAM的MID值於不同資歷治療師間存在差異性，資深治療師較資淺治療師對於判斷中風病人的能力改變程度上，有較小的MID及更好的敏感度。本研究結果將可提供臨床上不同資歷治療師使用STREAM評估中風病人的能力改變之判斷依據，以適時調整治療計畫。
Background and purpose：We can use the Stroke Rehabilitation Assessment of Movement(STREAM) to quickly and accurately measure the ability of stroke patients, and it has good reliability and validity. Some scholars proposed the idea of minimal important difference(MID), and believed that the experience and seniority will affect the accuracy of judgment. Therefore, we aimed to investigate the estimates of MID of the STREAM in terms of experience of therapists.
Methods：We invited four occupational therapists, and according to seniority divided into junior and senior groups. Four therapists viewed 80 stroke patients videos, and then used the 20-cm visual Analogue Scale(VAS) and the 15-point Likert scale to determine the MID of the STREAM. We used the weighted kappa to detect the consistency of therapists’ ratings grouping. We used paired t test to explore the different between the junior and senior groups. Finally, we compared the two groups of MID to understand the different MID in terms of experience of therapists.
Results：The therapists’ ratings had a moderate to low degree of consistency. The average scores of the senior group using VAS and 15-point Likert scale rating were almost greater than junior group. And there was some scales with significant differences between each other. The MID of the senior group was almost less than another.
Conclusion：This study demonstrated that the MID of STREAM was different between therapists, and senior therapists had smaller MID and better sensitivity. The results of this study will provide the base for different experiences of therapists using STREAM evaluating stroke patients, and therapists can adjust the treatment timely.
