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뇌졸중 환자의 운전재활 시기 결정을 위한 K-MBI의 임상적 유용성: 예비 연구

Clinical Usefulness on K-MBI for Decision of Driving Rehabilitation Period in Patients with Stroke: A pilot study

  • 박명옥 (백석대학교 보건학부 작업치료학과)
  • 투고 : 2017.02.23
  • 심사 : 2017.05.15
  • 발행 : 2017.05.31

초록

연구배경 및 목적: 수정된 바델지수(MBI)는 지역사회 재활세팅 및 재활 병원에서 흔히 사용되어지는 기본적인 일상생활 평가 도구이다. 선행 연구들에 의하면 노인 혹은 뇌졸중 환자들의 운전 능력과 일상생활활동의 수준은 유의미한 상관성이 있음을 보고된 바 있다. 그러나, 뇌졸중 환자의 운전능력을 예측함에 있어 임상에서 흔히 사용되는 일상생활 활동 기본 평가인 수정된 바델지수의 유용성을 밝힌 연구는 미비하다. 본 연구에서는 한국형 수정된 바델 지수(K-MBI)룰 활용하여 뇌졸중 환자의 운전 가능성을 알아봄으로서 운전 수행 능력을 예측함에 있어 한국형 수정된 바델 지수의 임상적 유용성을 알아보고자 하였다. 연구방법: 서울 소재 재활병원에서 재활치료를 받고 있는 뇌졸중 환자 48명이 연구에 참여하였다. 모든 연구 대상자에게 K-MBI 검사를 통해 기본적인 일상생활 활동 수준을 측정하였고 가상현실 운전시뮬레이터를 이용하여 운전 수행능력을 측정하였다. 운전 시뮬레이터상의 운전 수행 검사의 합격/불합격에 따른 K-MBI 점수의 예측 타당도를 ROC curve를 이용하여 검증하였다. 결과: 뇌졸중 이후 운전재활을 권고할 만한 기본적인 일상생활 활동 수준은 K-MBI 점수가 최소 86.5점인 경우가 적절한 것으로 나타났다. 결론: 본 연구는 뇌졸중 환자의 운전 재활을 권고하는 시기를 예측함에 있어 유용한 기초 자료가 될 것으로 판단된다.

Background & Object: Basic daily activity screening tool such as the Modified Barthel Index (MBI) has been used commonly in rehabilitation clinic and community based rehabilitation setting. Previous studies have shown the significant relations between the level of daily activities and driving ability on stroke or elderly people. However, there is a lack of studies to investigate the usefulness of MBI on prediction of driving ability for stroke patient. This study was to predict driving abilities of stroke survivor using Korean version Modified Barthel Index (K-MBI). Methods: A sample of 48 patients with stroke in rehabilitation hospital was recruited. All participants were tested level of basic daily activities using K-MBI. The driving ability of participants was tested using virtual reality driving simulator. The predictive validity was calculated of the K-MBI among pass or fail group of driving simulator test using receiver operating characteristics curves. Results: The cut-off score of >86.5 on the K-MBI is proper sensitivity to predict on driving performance ability. Conclusion: This pilot result offers clinical reference to therapists and caregivers for reasoning on driving recommendation period during rehabilitation stage of stroke survivors. Further studies need to identify prediction using real on-road test in a large population group.

키워드

참고문헌

  1. Murie-Fernandez, M., Iturralde, S., Cenoz, M., Casado, M., & Teasell, R. "Driving ability after a stroke: Evaluation and recovery", Neurologia (English Edition), vol. 29, no. 3, pp. 161-167, 2014. https://doi.org/10.1016/j.nrl.2012.05.006
  2. Marshall, S. C., Molnar, F., Man-Son-Hing, M., Blair, R., Brosseau, L., Finestone, H. M., Wilson, K. G. "Predictors of driving ability following stroke: A systematic review. Topics in Stroke Rehabilitation", vol. 14, no. 1, pp. 98-114, 2007. https://doi.org/10.1310/tsr1401-98
  3. Cieza, A., Geyh, S., Chatterji, S., Kostanjsek, N., Üstün, B. T., & Stucki, G. "Identification of candidate categories of the international classification of functioning disability and health (ICF) for a generic ICF core set based on regression modelling", BMC Medical Research Methodology, vol. 6, no. 1, p. 1, 2006. https://doi.org/10.1186/1471-2288-6-1
  4. World Health Organization. "International classification of functioning, disability and health: ICF", World Health Organization, 2001.
  5. Classen, S., Levy, C., McCarthy, D., Mann, W. C., Lanford, D., & Waid-Ebbs, J. K. " Traumatic brain injury and driving assessment: An evidence-based literature review", American Journal of Occupational Therapy, vol. 63, no. 5, pp. 580-591, 2009. https://doi.org/10.5014/ajot.63.5.580
  6. Hunt, L. A., & Arbesman, M. "Evidence-based and occupational perspective of effective interventions for older clients that remediate or support improved driving performance", American Journal of Occupational Therapy, vol. 62, no. 2, pp. 136-148, 2008. https://doi.org/10.5014/ajot.62.2.136
  7. Mackenzie, C., & Paton, G. "Resumption of driving with aphasia following stroke", Aphasiology, vol. 17, no. 2, pp. 107-122, 2003. https://doi.org/10.1080/729255215
  8. Mezuk, B., & Rebok, G. W. "Social integration and social support among older adults following driving cessation", The Journals of Gerontology. Series B, Psychological Sciences and Social Sciences, vol. 63, no. 5, pp. 298-303, 2008. https://doi.org/10.1093/geronb/63.5.S298
  9. Akinwuntan, A. E., Feys, H., De Weerdt, W., Baten, G., Arno, P., & Kiekens, C. "Prediction of driving after stroke: A prospective study", Neurorehabilitation and Neural Repair, vol. 20, no. 3, pp. 417-423. 2006. https://doi.org/10.1177/1545968306287157
  10. Ann-Helen Patomella, O., Kerstin Tham, O., & Anders Kottorp, O. "P-drive: Assessment of driving performance after stroke", J Rehabil. Med., vol. 38, pp. 273-279, 2006. https://doi.org/10.1080/16501970600632594
  11. Anstey, K. J., Wood, J., Lord, S., & Walker, J. G. "Cognitive, sensory and physical factors enabling driving safety in older adults", Clinical Psychology Review, vol. 25, no.1, pp. 45-65, 2005a. https://doi.org/10.1016/j.cpr.2004.07.008
  12. Devos, H., Akinwuntan, A. E., Nieuwboe, A., Ringoot, I., Van Berghen, K., Tant, M., De Weerdt, W. "Effect of simulator training on fitness-to-drive after stroke: A 5-year follow-up of a randomized controlled trial", Neurorehabilitation and Neural Repair, vol. 24, no. 9, pp. 843-850, 2010. https://doi.org/10.1177/1545968310368687
  13. Galski, T., Bruno, R. L., & Ehle, H. T. "Driving after cerebral damage: A model with implications for evaluation", American Journal of Occupational Therapy, vol. 45, no. 4, pp. 324-332, 1992. https://doi.org/10.5014/ajot.45.4.324
  14. Rapoport, M. J., Naglie, G., Weegar, K., Myers, A., Cameron, D., Crizzle, A., Marshall, S. "The relationship between cognitive performance, perceptions of driving comfort and abilities, and self-reported driving restrictions among healthy older drivers", Accident Analysis & Prevention, vol. 61, pp. 288-295, 2013. https://doi.org/10.1016/j.aap.2013.03.030
  15. Bouillon, L., Mazer, B., & Gelinas, I. "Validity of the cognitive behavioral driver's inventory in predicting driving outcome", American Journal of Occupational Therapy, vol. 40, no. 4, pp. 420-427, 2006.
  16. Lee, E. S., Park, S. W., Lee, B. S., Shin, O. S., Lee, J. H., & Kim, B. S. "Evaluating driving ability of brain damaged subjects with MMSE and MVPT", Annals of Rehabilitation Medicine, vol. 26, no. 33, pp. 268-272, 2002.
  17. Mazer, B. L., Korner-Bitensky, N. A., & Sofer, S. "Predicting ability to drive after stroke. Archives of Physical Medicine and Rehabilitation", vol. 79, no. 7, pp. 743-750, 1998. https://doi.org/10.1016/S0003-9993(98)90350-1
  18. Bour, A., Rasquin, S., Boreas, A., Limburg, M., & Verhey, F. "How predictive is the MMSE for cognitive performance after stroke?", Journal of Neurology, vol. 257, no. 4, pp. 630-637, 2010. https://doi.org/10.1007/s00415-009-5387-9
  19. Collin, C., Wade, D., Davies, S., & Horne, V. "The barthel ADL index: A reliability study", International Disability Studies, 2009.
  20. Declaration of Geneva World Medical Association http://www.wma.net/e/policy/c8.htm, 2008.
  21. Shah, S., & Cooper, B. "Commentary on a critical evaluation of the Barthel Index", The British Journal of Occupational Therapy, vol. 56, no. 2, pp. 70-72, 1993. https://doi.org/10.1177/030802269305600210
  22. Jung, H. Y., Park, B. K., Shin, H. S., Kang, Y. K., Pyun, S. B., Paik, N. J., Kim, S. H., Kim, T. H., & Han, T. R. "Development of the Korean version of modified barthel index (K-MBI): multi-center study for subjects with stroke", The Journal of Korean Academy of Rehabilitation Medicine, vol. 31, no. 3, pp. 283-297, 2007.
  23. Korner-Bitensky, N., Bitensky, J., Sofer, S., Man-Son-Hing, M., & Gelinas, I. "Driving evaluation practices of clinicians working in the united states and canada", American Journal of Occupational Therapy, vol. 60, no. 4, pp. 428-434, 2006. https://doi.org/10.5014/ajot.60.4.428
  24. Greiner, M., Pfeiffer, D., & Smith, R. "Principles and practical application of the receiver-operating characteristic analysis for diagnostic tests", Preventive Veterinary Medicine, vol. 45, no. 1, pp. 23-41, 2000. https://doi.org/10.1016/S0167-5877(00)00115-X
  25. Owsley, C., Stalvey, B., Wells, J., & Sloane, M. E. "Older drivers and cataract: Driving habits and crash risk", The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, vol. 54, no. 4, pp. 203-211, 1999. https://doi.org/10.1093/gerona/54.4.M203
  26. Nouri, F. M., & Lincoln, N. B. "Predicting driving performance after stroke", BMJ: British Medical Journal, vol. 307, no. 6902, pp. 482-483, 1993. https://doi.org/10.1136/bmj.307.6902.482
  27. Lee, H. C., Cameron, D., & Lee, A. H. "Assessing the driving performance of older adult drivers: on-road versus simulated driving", Accident Analysis & Prevention", vol. 35, no. 5, pp. 797-803, 2003. https://doi.org/10.1016/S0001-4575(02)00083-0
  28. Lew, H. L., Poole, J. H., Lee, E. H., Jaffe, D. L., Huang, H. C., & Brodd, E. "Predictive validity of driving-simulator assessments following traumatic brain injury: a preliminary study", Brain Injury, vol. 19, no. 3, pp. 177-188, 2005. https://doi.org/10.1080/02699050400017171
  29. Rizzo M, Dingus T. "Driving in Neurological Disease", Neurologist, vol. 2, no. 3, pp. 150-168, 1996.
  30. D'Ambrosio, L. A., Donorfio, L. K., Coughlin, J. F., Mohyde, M., & Meyer, J. "Gender differences in self-regulation patterns and attitude toward driving among older adults. Journal of women & aging", vol. 20, no. 3, pp. 265-282, 2008. https://doi.org/10.1080/08952840801984758
  31. Shechtman, O., Classen, S., Awadzi, K., Mann, W. "Comparison of driving errors between on-the-road and simulated driving assessment: a validation study", Traffic injury prevention, vol. 10, no. 4, pp. 379-385, 2009. https://doi.org/10.1080/15389580902894989

피인용 문헌

  1. Correlation of Cognitive Function, Activities of Daily Living and Driving Performance in Stroke Hemiplegic Patients vol.8, pp.2, 2017, https://doi.org/10.15268/ksim.2020.8.2.089