本研究交叉檢驗 STREAM 上、下肢動作次量表之單向度、羅序信度、題目 難度排序相關性、及二研究參數估計個案分數相關性。以單向度而言，上肢次 量表僅共同保留6 題目、題目數目偏少，而下肢次量表則保有 8 題目、較令人 滿意。而本研究估計之上、下肢次量表羅序信度均大於0.90、皆較先前研究更 佳。題目難度排序相關性方面，上肢次量表僅具低度相關 (Spearman's rho = -0.31)，推測可能與樣本特性差異有關，而下肢次量表則有中度相關
(Spearman's rho = 0.48)，較符合研究者預期。最後二研究參數估計個案分數相 關性，上肢次量表為高度相關 (Pearson's r = 0.96)、下肢次量表則為中度相關 (Pearson's r = 0.62)，雖然都符合研究者預期，但仍可深入分析下肢次量表僅有 中度相關的原因。
整體而言，目前 STREAM 上、下肢次量表心理計量特性之羅序分析結果不 完全一致。由於本研究仍存有部分限制，僅能就現有結果推論，建議未來可以 繼續探討STREAM 上、下肢次量表心理計量特性結果不一致的可能因素，並提 供解決的方法。如此一來，除了有助於提升STREAM 的評量價值、也讓臨床及 研究人員更了解量表的優缺點。
參考文獻
王文中（1997）。測驗的建構：因素分析還是 Rasch 分析？調查研究，3，129-166。
胡漢華（2008）。台灣腦中風防治指引 2008 第一版。台灣腦中風學會，2008，
75-94。
祝旭東、王淳厚、謝清麟、陳美香、陳瓊玲（1996）。布氏動作恢復量表之信度 及同時效度研究。職能治療學會雜誌，14，1-12。
Ahmed, S., Mayo, N. E., Higgins, J., Salbach, N. M., Finch, L., & Wood-Dauphinée, S. L. (2003). The Stroke Rehabilitation Assessment of Movement (STREAM):
A Comparison With Other Measures Used to Evaluate Effects of Stroke and Rehabilitation. Physical Therapy, 83, 617-630. doi:10.1093/ptj/83.7.617 Alt Murphy, M., Resteghini, C., Feys, P., & Lamers, I. (2015). An overview of
systematic reviews on upper extremity outcome measures after stroke. BMC Neurol, 15, 29. doi:10.1186/s12883-015-0292-6
Andrich, D. (1978). A rating formulation for ordered response categories.
Psychometrika, 43, 561-573. doi:10.1007/bf02293814
Biller J, L. B., Marsh E, et al. (1990). Spontaneous improvement after acute ischemic stroke. A pilot study. Stroke 1990;21:1008-12, 21, 1008-1012.
Bond TG, F. C. (2001). Applying the Rasch Model: Fundamental Measurement in the Human Sciences. Erlbaum, Mahwah. Erlbaum, Mahwah.
Bonita R, B. R. (1988). Recovery of motor function after stroke. Stroke, 19, 1497-1500.
Boone, W. J., Staver, J. R., & Yale, M. S. (2014). Person Reliability, Item Reliability, and More Rasch Analysis in the Human Sciences (pp. 217-234). Dordrecht:
Springer Netherlands.
Carr, J. H., Shepherd, R. B., Nordholm, L., & Lynne, D. (1985). Investigation of a New Motor Assessment Scale for Stroke Patients. Physical Therapy, 65, 175-180. doi:10.1093/ptj/65.2.175
Rehabilitation Outcomes: A Pilot Study in a Chinese Population. Physical &
Occupational Therapy In Geriatrics, 24, 1-14. doi:10.1080/J148v24n04_01 Chen, J., Liu, H. H., Li, Z., & Quiben, M. (2009). Multivariant Analysis of Stroke
Rehabilitation Outcomes: A Pilot Study in a Chinese Population. Physical &
Occupational Therapy In Geriatrics, 24, 1-14. doi:10.1080/J148v24n04_01 Daley K, M. N., Wood-Dauphinée S. (1999). Reliability of scores on the Stroke
Rehabilitation Assessment of Movement (STREAM) measure. Phys Ther.
1999 Jan, 79, 20-23.
Duncan, P. W., Goldstein, L. B., Matchar, D., Divine, G. W., & Feussner, J. (1992).
Measurement of motor recovery after stroke. Outcome assessment and sample size requirements. Stroke, 23, 1084-1089. doi:10.1161/01.str.23.8.1084
Duncan, P. W., Propst, M., & Nelson, S. G. (1983). Reliability of the Fugl-Meyer Assessment of Sensorimotor Recovery Following Cerebrovascular Accident.
Physical Therapy, 63, 1606-1610. doi:10.1093/ptj/63.10.1606 Fugl-Meyer, A. R., & Jääskö, L. (1980). Post-stroke hemiplegia and
ADL-performance. Scandinavian journal of rehabilitation medicine. Supplement, 7, 140-152.
G. Broeks, J., Lankhorst, G. J., Rumping, K., & Prevo, A. J. H. (1999). The long-term outcome of arm function after stroke: results of a follow-up study. Disability and Rehabilitation, 21, 357-364. doi:10.1080/096382899297459
Goldstein, L. B., Bertels, C., & Davis, J. N. (1989). Interrater reliability of the nih stroke scale. Archives of Neurology, 46, 660-662.
doi:10.1001/archneur.1989.00520420080026
Hattie, J. (1985). Methodology Review: Assessing Unidimensionality of Tests and ltenls. Applied Psychological Measurement, 9, 139-164.
doi:10.1177/014662168500900204
Hsueh, I.P., Hsieh, C.L. (2002). Responsiveness of two upper extremity function instruments for stroke inpatients receiving rehabilitation. Clinical
Rehabilitation, 16, 617-624. doi:10.1191/0269215502cr530oa
Hsueh, I.P., Wang, W., Wang, C.H., Sheu, C.F., Lo, S.K., Lin, J.H., Hsieh, C.L.
(2006). A simplified stroke rehabilitation assessment of movement instrument.
Phys Ther., 86, No. 7, 936-943.
Huang, C.Y., Lin, G.H., Huang, Y.J., Song, C.Y., Lee, Y.C., How, M.J., . . . Hsieh, C.L. (2016). Improving the utility of the Brunnstrom recovery stages in patients with stroke: Validation and quantification. Medicine, 95, e4508.
doi:10.1097/MD.0000000000004508
Huang, Y.J., C. K., Chou, Y.T., Hsueh, I.P., Hou, C.Y., Hsieh, C.L. (2015).
Comparison of the Responsiveness of the Long-Form and Simplified Stroke
Rehabilitation Assessment of Movement Group- and Individual-Level Analysis. Phys Ther., 95, NO. 8, 1172-1183.
Koh, C.L., Pan, S.L., Jeng, J.S., Chen, B.B., Wang, Y.H., Hsueh, I.P., & Hsieh, C.L.
(2015). Predicting recovery of voluntary upper extremity movement in subacute stroke patients with severe upper extremity paresis. PLoS One, 10, e0126857. doi:10.1371/journal.pone.0126857
Kumar, K. V., Joshua, A. M., Kedambadi, R., & Mithra, P. P. (2017). Eclectic/mixed model method for upper extremity functional recovery in stroke rehabilitation:
A pilot study. Journal of Natural Science, Biology, and Medicine, 8, 75-81.
doi:10.4103/0976-9668.198357
Kwok, T., Lo, R. S., Wong, E., Wai-Kwong, T., Mok, V., & Kai-Sing, W. (2006).
Quality of Life of Stroke Survivors: A 1-Year Follow-Up Study. Archives of Physical Medicine and Rehabilitation, 87, 1177-1182.
doi:http://dx.doi.org/10.1016/j.apmr.2006.05.015
Lannin, N. A. (2004). Reliability, validity and factor structure of the upper limb subscale of the Motor Assessment Scale (UL-MAS) in adults following stroke.
Disability and Rehabilitation, 26, 109-116.
doi:10.1080/0963828032000157970
Lin, G.H., Lu, Y., Wu, C.T., Chiu, E.C., Huang, S.L., Hsueh, I.P., & Hsieh, C.L.
(2016). Psychometric properties of the Five-Digit Test in patients with stroke.
Disabil Rehabil, 38, 97-102. doi:10.3109/09638288.2015.1031288
Linacre, J. M., & Wright, B. D. (1994). Reasonable mean-square fit values. . Rasch Measurement Transactions, 8, 370.
Lord, F. M., & Novick, M. R. (1968). Statistical theories of mental test scores.
Reading, MA: Addison-Wesley.
Lyden, P. D., Lu, M., Levine, S. R., Brott, T. G., & Broderick, J. (2001). A Modified National Institutes of Health Stroke Scale for Use in Stroke Clinical Trials.
Preliminary Reliability and Validity, 32, 1310-1317.
doi:10.1161/01.str.32.6.1310
Malouin, F., Pichard, L., Bonneau, C., Durand, A., & Corriveau, D. (1994).
Evaluating motor recovery early after stroke: Comparison of the Fugl-Meyer Assessment and the Motor Assessment Scale. Archives of Physical Medicine and Rehabilitation, 75, 1206-1212. doi:10.1016/0003-9993(94)90006-X Miller, K. J., Slade, A. L., Pallant, J. F., & Galea, M. P. (2010). Evaluation of the
psychometric properties of the upper limb subscales of the Motor Assessment Scale using a Rasch analysis model. J Rehabil Med, 42, 315-322.
doi:10.2340/16501977-0519
L., . . . de Vet, H. C. W. The COSMIN study reached international consensus on taxonomy, terminology, and definitions of measurement properties for health-related patient-reported outcomes. Journal of Clinical Epidemiology, 63, 737-745. doi:10.1016/j.jclinepi.2010.02.006
Rasch, G. (1960). Probabilistic Models for Some Intelligence and Attainment Tests.
Danish National Institute for Educational Research, Copenhagen.
Santisteban, L., Térémetz, M., Bleton, J.-P., Baron, J.-C., Maier, M. A., & Lindberg, P.
G. (2016). Upper Limb Outcome Measures Used in Stroke Rehabilitation Studies: A Systematic Literature Review. PLoS One, 11, e0154792.
doi:10.1371/journal.pone.0154792
Twitchell, T. E. (1951). THE RESTORATION OF MOTOR FUNCTION FOLLOWING HEMIPLEGIA IN MAN. Brain, 74, 443-480.
doi:10.1093/brain/74.4.443
Vongsirinavarat, M., & Hiengkaew, V. (2014). Factors determining functional ability of individuals with stroke in community (Vol. 97 Suppl 7).
Wang, C.H., H. C., Dai, M.H., Chen, C.H., Lai, Y.F. (2002). Inter-rater reliability and validity of the stroke rehabilitation assessment of movement (stream)
instrument. J Rehabil Med., 2002 Jan, 20-24.
Williams, B. K., Galea, M. P., & Winter, A. T. (2001). What is the functional outcome for the upper limb after stroke? Australian Journal of Physiotherapy, 47, 19-27. doi:http://dx.doi.org/10.1016/S0004-9514(14)60295-6
WJ, F. (1992). Fisher WJ. Reliability statistics. Rasch Measurement Transactions, 6, 238.
Wohlk Olsen, L. (2003). Essays on Georg Rasch and his contributions to statistics.
Wright, B. D., & Mok, M. (2000). Rasch models overview. Journal of Applied Measurement, 1, 83-106.
圖1 試題特徵曲線 (ICC)
註：當潛在特質越大，答對機率越趨近於1；反之潛在特質越小則答對機率趨近於 0。
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
-4 -3 -2 -1 0 1 2 3 4
答對機率
潛在特質 (logits)
圖2 上肢次量表－個案能力與個案信度散佈圖
0.5 0.6 0.7 0.8 0.9 1
-10 -8 -6 -4 -2 0 2 4 6 8 10
個案信度
個案能力 (logit)
圖3 下肢次量表－個案能力與個案信度散佈圖
0.5 0.6 0.7 0.8 0.9 1
-10 -8 -6 -4 -2 0 2 4 6 8 10
個案信度
個案能力 (logit)
圖4 上肢次量表－本研究及 Hsueh 等研究參數各別估計個案分數之散佈圖
-8 -6 -4 -2 0 2 4 6 8
-10 -5 0 5 10
本研究參數估計之個案分數 Hsueh等研究參數估計之個案
圖5 下肢次量表－本研究及 Hsueh 等研究參數各別估計個案分數之散佈圖
-8 -6 -4 -2 0 2 4 6 8
-10 -8 -6 -4 -2 0 2 4 6 8 10
本研究參數估計之個案分數 Hsueh等研究參數估計之個案分數
圖6 上肢次量表－本研究題目難度參數及個案能力分布圖
註：圖中左側X 代表個案、右側數字代表題目。
對應到最左邊數字為個案能力及題目難度之共用坐標軸（單位為logit）。
圖7 上肢次量表－Hsueh 等研究題目難度參數及個案能力分布圖
註：圖中左側X 代表個案、右側數字代表題目。
對應到最左邊數字為個案能力及題目難度之共用坐標軸（單位為logit）。
圖8 上肢次量表－本研究及 Hsueh 等研究題目難度散佈圖
註：上方圓點虛線為資料點的趨勢線、下方45°虛線為理想狀態下的一致線。
4.1
4.2
5.1
5.2
6.1
6.2
7.1
7.2
8.1
8.2
9.1
9.2
-4 -3 -2 -1 0 1 2 3 4 5
-4 -3 -2 -1 0 1 2 3 4 5
Hsueh等研究題目難度(logit)
本研究題目難度 (logit)
圖9 下肢次量表－本研究題目難度參數及個案能力分布圖
註：圖中左側X 代表個案、右側數字代表題目。
對應到最左邊數字為個案能力及題目難度之共用坐標軸（單位為logit）。
圖10 下肢次量表－Hsueh 等研究題目難度參數及個案能力分布圖
註：圖中左側X 代表個案、右側數字代表題目。
對應到最左邊數字為個案能力及題目難度之共用坐標軸（單位為logit）。
圖11 下肢次量表－本研究及 Hsueh 等研究題目難度散佈圖
表1 STREAM 之應用文獻分類表
Eclectic / mixed model method for upper extremity functional recovery in stroke
rehabilitation: A pilot study.
Kumar, K.V., et al. (2017) (Kumar, Joshua, Kedambadi, &
Mithra, 2017)
“Journal of Natural Science, Biology, and Medicine” analysis of stroke rehabilitation outcomes: A pilot study in a
Quiben, 2009)
1. 比較上
“Physical &
Occupational Therapy In Geriatrics” ability of individuals with stroke in community.
Vongsirinavarat, M., et al. (2014) (Vongsirinavarat
& Hiengkaew, 2014)
“Journal of the Medical Association of Thailand “ recovery of voluntary upper extremity movement in subacute stroke patients with severe upper extremity
“PLoS One” 個臨床變 properties of the Five-Digit Test in patients with stroke.
Lin, G.H., et al.
(2015) (Lin et al., 2016)
“Disability and Rehabilitation”
註：STREAM = Stroke Rehabilitation Assessment of Movement, BRS = Brunnstrom Recovery Scale,
STREAM-UE = STREAM-upper extremity subscale, GCS = Glasgow coma score, PASS = Postural
Assessment Scale for Stroke Patients , BI = Barthel index, ADL = Activities of Daily Living, NIHSS =
National Institute of Health Stroke Scale.
表2 STREAM 之心理計量驗證文獻分類表 Reliability of
scores on the Stroke Rehabilitation Assessment of Movement (STREAM) measure.
Daley K., et al.
(1999) (Daley K, 1999)
A simplified stroke rehabilitation assessment of movement instrument.
Hsueh IP, et al.
(2006) (Hsueh IP, 2006)
註：PT = physical therapist, S-STREAM = simplified STREAM, ICC = intraclass correlation
coefficient.
表3 STREAM 之上下肢動作次量表
表4 本研究對象之基本人口學資料 (N = 302)
變項 數值
性別（男／女） 180 / 122
年齡：平均（標準差） 65.3 (13.7) 中風類型 (%)
缺血性腦中風 198 (66%)
出血性腦中風 104 (34%)
發病後時間（月） 1
中風復健動作評估量表：平均（標準差）
上肢次量表 12.9 (6.2)
下肢次量表 12.2 (5.7)
表5 上下肢次量表之羅序信度
題目數目 信度
上肢次量表 7 .92
下肢次量表 9 .93
表6 上肢次量表之個案信度分布情形 (N=302) 信度 人數 (%)
> 0.90 243 (80.5%) 0.80 ~ 0.90 59 (19.5%)
表7 下肢次量表之個案信度分布情形 (N=302) 信度 人數 (%)
> 0.90 243 (80.5%) 0.80 ~ 0.90 59 (19.5%)
表8 本研究及 Hsueh 等研究之上肢次量表題目難度參數與排序
註：難度排序僅列出二篇研究共同保留之題目。數字大者，代表較困難。
本研究 排序 Hsueh 等研究 排序
U1 - - -0.02 -
U2 - - -0.77 -
U3 - - - -
U4 -0.16 3 -0.46 1
U5 0.82 6 1.29 3
U6 -0.65 2 1.50 4
U7 -0.82 1 1.78 5
U8 0.02 5 1.21 2
U9 -0.11 4 2.06 6
U10 0.90 - - -
表9 本研究及 Hsueh 等研究之下肢次量表題目難度參數與排序 本研究 排序 Hsueh 等研究 排序
L1 - - -0.40 -
L2 -1.40 2 -0.83 2
L3 -1.21 3 -2.12 1
L4 -0.51 5 0.87 3
L5 -0.12 4 1.26 5
L6 -1.48 1 1.56 6
L7 -0.09 6 2.12 7
L8 1.26 - - -
L9 1.67 7 0.93 4
L10 1.88 8 3.63 8
註：難度排序僅列出二篇研究共同保留之題目。數字大者，代表較困難。
表10 上下肢次量表－本研究及 Hsueh 等研究題目難度排序之相關性 Spearman's rho
上肢次量表 -0.31
下肢次量表 0.48
表11 上下肢次量表－本研究及 Hsueh 等研究參數各別估計個案分數之相關性 Pearson's r
上肢次量表 0.96
下肢次量表 0.62