功能性步态评估和平衡评估系统测试：识别帕金森病跌倒患者的可靠性、有效性、敏感性和特异性。
Functional gait assessment and balance evaluation system test: reliability, validity, sensitivity, and specificity for identifying individuals with Parkinson disease who fall.
机构信息
Washington University School of Medicine, St Louis, Missouri, USA.
出版信息
Phys Ther. 2011 Jan;91(1):102-13. doi: 10.2522/ptj.20100113. Epub 2010 Nov 11.
BACKGROUND
Gait impairments, balance impairments, and falls are prevalent in individuals with Parkinson disease (PD). Although the Berg Balance Scale (BBS) can be considered the reference standard for the determination of fall risk, it has a noted ceiling effect. Development of ceiling-free measures that can assess balance and are good at discriminating "fallers" from "nonfallers" is needed.
OBJECTIVE
The purpose of this study was to compare the Functional Gait Assessment (FGA) and the Balance Evaluation Systems Test (BESTest) with the BBS among individuals with PD and evaluate the tests' reliability, validity, and discriminatory sensitivity and specificity for fallers versus nonfallers.
DESIGN
This was an observational study of community-dwelling individuals with idiopathic PD.
METHODS
The BBS, FGA, and BESTest were administered to 80 individuals with PD. Interrater reliability (n=15) was assessed by 3 raters. Test-retest reliability was based on 2 tests of participants (n=24), 2 weeks apart. Intraclass correlation coefficients (2,1) were used to calculate reliability, and Spearman correlation coefficients were used to assess validity. Cutoff points, sensitivity, and specificity were based on receiver operating characteristic plots.
RESULTS
Test-retest reliability was .80 for the BBS, .91 for the FGA, and .88 for the BESTest. Interrater reliability was greater than .93 for all 3 tests. The FGA and BESTest were correlated with the BBS (r=.78 and r=.87, respectively). Cutoff scores to identify fallers were 47/56 for the BBS, 15/30 for the FGA, and 69% for the BESTest. The overall accuracy (area under the curve) for the BBS, FGA, and BESTest was .79, .80, and .85, respectively.
LIMITATIONS
Fall reports were retrospective.
CONCLUSION
Both the FGA and the BESTest have reliability and validity for assessing balance in individuals with PD. The BESTest is most sensitive for identifying fallers.
背景
步态障碍、平衡障碍和跌倒在帕金森病（PD）患者中很常见。尽管 Berg 平衡量表（BBS）可以被认为是确定跌倒风险的参考标准，但它有明显的天花板效应。需要开发无天花板的措施来评估平衡，并善于区分“跌倒者”和“非跌倒者”。
目的
本研究旨在比较功能性步态评估（FGA）和平衡评估系统测试（BESTest）与 PD 患者的 BBS，并评估这些测试的可靠性、有效性以及对跌倒者和非跌倒者的区分敏感性和特异性。
设计
这是一项对社区居住的特发性 PD 患者进行的观察性研究。
方法
对 80 名 PD 患者进行 BBS、FGA 和 BESTest 测试。3 名评估者评估了组内信度（n=15）。基于参与者的 2 次测试（n=24），2 周后进行了测试-重测信度。使用组内相关系数（2,1）计算可靠性，使用斯皮尔曼相关系数评估有效性。基于受试者工作特征曲线确定截断值、敏感性和特异性。
结果
BBS 的测试-重测信度为.80，FGA 的测试-重测信度为.91，BESTest 的测试-重测信度为.88。所有 3 项测试的组内信度均大于.93。FGA 和 BESTest 与 BBS 相关（r=.78 和 r=.87）。识别跌倒者的截断分数为 BBS 为 47/56，FGA 为 15/30，BESTest 为 69%。BBS、FGA 和 BESTest 的整体准确性（曲线下面积）分别为.79、.80 和.85。
局限性
跌倒报告是回顾性的。
结论
FGA 和 BESTest 均具有可靠性和有效性，可用于评估 PD 患者的平衡。BESTest 对识别跌倒者最敏感。
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