Basic daily life activity ability evaluation system suitable for cognitive impairment patient

Abstract

The invention discloses a basic daily life activity ability evaluation system suitable for a cognitive disorder patient. The basic daily life activity ability evaluation system comprises a data acquisition end and a data analysis end, the data acquisition end comprises a basic information registration module and an evaluation module, the evaluation module comprises an evaluation table, and the evaluation table comprises evaluation items, disability feature options and dependence evaluation scales and is used for evaluating disability features and dependence degrees of various daily activities. And the data analysis end comprises a dependency degree boundary value delimiting module, a cognitive-related disability grade sorting module, a disability feature and dependency degree matching module and a cognitive-related disability care decision support module. According to the system, the disability characteristic and the dependency degree are evaluated in parallel at the same time, and the system has good cognitive characteristics and is sensitive to detection of basic daily life activity disability caused by cognitive impairment; meanwhile, an evaluation scale is provided for the degree of dependence of single basic daily life activities, and the degree of dependence of the single basic daily life activities can be transversely compared with the degree of dependence of other disabled people.

Description

Technical Field

[0001] The present invention relates to the fields of public health and long-term care, and in particular to a basic daily living activities ability assessment system suitable for patients with cognitive impairment. Background Art

[0002] Basic daily living activities are essential activities for maintaining individual survival, such as bathing, personal hygiene, toileting, dressing, and eating. The decline of this ability is one of the important signs of disease progression and an important variable affecting the caregiver burden and social care costs. Scientifically assessing the basic daily living activities of patients with cognitive impairment will help clarify the disease stage, guide the formulation of care strategies, and rationally allocate social care resources.

[0003] Since the impairment of basic daily living activities in patients with cognitive impairment is mainly related to cognitive damage, traditional basic daily living activities assessment tools mainly reflect the degree of physical disability and lack sensitivity to cognitive-related disability, making it difficult to accurately reflect the actual functional status of patients with cognitive impairment.

[0004] In response to this problem, a variety of daily living activities assessment tools for patients with cognitive impairment have been developed internationally. However, these tools generally mix the behavioral manifestations of patients with cognitive impairment in their daily living activities with the degree of dependence, lack an accurate measurement of the degree of disability corresponding to the behavioral manifestations, and have different descriptions of the behavioral manifestations. In addition, these tools usually mix basic daily living activities with instrumental daily living activities, so there are more items and a larger test load. The above problems seriously undermine the possibility of horizontal comparison of assessment results and are not conducive to the promotion and application of the tools. Summary of the invention

[0005] The purpose of the present invention is to overcome the deficiencies of the above-mentioned prior art and provide a basic daily living activities ability assessment system suitable for patients with cognitive impairment, which realizes the separation of physical disability and cognitive-related disability, and can simultaneously evaluate disability characteristics and dependence levels, thereby overcoming the defect that the prior art cannot accurately evaluate the basic daily living activities ability of patients with cognitive impairment.

[0006] To achieve the above object, the technical solution of the present invention is:

[0007] A basic daily living activities ability assessment system suitable for patients with cognitive impairment, including a data collection end and a data analysis end;

[0008] The data collection end comprises:

[0009] The basic information registration module is used to record the basic demographic information and physical disability of the measured subjects;

[0010] The assessment module includes an assessment form, which includes assessment items, disability characteristic options and a dependence assessment scale; the assessment items include 7 basic daily living activities; the disability characteristic options include characteristic options for cognitive-related disability, which are used to assess the cognitive-specific disability performance of patients with cognitive impairment when performing each basic daily living activity, and obtain a cognitive-specific disability score; the dependence assessment scale includes a visual digital measurement scale for the degree of dependence, which is used to assess the degree of dependence of patients with cognitive impairment on manpower when performing basic daily living activity tasks, and obtain a dependence degree score.

[0011] The data analysis end includes:

[0012] The module for defining the cut-off value of the degree of dependence is used to sum up the scores of the degree of dependence and define the cut-off value of the overall degree of dependence on each basic daily living activity;

[0013] The ranking module of cognitive-related disability is based on the probability model of item response theory. It obtains the mean (logits value) of each cognitive-related disability feature option by analyzing large sample measured data, and ranks cognitive-related disability according to the mean of each option.

[0014] The disability characteristic and dependency level matching module uses the common subject linking method based on item response theory to link and match the disability characteristic scores with the dependency level scores.

[0015] Optionally, the data analysis end also includes: a care decision support module for cognitive-related disability, which adopts an evidence-based decision model, builds a corresponding evidence-based knowledge base (updated regularly), and matches the best care practice strategies for different disability feature combinations.

[0016] Optionally, matching the disability characteristics and the degree of dependence includes:

[0017] Get the jointly calibrated step length and difficulty values, anchor the step length and difficulty values ​​to each item and each option, obtain the subject's ability value X and the subject's ability value Y from the anchored disability characteristics and dependence levels, and draw a scatter plot. If the two are in a linear relationship, it indicates that the same latent trait is being measured.

[0018] Generate a transformation graph of subject ability values ​​and raw scores, and connect the raw scores of disability characteristics and dependence levels by matching equal or closest subject ability values ​​in the transformation graph.

[0019] Optionally, the cognitive-related disabilities are ranked according to the mean values ​​of each option, including

[0020] The formula for calculating the option mean is as follows:

[0021]

[0022] B n : The ability value of the nth subject, D i : Difficulty value of entry i, N k : The number of times option k is selected.

[0023] The option mean reflects the difficulty of the option. In this assessment system, the larger the option mean, the higher the difficulty. Therefore, by calculating the mean of each cognitive-related disability feature option, the cognitive-related disability can be ranked according to the size of the option mean.

[0024] Optionally, the dependence degree scores are summed up to define the level cutoffs for the overall dependence degree of each basic daily living activity, including:

[0025] Obtain the original dependency assessment score data and sum the dependency levels of various basic daily living activities of patients with cognitive impairment;

[0026] Combined with the general definition of physical disability, several dependency levels were preset, and the k-means clustering method was used to calculate the cut-off values ​​of the overall dependency level. The original dependency level assessment score data was converted into level sequence data, and concurrent validity test was performed with the level sequence of classic assessment tools.

[0027] Optionally, the basic information includes the measurement subject's gender, age, limb muscle strength, vision, hearing, communication and sleep conditions.

[0028] Optionally, the assessment items include bathing, personal hygiene, toileting, dressing, eating, transferring and walking on flat ground.

[0029] Optionally, the disability characteristic options include regular and independent performance, initiation disorder, planning disorder, organizational disorder, execution disorder, motor apraxia (can cooperate), motor apraxia (inability to cooperate) and resistance to help from others.

[0030] Compared with the prior art, the present invention has the following beneficial effects:

[0031] The basic daily living activities ability assessment system for patients with cognitive impairment provided by the embodiment of the present invention scientifically measures the degree of disability of the behavioral performance of basic daily living activities of patients with cognitive impairment based on the probability model of item response theory, has good cognitive specificity, and is sensitive to detecting the disability of basic daily living activities caused by cognitive damage. At the same time, the disability characteristics and the degree of dependence are evaluated in parallel, and the test load of the degree of dependence is reduced by a visual digital scale, providing a scientific, simple, and horizontal and vertical comparison-satisfying basic daily living activities ability assessment tool for patients with cognitive impairment. BRIEF DESCRIPTION OF THE DRAWINGS

[0032] Figure 1 A schematic diagram of the composition of a basic daily living activities ability assessment system for cognitive impairment patients provided by an embodiment of the present invention;

[0033] Figure 2 Flowchart for accurate matching of disability characteristics and dependency levels;

[0034] Figure 3 Flow chart for dividing the total dependency level into boundaries;

[0035] Figure 4 A flowchart constructed for the assessment tool. DETAILED DESCRIPTION

[0036] In order to make the purpose, technical scheme and advantages of the present invention more clearly understood, the present invention is further described in detail below in conjunction with the accompanying drawings and embodiments. It should be understood that the specific embodiments described herein are only used to explain the present invention and are not intended to limit the present invention. Here, the technical features involved in each embodiment of the present invention described below can be combined with each other as long as they do not conflict with each other.

[0037] Example:

[0038] See also Figure 1 As shown, the basic daily living activities ability assessment system for patients with cognitive impairment provided in this embodiment mainly includes a data collection end and a data analysis end;

[0039] The data collection terminal includes:

[0040] The basic information registration module is used to record the basic demographic information and physical disability of the subjects; specifically, the basic information includes demographic data (gender, age), general conditions (limb muscle strength, vision, hearing, communication and sleep conditions), so as to have a more comprehensive understanding of the basic conditions of patients with cognitive impairment. The specific contents are as follows:

[0041] The limb muscle strength is divided into six levels, namely level 5 (normal muscle strength, able to complete movement against gravity and additional resistance); level 4 (able to move against gravity and slight resistance); level 3 (able to move against gravity, but not against additional resistance); level 2 (able to perform muscle contraction and joint movement, but not against gravity); level 1 (only slight muscle contraction, no joint movement); level 0 (no muscle contraction).

[0042] Vision is divided into five levels: normal, slight difficulty (can see large fonts but not printed fonts in books and newspapers), moderate difficulty (cannot see large headlines but can distinguish objects), severe difficulty (difficulty in identifying target objects and can only see light, color and shape) and complete blindness.

[0043] Hearing conditions are divided into five levels: normal, slight difficulty (cannot hear clearly when speaking softly or at a distance of more than 2 meters), moderate difficulty (difficulty in normal communication, can only be heard when speaking loudly in a quiet environment), severe difficulty (difficulty in all situations, need to speak loudly or very slowly) and complete deafness.

[0044] Communication skills are divided into five levels: no difficulty (able to express needs clearly and understand the information expressed by others), mild difficulty (able to express one's needs and understand the information expressed by others, but it takes more time and less or no prompts), moderate difficulty (difficulty in expressing needs or understanding, requiring frequent prompts, frequent repetitions or simplified verbal expressions), severe difficulty (unable to fully understand the information expressed by others and can only express general intentions with simple words or gestures) and complete difficulty (completely unable to understand the information expressed by others and cannot express it).

[0045] Sleep conditions mainly include normal sleep, fragmented sleep, day and night reversal, sleeping a lot during the day, nocturnal activities, making noises in the middle of the night, and other abnormal sleep conditions. Basic information can be obtained by asking patients with neurocognitive disorders or their primary caregivers.

[0046] The assessment module includes an assessment form, which includes assessment items, disability characteristic options and a dependence assessment scale; the assessment items include 7 basic daily living activities; the disability characteristic options include characteristic options for cognitive-related disability, which are used to assess the cognitive-specific disability performance of patients with cognitive impairment when performing each basic daily living activity, and obtain a cognitive-specific disability score; the dependence assessment scale includes a visual digital measurement scale for the degree of dependence, which is used to assess the degree of dependence of patients with cognitive impairment on manpower when performing basic daily living activities, and obtain a dependence degree score.

[0047] In this way, by distinguishing between the two categories of disability characteristics and dependence level, the disability and dependence levels of basic daily living activities in patients with cognitive impairment are evaluated at the same time, solving the technical problem of existing technologies that mix the disability and dependence levels in the daily living activities of patients with cognitive impairment. This not only allows for a detailed evaluation of the functional status of patients with cognitive impairment, but also provides a more scientific and accurate basis for clinical diagnosis and allocation of nursing resources, significantly improving the level of evaluation of basic daily living activities in patients with cognitive impairment.

[0048] The data analysis end includes:

[0049] The module for defining the cut-off value of the degree of dependence is used to sum the scores of the degree of dependence and define the cut-off value of the overall degree of dependence on basic daily living activities; this result helps to assist clinical diagnosis and guide the allocation of care resources.

[0050] The ranking module of cognitive-related disability is based on the probability model of item response theory. It obtains the mean (logits value) of each cognitive-related disability feature option by analyzing the measured data of a large sample, and ranks cognitive-related disability according to the mean of each option. This result has achieved a scientific measurement of the degree of disability of the behavioral performance of basic daily living activities in patients with cognitive impairment.

[0051] The disability characteristics and dependency level matching module uses the common subject linking method based on item response theory to link and match the disability characteristics scores with the dependency level scores. This result helps to compare the evaluation results of different assessment tools horizontally and provides support for the conversion and comprehensive analysis of results between different tools.

[0052] The care decision support module for cognitive-related disability adopts an evidence-based decision model and builds a corresponding evidence-based knowledge base (updated regularly) to match the best care practice strategies for different combinations of disability characteristics.

[0053] It can be seen that the basic daily living activities ability assessment system for patients with cognitive impairment provided in this embodiment scientifically measures the degree of disability of the behavioral performance of basic daily living activities of patients with cognitive impairment based on the probability model of item response theory, solving the technical problem that the prior art lacks accurate measurement of the degree of disability corresponding to the behavioral performance. At the same time, the disability characteristics and the degree of dependence are evaluated in parallel, and the test load of the degree of dependence is reduced by a visual digital scale, providing a scientific, simple, and basic daily living activities ability assessment tool that meets the needs of horizontal and vertical comparison for patients with cognitive impairment.

[0054] In a specific embodiment, if Figure 2 As shown, the linking and matching of the disability feature score and the dependency score includes:

[0055] Get the jointly calibrated step length and difficulty values, anchor the step length and difficulty values ​​to each item and each option, obtain the subject's ability value X and the subject's ability value Y from the anchored disability characteristics and dependence levels, and draw a scatter plot. If the two are in a linear relationship, it indicates that the same latent trait is being measured.

[0056] Generate a transformation graph of subject ability values ​​and raw scores, and connect the raw scores of disability characteristics and dependence levels by matching equal or closest subject ability values ​​in the transformation graph.

[0057] In this way, the disability characteristics and degree of dependence can be accurately matched through the above method, which enables a horizontal comparison of the evaluation results of different assessment tools, providing support for the conversion and comprehensive analysis of results between different tools.

[0058] In a specific embodiment, the ranking of the cognitive-related disabilities includes:

[0059] Adopting the probability model of the item response theory, obtaining the mean value (logits value) of the cognitive-related disability characteristic options based on the large-sample measured data, and ranking the cognitive-related disabilities according to the mean values of each option.

[0060] The calculation formula for the mean value of the option is as follows:

[0061]

[0062] B n : The ability value of the nth subject, D i : The difficulty value of item i, N k : The number of times option k is selected.

[0063] The mean value of the option reflects the option difficulty. In this evaluation system, the larger the mean value of the option, the higher the difficulty corresponding to the option. Therefore, by calculating the mean values of the cognitive-related disability characteristic options, the cognitive-related disabilities can be ranked according to the size of the mean values. Theoretically, the mean value of the option is consistent with the option ranking of the scale itself. If the mean value of the option is disordered, it may lead to a deviation between the score and the true ability of the measured person.

[0064] In this embodiment, the result shows that the mean value ranking of the option "UR. Resistance to help" is disordered, specifically manifested as its mean value not conforming to the expected option difficulty, resulting in unreasonable scoring, so it is excluded from the ranking result. Finally, the mean value ranking results of the cognitive-related disability characteristic options are as follows:

[0065] A. Regular and independent < B. Initiation disorder < C. Planning disorder < D. Organizational disorder < E. Execution disorder < F. Motor apraxia (cooperable) < G. Motor apraxia (incooperable).

[0066] In this way, through the above operations, by calculating the mean values of the cognitive-related disability characteristic options, the ranking of the levels of cognitive-related disabilities is realized, and the degree of disability in the behavioral manifestations of the basic daily life activities of cognitive disorder patients is scientifically measured.

[0067] In a specific embodiment, as Figure 3 shown, the summing of the dependence degree scores and delimiting the grade boundary values for the overall dependence degree of each basic daily life activity includes:

[0068] Obtaining the original dependence degree evaluation data;

[0069] Summing the dependence degree scores of the 7 activities;

[0070] Division of overall dependence level cutoffs: The overall degree of dependence is preset to be divided into four levels, namely no dependence (no help from others), mild dependence (a small amount of help), moderate dependence (most of the help) and severe dependence (all help required). The k-means clustering method is used to calculate the critical values ​​of the four dependence levels.

[0071] Forming grade sequence data: According to the dependency grade boundary value defined in the previous step, the original total dependency score is converted into grade sequence data.

[0072] Calculate concurrent validity: Use the grade results of the classic assessment tool as a calibration standard and conduct correlation analysis with the overall dependent grade series data to test concurrent validity.

[0073] In this way, through the above operations, the total score of the degree of dependence is divided into threshold values, and the degree of dependence can be determined according to the total score. This result helps to assist clinical diagnosis and guide the allocation of care resources.

[0074] In a specific embodiment, if Figure 4 As shown, the evaluation items are determined in the following way:

[0075] According to the review and analysis of the existing daily function assessment scales for patients with cognitive impairment, it was found that the basic daily living activities covered by at least two existing assessment tools include bathing, personal hygiene, toileting, dressing, eating, transfer and walking on the ground. Therefore, the items assessed by this assessment form are determined to be the above-mentioned 7 activities. The seven basic daily living activities assessed by the present invention adopt the coding and definition in the framework of the WHO International Classification of Functioning, Disability and Health (ICF), as follows:

[0076] Table 1 Coding and definition of basic daily living activities assessment activities

[0077]

[0078]

[0079] The entry options and scoring methods are as follows:

[0080] Each activity is provided with a disability feature option and a dependency assessment scale to simultaneously assess the cognitive-specific disability manifestations and the degree of dependence on caregivers when performing each basic daily living activity (see Figure 1 ).

[0081] The disability feature options usually include 8 items, numbered with letters, in the following order:

[0082] A. Independent execution (able to perform the activity regularly and independently);

[0083] B. Initiation barriers (failure to initiate the activity at the appropriate time and frequency);

[0084] C. Planning barriers (unable to independently complete the preparation of supplies);

[0085] D. Organizational impairment (inability to complete activities step by step and with concentration);

[0086] E. Executive dysfunction (problem identification and solution difficulties and distraction);

[0087] F. Motor apraxia but cooperation (unable to perform the activity but able to cooperate);

[0088] G. Motor apraxia and inability to cooperate (unable to perform the activity and unable to cooperate);

[0089] UR.Resisting help from others.

[0090] Categories A to UR are digitally coded from 0 to 7 to facilitate later data analysis. Multiple options for disability characteristics can be selected, and the highest score is used for scoring. In addition, because the mean of resistance to help does not match the expected difficulty of the options, it is impossible to reasonably assign points, so it is not included in the analysis when converting scores. This part is the advantage of the present invention. It fully considers the cognitive-related disability that occurs in patients with cognitive impairment when performing basic daily living activities, which helps the clinic to evaluate the basic daily living activities of patients with cognitive impairment in detail and accurately, provide corresponding support strategies, and retain the patient's self-care ability as much as possible to avoid excessive care.

[0091] The degree of dependence is scored using a visual numerical measurement scale of 0-10, where

[0092] 0 points means complete self-care;

[0093] 1-3 points are mild dependence, which means that the child does not need contact assistance but needs verbal guidance or care from others;

[0094] 4-6 points are moderate dependence, which means that a small amount of physical help from others is required;

[0095] 7-9 points are severe dependence, which means that a lot of physical help from others is needed;

[0096] 10 points means total dependence, which means being completely dependent on the help of others.

[0097] Some of the evaluation points involved in the entry options are explained as follows:

[0098] (1) Able to perform regularly and independently and fully self-sufficient: This means that the patient completes the activity without being reminded or assisted. If the patient is reminded to start or needs prompting when performing the activity, it is not considered independent or fully self-sufficient.

[0099] (2) Verbal guidance or care means that the patient needs someone to watch or give verbal guidance while performing activities, which takes up the caregiver's time.

[0100] (3) A small amount of physical help means that the patient mainly completes the activity by himself, and the caregiver provides some support.

[0101] (4) Extensive physical assistance refers to the patient completing a small amount of daily activities by himself or herself and relying mainly on the help of others.

[0102] Scale reliability and validity test: The evaluation indicators include Cronbach's α coefficient, inter-rater reliability, test-retest reliability (after 2 weeks), scale content validity index, item content validity index, and concurrent validity (correlated with the scores of classic assessment tools). A scale with good reliability should meet Cronbach's α coefficient>0.80, test-retest reliability and inter-rater reliability>0.70. The scale content validity index (S-CVI) and item content validity index (I-CVI) are both>0.70, and concurrent validity>0.70.

[0103] The above embodiments are only for illustrating the technical concept and features of the present invention, and their purpose is to enable ordinary technicians in the field to understand the content of the present invention and implement it accordingly, and they cannot be used to limit the protection scope of the present invention. Any equivalent changes or modifications made based on the essence of the content of the present invention should be included in the protection scope of the present invention.

Claims

1. A basic daily living activities ability assessment system suitable for patients with cognitive impairment, characterized in that: Including data collection end and data analysis end; The data collection end comprises: The basic information registration module is used to record the basic demographic information and physical disability of the measured subjects; The assessment module includes an assessment form, wherein the assessment form includes assessment items, disability characteristic options, and a dependency assessment scale; the assessment items include a number of basic daily living activities; the disability characteristic options include characteristic options of cognitive-related disability, which are used to assess the cognitive-specific disability performance of patients with cognitive impairment when performing each basic daily living activity, and obtain a cognitive-specific disability score; the dependency assessment scale includes a visual digital measurement scale for the degree of dependence, which is used to assess the degree of dependence of patients with cognitive impairment on manpower when performing basic daily living activities, and obtain a degree of dependence score; The data analysis end includes: The module for defining the cut-off value of the degree of dependence is used to sum up the scores of the degree of dependence and define the cut-off value of the overall degree of dependence on each basic daily living activity; The module for ranking cognitive-related disability is based on the probability model of item response theory. It obtains the mean of each cognitive-related disability feature option by analyzing large sample measured data, and ranks cognitive-related disability according to the mean of each option. The disability characteristic and dependency level matching module uses the common subject linking method based on item response theory to link and match the disability characteristic scores with the dependency level scores.

2. The basic daily living activities ability assessment system for patients with cognitive impairment according to claim 1, characterized in that: The data analysis end also includes: The care decision support module for cognitive-related disability adopts an evidence-based decision-making model, builds a corresponding evidence-based knowledge base and updates it regularly to match the best care practice strategies for different combinations of disability characteristics.

3. The basic daily living activities ability assessment system for patients with cognitive impairment according to claim 1, characterized in that: The linking and matching of the disability characteristic score with the dependency degree score includes: Get the jointly calibrated step length and difficulty values, anchor the step length and difficulty values ​​to each item and each option, obtain the subject's ability value X and the subject's ability value Y from the anchored disability characteristics and dependence levels, draw a scatter plot, and if the two are in a linear relationship, it indicates that the same latent trait is measured; Generate a transformation graph of subject ability values ​​and raw scores, and connect the raw scores of disability characteristics and dependence levels by matching equal or closest subject ability values ​​in the transformation graph.

4. The basic daily living activities ability assessment system for patients with cognitive impairment according to claim 1, characterized in that: The cognitive-related disabilities are ranked according to the mean values ​​of each option, including: The formula for calculating the option mean is as follows: B n : The ability value of the nth subject, D i : Difficulty value of entry i, N k : The number of times option k is selected; The mean of the options reflects the difficulty of the options. According to the size of the mean of the options, cognitive-related disabilities are ranked.

5. The basic daily living activities ability assessment system for patients with cognitive impairment according to claim 1, characterized in that: The above-mentioned method of summing up the dependency scores and defining the level cutoff value for the overall dependency level includes: Obtain the original dependency assessment score data and sum the dependency levels of various basic daily living activities of patients with cognitive impairment; Combined with the general definition of physical disability, several dependency levels were preset, and the k-means clustering method was used to calculate the cut-off values ​​of the overall dependency level. The original dependency level assessment score data was converted into level sequence data, and concurrent validity test was performed with the level sequence of classic assessment tools.

6. The basic daily living activities ability assessment system for patients with cognitive impairment according to claim 1, characterized in that: The basic information includes the gender, age, limb muscle strength, vision, hearing, communication and sleep conditions of the test subject.

7. The basic daily living activities ability assessment system for patients with cognitive impairment according to claim 1, characterized in that: Items on the scale include bathing, personal hygiene, toileting, dressing, eating, transferring, and level walking.

8. The basic daily living activities ability assessment system for patients with cognitive impairment according to claim 4, characterized in that: The disability feature options include independent execution, initiation disorder, planning disorder, organizational disorder, execution disorder, motor apraxia with cooperation, motor apraxia with inability to cooperate, and resistance to help from others.

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