2016-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/646504摘要：背景：投入職場工作不僅是思覺失調症患者精神復健的主要目標，亦為社區安置之關鍵。工作社交技 巧（work-related social skills)為個人於職場所需具備的人際互動能力，亦為影響患者求職、工作適應 與學習的主因之一。完整、精確且快速地評估患者之工作社交技巧，可協助臨床人員擬定職業復健計 晝，也可呈現復健成效。然而目前學術與臨床均缺乏内容完整、對於施測者負擔小、具備良好心理計 量特性的工作社交技巧評估工具。此限制嚴重影響專業人員快速且精準地掌握患者問題，使得社交技 巧復健與職業重建的成效難以進一步提升。缺乏完整、精確之工作社交技巧評估工具亦影響相關學術 研究與實證醫學之進行。為解決現有評估工具之限制，將角色扮演測驗電腦化與多層面電腦適性測驗 (computerized adaptive testing, CAT) 二者結合之施測技術為一有效且可行的解決途徑。此結合技術具 有二項優勢：（1)可於同時兼顧評估内容完整性與施測精準度之條件下，大量縮短評估時間；（2)大幅 降低施測者訓練時間與施測負擔。目的：擬運用電腦化角色扮演測驗與多層面CAT技術，發展一套適用於思覺失調症患者之完整、快速 暨精準的工作社交技巧電腦適性測驗系統（Computerized Adaptive Testing - SOcial skills required for WORk, CAT-SOWOR)，並完整驗證CAT-SOWOR之心理計量特性（含信度、效度及反應性）與施測效率（施測題數與時間）。方法：以3年三階段完成CAT-SOWOR之發展，含第一階段：題庫建構、第二階段：系統與施測平台 建置，及第三階段：臨床驗證。於第一階段，研究者將回顧文獻與訪談思覺失調症患者、家屬與臨床 專家，以編製涵蓋多層面工作社交技巧之初版題庫（100題）。並請專家確認CAT-SOWOR之初版題庫 與欲評量之工作社交技巧概念與層面相符。其後施測CAT-SOWOR之初版題庫於400位不同社交技巧 程度之思覺失調症患者，以利分析不同難易程度題目之特質。最後以多層面項目反應理論 (multidimensional item response theory)分析初版題庫，以篩選合適之題目以建構CAT-SOWOR之最終 題庫。第二階段研究者將完成CAT-SOWOR施測系統之模擬分析，以設定CAT-SOWOR之施測起始 題、分數估計、選題、終止施測標準等系統施測程序，並將CAT-SOWOR建置為網路/雲端施測系統。 第三階段研究者將驗證CAT-SOWOR之區辨效度、預測效度、反應性、再測信度與施測者間信度。研究預期結果：CAT-SOWOR將具備以下特點：（1)題庫涵蓋不同工作社交技巧高低程度，可廣泛適 用並精準評量各能力程度之思覺失調症患者。（2)可以最精簡之題目數量，快速掌握患者各層面之工 作社交技巧程度，且具備一定水準之精準度，可大幅提升臨床評量效率並降低施測者負擔。（3)具備 良好實用功能，可有效區辨不同嚴重程度之患者，預測患者出院之求職/工作情況及偵測患者些微之 技巧改變情形，促進臨床人員早期掌握患者工作社交技巧程度與改變，早期介入，以提升治療成 效。（4)具備良好的再測信度與施測者間信度，於重複測量時能提供穩定可靠的評量結果，且評估結 果受施測者影響程度低。對社會、經濟、學術發展等面向的預期影響性：CAT-SOWOR可能是國際上第一套針對思覺失調症患者發展，完整涵蓋各層面工作社交技巧之CAT系統。CAT-SOWOR具備完整、精準、快速且對於 與施測者負擔小等優勢，將可節省人力成本，並運用於精神復健、職業重建領域之例行評估與學術 研究，以協助預測患者適合的職務，擬定合適的工作社交技巧與職業重建訓練方案，並作長期追蹤。<br> Abstract: Background: Work is not only a primary goal of psychiatric rehabilitation, but also plays a critical role in enabling mentally disabled individuals to reintegrate into the community. Work-related social skills can be defined as the capability to interact appropriately with others or deal with social situations that are required at work. For patients with schizophrenia, a lack of work-related social skills has been recognized as one of the major barriers in seeking employment, adapting to a new job, and learning job-specific skills. Thus, accurate and precise assessments of work-related social skills is the basis for successful vocational rehabilitation. However, there are no content-comprehensive, low-burden, and psychometrically sound measures of work-related social skills. Such a limitation has restricted clinicians in efficiently capturing the problems of patients, thereby compromising the treatment effects of social skills training and vocational rehabilitation. Combining computerized role-play tests and multi-dimensional computerized adaptive testing (CAT) could be a way to ameliorate the drawbacks of the existing measures. The system would have the following strengths: (1) efficient, comprehensive, and precise assessments; (2) low administration burden on the raters and little time required for rater training.Purposes: This project will develop a content-comprehensive, efficient, and precise CAT system for assessing social skills required for work in patients with schizophrenia; i.e., the Computerized Adaptive Testing - SOcial skills required for WORk (CAT-SOWOR). We also aim to examine the psychometric properties and efficiency of the CAT-SOWOR.Methods: This 3-year project will be divided into 3 stages:⑴ development of the item bank of the CAT-SOWOR, item testing on 400 subjects, and item analysis using Rasch analysis; (2) construction of the CAT-SOWOR system and a web-based testing platform for the CAT-SOWOR; (3) investigation of the psychometric properties (including discriminative validity, predictive validity, responsiveness, intra- and inter-rater reliabilities) of the CAT-SOWOR on 150 patients with schizophrenia.Expected results: The CAT-SOWOR will have 4 advantages: (1) the content will cover the entire spectrum of work-related social skills; (2) the CAT-SOWOR will be able to comprehensively measure work-related social skills in a timely, precise, and low-burden fashion; (3) the CAT-SOWOR will be able to discriminate the levels of work-related social skills among patients, to predict employment outcomes and work performance after discharge, and to detect the progress of work-related social skills in patients; (4) the CAT-SOWOR will yield consistent results among repeated assessments.Expected impacts on the society, economy, and academic fields: Our CAT-SOWOR would be the first CAT in the world to assess social skills required for work in patients with schizophrenia. The CAT-SOWOR can be a routine assessment measure used to help clinicians and researchers in treatment planning, prognosis, outcome evaluations, and long-term follow-up. Moreover, the CAT-SOWOR will reduce the costs of human resources and clinical resources for assessing work-related social skills.思覺失調症社交技巧電腦適性測驗心理計量特性schizophreniasocial skillscomputerized adaptive testingpsychometric properties