數位版箱子與積木測驗於健康者及中風和創傷性腦傷患者之常模與信效度探討

研究背景與目的：箱子積木測驗（Box and Block Test, BBT）為臨床常用之手部測驗工具，而目前缺乏中風與創傷性腦傷患者常模。使用數位化的評估可增加便利及效率且提供量化的客觀數據，有效追蹤病人能力的變化。本研究的目的:（一）傳統版與數位版積木與箱子測驗於健康人（因子：年齡、性別、慣用手與慣用手）、中風及創傷性腦傷患者（因子：健側手與偏癱手、遠端布朗斯壯層級、年齡）分析之常模研究。（二）探討數位版BBT之同時效度、再測信度。（三）探討數位版BBT的使用友善性。研究方法：本研究於中部某醫院使用方便、滾雪球取樣方式招募健康人共90位、患者45位來進行傳統版與數位版BBT的三個子測驗。使用三因子混合變異數分析（three-way mixed ANOVA），來分析因子間的交互作用，並整理成常模表，使用Pearson Correlation相關性分析，驗證數位版與傳統版的同時效度，並使用Intraclass Correlation Coefficient, ICC檢驗傳統版與數位版的再測信度。使用友善性透過問卷請45位患者與20位治療師填寫，以了解其易用性、有用性、心智負荷與數位版的優缺點。結果與討論：在健康人測驗結果中mBBT在三階有顯著交互作用，且sBBT、數位版sBBT、tBBT皆則在二階有顯著交互作用，tBBT、數位版mBBT的主效果亦有顯著差異。而在患者測驗結果中，所有的子測驗皆為二階顯著作用，且數位版sBBT主效果也有顯著差異。然而有些子測驗結果並不合乎我們預期的假設，推測年輕組人認為測驗過於簡單而無盡全力、中年組容易受他人影響，導致測驗結果沒有顯著。在患者的傳統版與數位版測驗結果中，因子的交互作用與我們的預期相同，這表明遠端布朗斯壯層級會影響其表現。數位版BBT與傳統版BBT的同時效度不論在健康人（r > .70）或患者（r > .90）間皆良好。數位版BBT運用在健康人ICC大於.80，且在中風與腦傷患者中，ICC大於.90，均有良好的再測信度。在使用友善性中有用性以及易用性方面都受到受試者良好的評價以及較輕的心智負荷。結論：本研究提供正常人與患者在傳統版與數位版的常模資料、及手功能測驗參考依據。結果顯示數位版BBT的同時效度、再測信度與友善性良好，可作為省時、省力且明確客觀的手功能測量工具。

Background and Objectives: The Box and Block Test (BBT) is a widely used clinical tool for assessing hand function, yet normative data for stroke and traumatic brain injury (TBI) patients remain limited. Digital assessments offer improved convenience, efficiency, and objective data to monitor patient progress over time. The study objectives are to establish normative data for the traditional and digital BBT in healthy individuals (factors: age, gender, dominant hand, and non-dominant hand) and in stroke/TBI patients (factors: unaffected hand, paretic hand, distal Brunnstrom stage, and age), to examine the concurrent validity and test-retest reliability of the digital BBT, and to assess the user-friendliness of the digital BBT.Research Methods: This study recruited 90 healthy individuals and 45 patients from a central Taiwan hospital using convenience and snowball sampling. Participants completed three subtests of the traditional and digital Box and Block Test (BBT). A three-way mixed ANOVA analyzed factor interactions, and normative data tables were compiled. Pearson correlation assessed concurrent validity, and Intraclass Correlation Coefficient (ICC) evaluated test-retest reliability. User-friendliness was assessed via questionnaires from 45 patients and 20 therapists, focusing on usability, usefulness, and mental workload.Results and Discussion: In healthy participants, significant interactions were observed for mBBT (three-way) and sBBT, digital sBBT, and tBBT (two-way). Significant main effects were found for tBBT and digital mBBT. For patients, all subtests showed significant two-way effects, and the digital sBBT exhibited a significant main effect. However, deviations from expectations may reflect younger participants’ reduced effort and external distractions for middle-aged participants. Patient results aligned with expectations, showing Brunnstrom distal stages influenced performance. The digital BBT demonstrated strong concurrent validity (healthy: r > .70; patients: r > .90) and excellent test-retest reliability (healthy: ICC > .80; patients: ICC > .90). User evaluations indicated high usability, usefulness, and low mental workload.Conclusion: This study provides normative data for both healthy individuals and patients on the traditional and digital versions of the BBT, serving as a reference for hand function assessments. Results demonstrate that the digital BBT has strong concurrent validity, test-retest reliability, and user-friendliness, making it a time-efficient, labor-saving, and objective tool for measuring hand function.