Winzenberg Tania, Shaw Kelly A
Menzies Research Institute, University of Tasmania, Australia.
Aust Fam Physician. 2011 Jan-Feb;40(1-2):57-61.
It is unclear what is the best method of accurately identifying physically inactive patients in general practice. This study aimed to compare the performance of different methods of assessing patient physical activity levels in general practice.
Thirteen general practitioners were randomly allocated to perform either their usual assessment, or this with a Lifescripts tool, on consecutive patients. The authors measured patients' physical activity by accelerometer over 1 week, including steps per day, then calculated agreement, kappa specificity, sensitivity, positive and negative predictive value (PV) and ROC characteristics for each assessment method (GPs' usual assessment, Lifescripts tool and steps per day) against the reference standard of accelerometer classification.
Data from 29 patients was included. Agreement between subjective assessments was highest for GPs' usual assessment (agreement 73%; kappa 0.47; p=0.03), which also gave the highest area under the ROC curve (0.75, 95% CI: 0.52-0.98). However, this still had low specificity (67%) and positive PV (63%). Using a cut-off of 7500 steps/day maximised the area under the ROC curve at 0.91 (95% CI: 0.82-1.00), 19.2% greater than GPs' usual assessment.
Measuring steps per day may be a feasible and more effective way to screen for physically inactive patients than self report. A large scale study to confirm these results is necessary.
在全科医疗中，尚不清楚准确识别身体活动不足患者的最佳方法是什么。本研究旨在比较全科医疗中评估患者身体活动水平的不同方法的性能。
13名全科医生被随机分配，对连续的患者进行常规评估或使用Lifescripts工具进行评估。作者通过加速度计测量患者1周的身体活动，包括每日步数，然后针对每种评估方法（全科医生的常规评估、Lifescripts工具和每日步数）与加速度计分类的参考标准计算一致性、kappa特异性、敏感性、阳性和阴性预测值（PV）以及ROC特征。
纳入了29名患者的数据。全科医生的常规评估在主观评估之间的一致性最高（一致性73%；kappa 0.47；p = 0.03），其ROC曲线下面积也最大（0.75，95%CI：0.52 - 0.98）。然而，其特异性（67%）和阳性预测值（63%）仍然较低。使用每日7500步的截断值可使ROC曲线下面积最大化，为0.91（95%CI：0.82 - 1.00），比全科医生的常规评估大19.2%。
与自我报告相比，测量每日步数可能是筛查身体活动不足患者的一种可行且更有效的方法。有必要进行大规模研究以证实这些结果。
