Jepsen Jørgen R, Laursen Lise H, Kreiner Svend, Larsen Anders I
Department of Occupational Medicine, Sydvestjysk Sygehus Esbjerg, Østergade 81-83, DK-6700 Esbjerg, Denmark.
Open Neurol J. 2009 Sep 15;3:54-63. doi: 10.2174/1874205X00903010054.
We have previously demonstrated that neurological individual findings and patterns can be reliably assessed in the examination of the upper limb and also that they are related to pain, weakness, and/or numbness/tingling. This study aimed to study further aspects of the construct validity of the neurological examination.
Blinded to patient-characteristics, two examiners assessed the function of 16 muscles, the sensibility in 7 territories, and the nerve-mechanosensitivity at 20 locations in 82 upper limbs. Based on anatomical patterns and pre-designed algorithms, one or both examiners rated neuropathy as "possible" or "definite" in 40 limbs and also determined the location( s). We developed and tested hypotheses on anatomically and regionally related locations of nerve afflictions (a selective vulnerability of neurons, double and multiple crush, and a tendency to regional spread) and examined the stability of the internal structure of the constructs in different situations. The interrelations of findings were analyzed by hypothesis testing and factor analyses, and the homogeneity of location profiles was analyzed by a conditional likelihood test.
Out of 30 limbs with related locations of neuropathy, the findings of each examiner correlated positively (gamma > 0.35) in 22/25, respectively. The patterns of the interrelations identified by the two examiners were similar, with no evidence of any heterogeneity of location profiles for either examiner.
This study supports the validity of the physical examination. However, feasibility of its application requires the demonstration of further aspects of construct validity and a favorable influence on patient-management and/or prevention.
我们之前已经证明，在上肢检查中可以可靠地评估神经学上的个体发现和模式，并且它们与疼痛、无力和/或麻木/刺痛有关。本研究旨在进一步探讨神经学检查的结构效度。
在对患者特征不知情的情况下，两名检查者评估了82条上肢中16块肌肉的功能、7个区域的感觉以及20个部位的神经机械敏感性。基于解剖模式和预先设计的算法，一名或两名检查者将40条上肢的神经病变评为“可能”或“确定”，并确定其位置。我们针对神经病变在解剖学和区域上相关的位置（神经元的选择性易损性、双重和多重压迫以及区域扩散倾向）提出并检验了假设，并检查了不同情况下结构内部结构的稳定性。通过假设检验和因子分析分析结果之间的相互关系，并通过条件似然检验分析位置分布的同质性。
在30条存在神经病变相关位置的上肢中，每位检查者的结果在22/25例中呈正相关（γ>0.35）。两名检查者确定的相互关系模式相似，没有证据表明任何一名检查者的位置分布存在异质性。
本研究支持体格检查的效度。然而，其应用的可行性需要进一步证明结构效度的其他方面以及对患者管理和/或预防的有利影响。
