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Assessment of risk of falling in community-dwelling elderly by using the
  179 J Med Tech Phy Ther ë Vol.22 No.2 ë May-August 2010 « “ √  “ √ ‡∑§π‘§°“√·æ∑¬å ·≈–°“¬¿“æ∫”∫—¥ JOURNAL OF MEDICAL TECHNOLOGY AND PHYSICAL THERAPY π‘æπ∏åµâπ©∫—∫ ORIGINAL ARTICLE πâÕ¡®‘µµå π«≈‡πµ√å  1 * , ®—π∑‘¡“¿√≥å »√’‡√◊Õß 2  , √—µπ“ ∫ÿ≠¡“» 2  , Õ“√¥“ ‰™¬¡Ÿ≈ 2  , »‘√‘¡“ ∫ÿ≠≠√—µπå  3 °“√ª√–‡¡‘𧫓¡‡’ Ë¬ßµàÕ°“√À°≈â¡¢ÕߺŸ  âŸßÕ“¬ÿ „π™ÿ¡™π¥â«¬·∫∫ª√–‡¡‘π Thai Fall Risk Assessment Tool ·≈– Berg Balance Scale 1  “¬«‘™“°“¬¿“æ∫”∫—¥ 2  π—°»÷°…“°“¬¿“æ∫”∫—¥ ™— Èπªï∑’ Ë 4 §≥–‡∑§π‘§°“√·æ∑¬å ¡À“«‘∑¬“≈—¬¢Õπ·°àπ 3  ·ºπ°°“¬¿“æ∫”∫—¥ ‚√ß欓∫“≈¢Õπ·°àπ* ºŸ â√—∫º‘¥™Õ∫∫∑§«“¡ ∫∑§—¥¬àÕ °“√À°≈â¡„πºŸ âŸßÕ“¬ÿ°àÕ„À⇰‘¥§«“¡‡®Á∫ªÉ«¬·≈–𔉪Ÿ à¿“«–∑ÿææ≈¿“æÀ√◊Õ‡’¬™’«‘µ °“√ªÑÕß°—π°“√À°≈â¡‚¥¬‡©æ“–  „πºŸ â∑’ Ë¡’§«“¡‡’ Ë¬ßµàÕ°“√À°≈â¡®÷߇ªìπ‡√◊ ËÕß”§—≠ ·≈–§«√æ‘®“√≥“ªí®®—¬‡’ Ë¬ßÕ¬à“ß√Õ∫¥â“π Thai Fall Risk Assessment Tool (Thai FRAT) ‡ªìπ·∫∫ª√–‡¡‘𧫓¡‡’ Ë¬ßµàÕ°“√À°≈â¡∑’ Ëæ‘®“√≥“ªí®®—¬‡’ Ë¬ß∑— Èß¿“¬„π·≈–¿“¬πÕ° „π¢≥–∑’ Ë·∫∫ª√–‡¡‘π Berg Balance Scale (BBS) ®–„À⧫“¡”§—≠‡©æ“–°—∫ªí®®—¬‡’ Ë¬ß¿“¬„π °“√«‘®—¬π’ È¡’«—µ∂ÿª√–ߧå‡æ◊ ËÕ»÷°…“§«“¡ Õ¥§≈âÕß°—π¢Õß·∫∫ª√–‡¡‘π Thai FRAT ·≈– BBS „π°“√ª√–‡¡‘𧫓¡‡’ Ë¬ßµàÕ°“√À°≈â¡¢ÕߺŸ âŸßÕ“¬ÿ „π™ÿ¡™π Õ““ ¡—§√§◊ÕºŸ âŸßÕ“¬ÿ∑’ Ë¡’Õ“¬ÿ 70 ªï¢÷ Èπ‰ª∑’ ËÕ“»—¬„π™ÿ¡™π“¡‡À≈’ Ë¬¡ ®—ßÀ«—¥¢Õπ·°àπ ®”π«π 47 §π (™“¬ 18 §π À≠‘ß 29 §π Õ“¬ÿ‡©≈’ Ë¬ 76.3 ±  4.2 ªï) «‘‡§√“–À姫“¡Õ¥§≈âÕß°—π¢Õß·∫∫ª√–‡¡‘π∑— ÈßÕß„π°“√√–∫ÿ§«“¡‡’ Ë¬ßµàÕ°“√À°≈â¡¢ÕߺŸ âŸß Õ“¬ÿ¥â«¬∂‘µ‘ Kappa º≈°“√»÷°…“æ∫«à“§à“§–·ππ¢Õß Thai FRAT ·≈– BBS ¡’§«“¡Õ¥§≈âÕß°—π„π°“√√–∫ÿ§«“¡‡’ Ë¬ß µàÕ°“√À°≈â¡¢ÕßÕ““¡—§√„π√–¥—∫æÕ„™â (K = 0.33,  P  = 0.009) º≈°“√»÷°…“π’ ÈÕ“®∫àß™’ È«à“π—°°“¬¿“æ∫”∫—¥§«√„™â ·∫∫ª√–‡¡‘π∑— ÈßÕß√à«¡°—π„π°“√ª√–‡¡‘𧫓¡‡’ Ë¬ßµàÕ°“√À°≈â¡¢ÕߺŸ âŸßÕ“¬ÿ „π™ÿ¡™π ‡æ◊ ËÕ‡ªìπ°“√ª√–‡¡‘π∑’ Ë§√Õ∫§≈ÿ¡∑— Èß ªí®®—¬‡’ Ë¬ß¿“¬„π·≈–¿“¬πÕ° §””§—≠: §«“¡‡’ Ë¬ßµàÕ°“√À°≈â¡, ºŸ âŸßÕ“¬ÿ, ·∫∫ª√–‡¡‘𧫓¡‡’ Ë¬ßµàÕ°“√À°≈â¡¢ÕߺŸ âŸßÕ“¬ÿ ‰∑¬„π™ÿ¡™π, ·∫∫ ª√–‡¡‘π°“√∑√ßµ—«‡∫‘√å°  180 «“√“√‡∑§π‘§°“√·æ∑¬å·≈–°“¬¿“æ∫”∫—¥ ë ªï∑’ Ë 22 ©∫—∫∑’ Ë 2 ë 情¿“§¡-‘ßÀ“§¡ 2553 « “ √  “ √ ‡∑§π‘§°“√·æ∑¬å ·≈–°“¬¿“æ∫”∫—¥ JOURNAL OF MEDICAL TECHNOLOGY AND PHYSICAL THERAPY Assessment of risk of falling in community-dwelling elderly by using theThai Fall Risk Assessment Tool and the Berg Balance Scale 1  Department of Physical Therapy, 2  The fourth year Physical Therapy student, Faculty of Associated Medical Sciences, Khon Kaen University 3  Department of Physical Therapy, Khon Kaen Hospital* Corresponding author (e-mail: π‘æπ∏åµâπ©∫—∫ ORIGINAL ARTICLE Nomjit Nualnetr 1 *, Juntimaporn Sriruang 2 , Rattana Boonmat 2 , Arada Chaiyamoon 2 , Sirima Boonyarat 3 Abstract Falls are a cause of health problem and lead to disability or death in the elderly. Prevention of falls,especially in the high risk group, is thus important with the determination of overall risk factors. The Thai FallRisk Assessment Tool (Thai FRAT) is a test for evaluating the risk of falls by considering both intrinsic andextrinsic risk factors. Meanwhile the Berg Balance Scale (BBS) emphasizes only the intrinsic factors. This studyaimed to examine the agreement of the Thai FRAT and the BBS on identifying the risk of falls in 47community-dwelling elderly (18 men and 29 women, mean age 76.3 ±  4.2 years) of Samliam Community,Khon Kaen Province. The agreement of the Thai FRAT and the BBS was analyzed by Kappa statistic. The resultshowed that the agreement of the Thai FRAT and the BBS on identifying the elderly at risk for falling was fair(K = 0.33, P  = 0.009). This finding may indicate that physical therapists should apply the Thai FRAT and theBBS for assessing risk of falls of the elderly in community to obtain both intrinsic and extrinsic risk factors. Keywords: Risk of falls, Elderly, Thai Fall Risk Assessment Tool, Berg Balance Scale  181 J Med Tech Phy Ther ë Vol.22 No.2 ë May-August 2010 ∫∑π” °“√À°≈⡇ªìπ‡Àµÿ°“√≥å∑’ Ëæ∫‰¥â∫àÕ¬„πºŸ âŸßÕ“¬ÿ ¡’√“¬ß“π«à“ºŸ âŸßÕ“¬ÿ ‰∑¬¡’Õ—µ√“°“√À°≈⡪√–¡“≥√âÕ¬≈– 19 (1) °“√À°≈⡇ªìπ—≠≠“≥‡µ◊Õπ∑’ Ë∫àß∫Õ°∂÷ߧ«“¡‡®Á∫ªÉ«¬∑’ ËÕ“®π”‰ªŸ à¿“«–∑ÿææ≈¿“æÀ√◊Õ‡’¬™’«‘µ ‚¥¬√âÕ¬≈– 75 ¢Õß ºŸ âŸßÕ“¬ÿ∑’ ËÀ°≈â¡®–‡°‘¥°“√∫“¥‡®Á∫ ·≈–√âÕ¬≈– 45 ¡’°√–¥Ÿ°–‚æ°À—°´÷ ËßµâÕß√—°…“¥â«¬°“√ºà“µ—¥∑ÿ°√“¬ (2)  ∑”„À⺟ âŸßÕ“¬ÿ‡°‘¥§«“¡‡®Á∫ªÉ«¬∑— Èß∑“ß°“¬·≈–„® ‡°‘¥¿“«–´÷¡‡»√Ⓡπ◊ ËÕß®“°°—ß«≈«à“Õ“®®–‡°‘¥°“√À°≈â¡´È ” ∑”„À≡àÕ¬“°∑”°‘®°√√¡µà“ß Ê À√◊ÕÕÕ°πÕ°∫â“π àߺ≈„À⇰‘¥§«“¡æ‘°“√·≈–§«“¡Ÿ≠‡’¬∑“߇»√…∞°‘®∑— ÈßµàÕ§√Õ∫§√—«·≈–—ߧ¡‚¥¬√«¡µ“¡¡“ °“√ªÑÕß°—π°“√À°≈â¡„πºŸ âŸßÕ“¬ÿ ®÷߇ªìπ‡√◊ ËÕß”§—≠ ‚¥¬‡©æ“–ºŸ â∑’ Ë¡’§«“¡‡’ Ë¬ßµàÕ°“√À°≈â¡ ªí®®—¬‡’ Ë¬ß¢Õß°“√À°≈â¡„πºŸ âŸßÕ“¬ÿ¡’∑— Èßªí®®—¬‡’ Ë¬ß ¿“¬πÕ°´÷ Ë߇°’ Ë¬«¢âÕß°—∫¿“æ·«¥≈âÕ¡ ‡™àπ ·ß«à“߉¡à‡æ’¬ßæÕ æ◊ Èπ≈◊ Ëπ ¢√ÿ¢√– ¡’‘ Ëß°’¥¢«“ß ‰¡à¡’√“«¬÷¥À√◊Õ∑’ Ë®—∫ ‡°“–∫√‘‡«≥∫—π‰¥À√◊Õ¿“¬„πÀâÕßπÈ ” °“√„™â¬“∑’ Ë¡’º≈∑”„Àâßà«ß´÷¡ ‡ªìπµâπ ·≈–ªí®®—¬‡’ Ë¬ß¿“¬„π´÷ Ë߇°’ Ë¬«¢âÕß°—∫§«“¡ ∫°æ√àÕß„π°“√∑”ß“π¢Õß√–∫∫µà“ß Ê ¢Õß√à“ß°“¬∑’ Ë„™â„π°“√∑√ßµ—« ‰¥â·°à √–∫∫ª√–“∑ √–∫∫°“¬—¡º—∑— Ë«‰ª √–∫∫ °“√¡Õ߇ÀÁπ √–∫∫‡«µ‘∫Ÿ≈à“√å ·≈–√–∫∫‚§√ß√à“ß·≈–°≈â“¡ ‡π◊ ÈÕ (2,3)  „π°“√ª√–‡¡‘𧫓¡‡’ Ë¬ßµàÕ°“√À°≈â¡¢ÕߺŸ âŸßÕ“¬ÿ π—° °“¬¿“æ∫”∫—¥¡—°π‘¬¡„™â·∫∫ª√–‡¡‘π Berg Balance Scale (BBS) (4) ´÷ Ëß„À⧫“¡”§—≠°—∫°“√ª√–‡¡‘πªí®®—¬‡’ Ë¬ß¿“¬„π  ‚¥¬ª√–‡¡‘𧫓¡“¡“√∂„π°“√∑”°‘®°√√¡„π™’«‘µª√–®”«—π ¢ÕߺŸ âŸßÕ“¬ÿ 14 √“¬°“√ „™â‡«≈“„π°“√∑¥Õ∫ª√–¡“≥ 15 π“∑’ ·≈–µâÕß„™âÕÿª°√≥å®”π«πÀπ÷ Ëß√à«¡„π°“√∑¥Õ∫¥â«¬®÷ßÕ“®‰¡à‡À¡“–¡”À√—∫°“√𔉪„™â„π™ÿ¡™π¡“°π—° ”À√—∫  „πª√–‡∑»‰∑¬ ≈—¥¥“ ‡∂’¬¡«ß»å ·≈–§≥– (5,6,7)  ‰¥âæ—≤π“·∫∫ª√–‡¡‘𧫓¡‡’ Ë¬ßµàÕ°“√À°≈â¡¢ÕߺŸ âŸßÕ“¬ÿ∑’ ËÕ“»—¬„π ™ÿ¡™π¢÷ Èπ ‡√’¬°«à“ Thai Fall Risk Assessment Tool (Thai FRAT) ´÷ Ëß„À⧫“¡”§—≠°—∫°“√ª√–‡¡‘πªí®®—¬‡’ Ë¬ß∑— Èß ¿“¬„π·≈–¿“¬πÕ° ·≈–‰¥â¡’ºŸ âπ”·∫∫ª√–‡¡‘ππ’ È‰ª„™â„π°“√»÷°…“«‘®—¬‡°’ Ë¬«°—∫°“√À°≈â¡¢ÕߺŸ âŸßÕ“¬ÿ„π™ÿ¡™π (8) æ∫«à“‡ªìπ‡§√◊ ËÕß¡◊Õ∑’ Ë„™âßà“¬ „™â‡«≈“„π°“√ª√–‡¡‘πª√–¡“≥ 2-3 π“∑’ ·≈–‰¡à®”‡ªìπµâÕß„™âÕÿª°√≥å„¥ Ê ·∫∫ª√–‡¡‘πThai FRAT ®÷ßπà“®–‡ªìπÕ’°µ—«‡≈◊Õ°Àπ÷ Ëß”À√—∫π—°°“¬¿“æ∫”∫—¥„π°“√„™âª√–‡¡‘𧫓¡‡’ Ë¬ßµàÕ°“√À°≈â¡¢Õß ºŸ âŸßÕ“¬ÿ „π™ÿ¡™π ºŸ â«‘®—¬®÷ß¡’§«“¡π„®„π·∫∫ª√–‡¡‘π Thai FRAT ·≈–∑”°“√»÷°…“§√— Èßπ’ È‡æ◊ ËÕ»÷°…“§«“¡Õ¥§≈âÕß°—π (agreement) ¢Õß·∫∫ª√–‡¡‘π Thai FRAT ·≈– BBS „π°“√ª√–‡¡‘𧫓¡‡’ Ë¬ßµàÕ°“√À°≈â¡¢ÕߺŸ âŸßÕ“¬ÿ „π™ÿ¡™π «—¥ÿ·≈–«‘∏’°“√»÷°…“ °≈ÿ à¡µ—«Õ¬à“ß °≈ÿ à¡µ—«Õ¬à“ߢÕß°“√»÷°…“§◊ÕºŸ âŸßÕ“¬ÿ∑’ ËÕ“»—¬„π™ÿ¡™π “¡‡À≈’ Ë¬¡ µ.„π‡¡◊Õß Õ.‡¡◊ÕߢÕπ·°àπ ®.¢Õπ·°àπ ‚¥¬ ‡ªìπà«πÀπ÷ ËߢÕßÕ““¡—§√„π°“√»÷°…“°àÕπÀπâ“π’ È∑’ Ë‡°’ Ë¬« °—∫°“√∑√ßµ—«¢ÕߺŸ âŸßÕ“¬ÿ „π™ÿ¡™π (9,10)  ‡°≥±å°“√§—¥‡≈◊Õ°Õ““¡—§√§◊Õ ‡ªìπºŸ â∑’ Ë¡’Õ“¬ÿ 70 ªï¢÷ Èπ‰ª “¡“√∂‡¥‘π‰¥â  ‚¥¬Õ“®„™âÕÿª°√≥å™à«¬‡¥‘π¥â«¬ ◊ ËÕ“√‰¥â‡¢â“„® ·≈–¡—§√  „®∑’ Ë®–‡¢â“√à«¡°“√«‘®—¬ à«π‡°≥±å°“√§—¥ÕÕ°§◊Õ ¡’¿“«–∑’ Ë ‡ªìπ¢âÕ®”°—¥µàÕ°“√ª√–‡¡‘π¥â«¬ BBS ‡™àπ ªí≠À“‡°’ Ë¬«°—∫  ‚√§À—«„®·≈–À≈Õ¥‡≈◊Õ¥∑’ Ë§«∫§ÿ¡‰¡à‰¥â ¡’¢âÕ®”°—¥„π°“√‡§≈◊ ËÕπ‰À«‡π◊ ËÕß®“°Õ“°“√‡®Á∫ª«¥ ¿“«–°√–¥Ÿ°À—° ¢âÕµ‘¥ ·≈–Õ◊ Ëπ Ê µ“∫Õ¥∑— Èß 2 ¢â“ß ¡’ª√–«—µ‘°“√‡®Á∫ªÉ«¬¥â«¬‚√§ ∑“ß√–∫∫ª√–“∑ ¡’Õ“°“√«‘߇«’¬π»’√…– Àπâ“¡◊¥ µ“≈“¬‡ªìπµâπ µ—«·ª√·≈–‡§√◊ ËÕß¡◊Õ„π°“√«‘®—¬ µ—«·ª√∑’ Ë„™â„π°“√»÷°…“§◊Õ§«“¡‡’ Ë¬ßµàÕ°“√À°≈â¡¢Õß ºŸ âŸßÕ“¬ÿ ´÷ Ëߪ√–‡¡‘π¥â«¬·∫∫ª√–‡¡‘π Thai FRAT (¿“§ ºπ«° °) ·≈– BBS (¿“§ºπ«° ¢) ‚¥¬°“√ª√–‡¡‘π¥â«¬Thai FRAT ‡ªìπ°“√µ√«®Õ∫«à“ºŸ âŸßÕ“¬ÿ·µà≈–√“¬¡’§«“¡‡’ Ë¬ß∑’ Ë®–𔉪Ÿ à°“√À°≈â¡¡“°πâÕ¬‡æ’¬ß„¥¥â«¬°“√ ª√–‡¡‘πªí®®—¬‡’ Ë¬ß 6 √“¬°“√ ª√–°Õ∫¥â«¬ªí®®—¬‡’ Ë¬ß¿“¬„π 3 √“¬°“√ ‰¥â·°à ‡æ»À≠‘ß §«“¡∫°æ√àÕߢÕß°“√¡Õ߇ÀÁπ ·≈–°“√∑√ßµ—« ªí®®—¬‡’ Ë¬ß¿“¬πÕ° 2 √“¬°“√ ‰¥â·°à °“√  „™â¬“ ·≈–¿“æ∑’ ËÕ¬Ÿ àÕ“»—¬ √«¡∑— Èßæ‘®“√≥“‡√◊ ËÕߪ√–«—µ‘°“√ À°≈⡥⫬ °“√æ‘®“√≥“„Àâ§à“πÈ ”Àπ—°¢Õß·µà≈–ªí®®—¬®–‡ªìπ µ—«‡≈¢ ¡’§–·ππÕ¬Ÿ à„π™à«ß 0-11 §–·ππ ‚¥¬ºŸ âŸßÕ“¬ÿ∑’ Ë¡’ §à“§–·ππ√«¡ 4 §–·ππ¢÷ Èπ‰ª∂◊Õ«à“‡ªìπºŸ â∑’ Ë¡’§«“¡‡’ Ë¬ßµàÕ °“√À°≈â¡ ·∫∫ª√–‡¡‘π Thai FRAT ¡’§à“§«“¡‰«(sensitivity) ·≈–§«“¡®”‡æ“– (specificity) ‡∑à“°—∫√âÕ¬≈– 91.7 ·≈– 83.3 µ“¡≈”¥—∫ (7)  Õ¬à“߉√°Áµ“¡ ¬—߉¡àæ∫√“¬ß“π‡°’ Ë¬«°—∫§ÿ≥¡∫—µ‘¥â“𧫓¡‡™◊ ËÕ¡— Ëπ√–À«à“ߺŸ â∑¥Õ∫  182 «“√“√‡∑§π‘§°“√·æ∑¬å·≈–°“¬¿“æ∫”∫—¥ ë ªï∑’ Ë 22 ©∫—∫∑’ Ë 2 ë 情¿“§¡-‘ßÀ“§¡ 2553 (interrater reliability) ·≈–¿“¬„πºŸ â∑¥Õ∫ (intraraterreliability) ¢Õß Thai FRATà«π BBS „™âª√–‡¡‘𧫓¡“¡“√∂„π°“√∑”°‘®°√√¡ „π™’«‘µª√–®”«—π 14 √“¬°“√ ∑’ Ë°”Àπ¥„À⺟ â∂Ÿ°∑¥Õ∫∑”°‘®°√√¡∑’ Ë¡’√–¥—∫§«“¡¬“°·µ°µà“ß°—πÕÕ°‰ª ¡’°“√‡ª≈’ Ë¬π·ª≈ß¢π“¥¢Õß∞“π√Õß√—∫√à“ß°“¬ ‡ª≈’ Ë¬π∑à“∑“ß®“°∑à“π— Ë߉ª¬◊π À¡ÿπµ—« ¬â“¬‡°â“Õ’ È °â“«¢÷ Èπ≈ß∫—π‰¥ °â¡‡°Á∫ ¢Õß®“°æ◊ Èπ À√◊Õ‡Õ◊ ÈÕ¡·¢π‰ª¢â“ßÀπâ“ ·µà≈–√“¬°“√®–∂Ÿ° ª√–‡¡‘π®“°√–¥—∫§–·ππ 0 (‰¡à“¡“√∂∑”°‘®°√√¡√“¬°“√ π— Èπ‰¥â) ∂÷ß 4 (“¡“√∂∑”°‘®°√√¡√“¬°“√π— Èπ‰¥âÕ¬à“ßÕ‘√–) √«¡§–·ππ‡µÁ¡ 56 §–·ππ ‚¥¬∂⓺Ÿ â∂Ÿ°∑¥Õ∫¡’§à“§–·ππ√«¡πâÕ¬°«à“ 45 ∂◊Õ«à“‡ªìπºŸ â∑’ Ë¡’§«“¡‡’ Ë¬ßµàÕ°“√ À°≈â¡ (11)  BBS ¡’§«“¡‡™◊ ËÕ¡— Ëπ√–À«à“ߺŸ â∑¥Õ∫·≈–¿“¬„π ºŸ â∑¥Õ∫Ÿß (ICC ‡∑à“°—∫ 0.98 ·≈– 0.99 µ“¡≈”¥—∫) Õ’° ∑— È߬—ß¡’§«“¡‡∑’ Ë¬ß¿“¬„π (internal consistency) Ÿß(Cronbachûs alpha > 0.83) (4,12) ¢— ÈπµÕπ°“√«‘®—¬ ‡¡◊ ËÕ‰¥â√—∫√“¬™◊ ËÕºŸ âŸßÕ“¬ÿ∑’ ËÕ“»—¬„π™ÿ¡™π“¡‡À≈’ Ë¬¡ ®“°‡®â“Àπâ“∑’ ËÀπ૬∫√‘°“√ª∞¡¿Ÿ¡‘·≈â« ºŸ â«‘®—¬π”¢âÕ¡Ÿ≈¡“§—¥ °√Õ߇∫◊ ÈÕßµâπµ“¡‡°≥±å∑’ Ë°”Àπ¥‰«â ·≈⫪√–“πß“π°—∫‡®â“Àπâ“∑’ Ëœ ·≈–Õ““¡—§√“∏“√≥ÿ¢ª√–®”À¡Ÿ à∫â“π‡æ◊ ËÕ °”À𥫗𠇫≈“ ·≈–∂“π∑’ Ë∑’ Ë®–∑”°“√ª√–‡¡‘π BBS ”À√—∫ ºŸ âŸßÕ“¬ÿ∑’ Ëºà“π‡°≥±å°“√§—¥°√Õ߇∫◊ ÈÕßµâπ „π«—π∑’ Ë°”Àπ¥ ‡°Á∫¢âÕ¡Ÿ≈ºŸ â«‘®—¬™’ È·®ß«—µ∂ÿª√–ߧ堪√–‚¬™πå ¢— ÈπµÕπ ·≈– «‘∏’°“√«‘®—¬·°àºŸ âŸßÕ“¬ÿ ®“°π— ÈπºŸ â«‘®—¬§π∑’ Ë 2-5 ª√–‡¡‘𠧫“¡“¡“√∂„π°“√∑”°‘®°√√¡¢ÕßÕ““¡—§√·µà≈–√“¬¥â«¬ BBS ‚¥¬Õ““¡—§√“¡“√∂À¬ÿ¥æ—°‡ªìπ√–¬– Ê ‰¥â„π√–À«à“ß∑”°“√ª√–‡¡‘π À≈—ß®“°π— Èπ¿“¬„π 1 —ª¥“Àå ºŸ â«‘®—¬ §π∑’ Ë 1 ‡¬’ Ë¬¡∫â“πÕ““¡—§√·µà≈–√“¬‡æ◊ ËÕª√–‡¡‘𧫓¡ ‡’ Ë¬ßµàÕ°“√À°≈⡥⫬ Thai FRAT °“√‡°Á∫√«∫√«¡¢âÕ¡Ÿ≈∑— ÈßÀ¡¥¥”‡π‘π°“√√–À«à“߇¥◊Õπ情¿“§¡∂÷߇¥◊Õπ‘ßÀ“§¡ æ.». 2551‡¡◊ ËÕ°“√√«∫√«¡¢âÕ¡Ÿ≈‡√Á®‘ Èπ ºŸ â«‘®—¬π”¢âÕ¡Ÿ≈‰ª «‘‡§√“–Àåº≈‚¥¬°“√·®°·®ß§«“¡∂’ Ë §à“√âÕ¬≈– ·≈–ª√–‡¡‘𧫓¡Õ¥§≈âÕß°—π¢Õß·∫∫ª√–‡¡‘π∑— ÈßÕß„π°“√√–∫ÿ§«“¡‡’ Ë¬ßµàÕ°“√À°≈â¡¢ÕߺŸ âŸßÕ“¬ÿ¥â«¬∂‘µ‘ Kappa (13) °“√«‘‡§√“–Àå¢âÕ¡Ÿ≈∑— ÈßÀ¡¥∑”‚¥¬‚ª√·°√¡∂‘µ‘ STATAversion 10 ·≈–°”Àπ¥√–¥—∫π—¬”§—≠∑“ß∂‘µ‘∑’ Ë P  < 0.05 º≈°“√»÷°…“ ®“°¢âÕ¡Ÿ≈¢ÕßÀπ૬∫√‘°“√ª∞¡¿Ÿ¡‘“¡‡À≈’ Ë¬¡ ≥ ‡¥◊Õπ 情¿“§¡ 2551 æ∫«à“æ◊ Èπ∑’ Ë∑’ Ë∑”°“√»÷°…“¡’ºŸ âŸßÕ“¬ÿ∑’ Ë¡’Õ“¬ÿ 70 ªï¢÷ Èπ‰ª ®”π«π 87 √“¬ „π®”π«ππ’ È‡ªìπºŸ â∑’ Ëºà“π‡°≥±å °“√§—¥‡¢â“¢Õß°“√»÷°…“∑— ÈßÀ¡¥ 47 √“¬ (√âÕ¬≈– 54) ”À√—∫ ºŸ âŸßÕ“¬ÿ 40 √“¬∑’ Ë∂Ÿ°§—¥ÕÕ°®“°°“√«‘®—¬π— Èπ ¡’®”π«π 24 √“¬∑’ Ë‰¡à“¡“√∂µ‘¥µàÕ‰¥â‡π◊ ËÕß®“°¬â“¬∑’ ËÕ¬Ÿ à ®”π«π∑’ Ë‡À≈◊Õ à«π„À≠à∂Ÿ°§—¥ÕÕ°‡π◊ ËÕß®“°“‡Àµÿ¥â“πÿ¢¿“æ ¡’‡æ’¬ß 3 √“¬ ∑’ Ë‰¡à¡—§√„®‡¢â“√à«¡°“√«‘®—¬ Õ““¡—§√ºŸ âŸßÕ“¬ÿ∑’ Ë‡¢â“√à«¡ °“√»÷°…“∑— ÈßÀ¡¥ 47 √“¬ ‡ªìπ‡æ»À≠‘ß 29 √“¬ ™“¬ 18 √“¬ Õ“¬ÿ‡©≈’ Ë¬ 76.3 ±  4.2 ªï ( µ“√“ß∑’ Ë 1 ) ‚¥¬à«π„À≠à¡’ ‚√§ª√–®”µ—« ·≈–“¡“√∂‡¥‘π‰¥â ‚¥¬‰¡à„™âÕÿª°√≥å™à«¬‡¥‘𠵓√“ß∑’ Ë 2  ·¥ß®”π«πÕ““¡—§√∑’ Ë¡’§«“¡‡’ Ë¬ß·≈–  ‰¡à‡’ Ë¬ßµàÕ°“√À°≈⡇¡◊ ËÕª√–‡¡‘π¥â«¬·∫∫ª√–‡¡‘π ThaiFRAT ·≈– BBS æ∫«à“®“°Õ““¡—§√®”π«π 47 √“¬ ‡¡◊ ËÕ ª√–‡¡‘π¥â«¬ Thai FRAT æ∫ºŸ âŸßÕ“¬ÿ∑’ Ë¡’§«“¡‡’ Ë¬ßµàÕ °“√À°≈â¡®”π«π 11 √“¬ (√âÕ¬≈– 23.4) „π¢≥–∑’ Ë°“√ª√–‡¡‘π¥â«¬ BBS æ∫ºŸ â∑’ Ë¡’§«“¡‡’ Ë¬ßµàÕ°“√À°≈â¡®”π«π 16 √“¬ (√âÕ¬≈– 34) ‡¡◊ ËÕª√–‡¡‘𧫓¡Õ¥§≈âÕß°—π¢Õß ·∫∫ª√–‡¡‘π∑— ÈßÕß„π°“√√–∫ÿ§«“¡‡’ Ë¬ßµàÕ°“√À°≈â¡¢Õß Õ““¡—§√¥â«¬∂‘µ‘ Kappa ‰¥â§à“ K ‡∑à“°—∫ 0.33( P  = 0.009) ´÷ ËßÀ¡“¬§«“¡«à“·∫∫ª√–‡¡‘π∑— ÈßÕß¡’§«“¡ Õ¥§≈âÕß°—π„π√–¥—∫æÕ„™â «‘®“√≥å·≈–√ÿªº≈°“√»÷°…“ °“√À°≈â¡¡—°‡°‘¥®“°ªí®®—¬‡’ Ë¬ßÀ≈“¬Õ¬à“ß√à«¡°—π(multifactorial condition) (8,14,15)  „π°“√ª√–‡¡‘𧫓¡‡’ Ë¬ßµàÕ°“√À°≈â¡¢ÕߺŸ âŸßÕ“¬ÿºŸ âª√–‡¡‘π®÷ߧ«√æ‘®“√≥“ ªí®®—¬‡’ Ë¬ßÕ¬à“ß√Õ∫¥â“π Thai FRAT ´÷ Ë߇ªìπ·∫∫ª√–‡¡‘𠧫“¡‡’ Ë¬ßµàÕ°“√À°≈â¡∑’ Ë„À⧫“¡”§—≠°—∫ªí®®—¬‡’ Ë¬ß∑— Èß ¿“¬„π·≈–¿“¬πÕ° „™âßà“¬ √«¥‡√Á« ·≈–ª√–À¬—¥ ®÷ßπà“®– ‡ªìπµ—«‡≈◊Õ°Àπ÷ Ëß”À√—∫π—°°“¬¿“æ∫”∫—¥‚¥¬‡©æ“–ºŸ â∑’ Ë ªØ‘∫—µ‘ß“π„π™ÿ¡™π πÕ°‡Àπ◊Õ‰ª®“°°“√„™â·∫∫ª√–‡¡‘π BBS ∑’ Ëπ‘¬¡„™â°—π‚¥¬∑— Ë«‰ª °“√«‘®—¬π’ È®÷ßµâÕß°“√»÷°…“«à“°“√ ª√–‡¡‘𧫓¡‡’ Ë¬ßµàÕ°“√À°≈â¡¢ÕߺŸ âŸßÕ“¬ÿ„π™ÿ¡™π¥â«¬·∫∫ª√–‡¡‘π∑— ÈßÕßπ’ È®–„Àâº≈Õ¥§≈âÕß°—πÀ√◊Õ‰¡à·≈–Õ¬à“߉√ ‡æ◊ ËÕ‡ªìπ¢âÕ¡Ÿ≈”À√—∫π—°°“¬¿“æ∫”∫—¥„π°“√ª√–¬ÿ°µå„™â Thai FRAT °—∫ß“πºŸ âŸßÕ“¬ÿ „π™ÿ¡™πµàÕ‰ª  183 J Med Tech Phy Ther ë Vol.22 No.2 ë May-August 2010 °“√»÷°…“π’ Èæ∫«à“ Thai FRAT ·≈– BBS ¡’§«“¡Õ¥§≈âÕß°—π„π°“√√–∫ÿ§«“¡‡’ Ë¬ßµàÕ°“√À°≈â¡¢ÕßÕ““¡—§√‡æ’¬ß„π√–¥—∫æÕ„™â (K = 0.33) ´÷ Ëßµ“¡À≈—°°“√·≈â« §à“ K ∑’ Ë·¥ß∂÷ߧ«“¡Õ¥§≈âÕß°—π„π√–¥—∫∑’ Ë‡ªìπ∑’ Ë¬Õ¡√—∫  ‰¥â§«√¡’§à“Õ¬à“ßπâÕ¬‡∑à“°—∫ 0.80 (13)  º≈°“√»÷°…“π’ ÈÕ“®∫àß ™’ È«à“·∫∫ª√–‡¡‘π∑— ÈßÕßπ’ È¬—߉¡àπà“∑’ Ë®–𔉪„™â∑¥·∑π°—π  ‰¥â∑’‡¥’¬«π—°„π°“√µ—¥‘π«à“ºŸ âŸßÕ“¬ÿ„π™ÿ¡™π¡’§«“¡‡’ Ë¬ßµàÕ°“√À°≈â¡À√◊Õ‰¡à·≈–¡“°πâÕ¬‡æ’¬ß„¥ Õ¬à“߉√°Áµ“¡ Õ“® ®”‡ªìπµâÕß∑”°“√»÷°…“‡æ‘ Ë¡‡µ‘¡‚¥¬‡æ‘ Ë¡¢π“¥µ—«Õ¬à“ß ·≈– »÷°…“„πºŸ âŸßÕ“¬ÿ∑— Èß„π™ÿ¡™π‡¡◊Õß·≈–™ÿ¡™π™π∫∑ √«¡∑— Èß ∑”°“√»÷°…“‡°’ Ë¬«°—∫§ÿ≥¡∫—µ‘¢Õß Thai FRAT „π‡√◊ ËÕß §«“¡‡∑’ Ë¬ß (validity) ·≈–§«“¡‡™◊ ËÕ¡— Ëπ∑— Èß¿“¬„π·≈– √–À«à“ߺŸ â∑¥Õ∫¥â«¬ °“√∑’ Ë Thai FRAT ·≈– BBS „Àâº≈°“√ª√–‡¡‘𧫓¡ ‡’ Ë¬ßµàÕ°“√À°≈â¡¢ÕߺŸ âŸßÕ“¬ÿ∑’ ËÕ¥§≈âÕß°—π‡æ’¬ß√–¥—∫ Àπ÷ Ëßπ— Èπ πà“®–‡ªìπº≈®“°À≈—°‡°≥±å°“√„Àâ§à“§–·ππ¢Õß µ“√“ß∑’ Ë 1  §ÿ≥≈—°…≥–∑— Ë«‰ª¢ÕßÕ““¡—§√ (N = 47) µ“√“ß∑’ Ë 2  ®”π«πÕ““¡—§√∑’ Ë¡’§«“¡‡’ Ë¬ßµàÕ°“√À°≈â¡ ‡¡◊ ËÕª√–‡¡‘π¥â«¬ Thai FRAT ·≈– BBS (N = 47) * Thai FRAT 4 §–·ππ¢÷ Èπ‰ª, ** BBS πâÕ¬°«à“ 45 §–·ππ
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