Department of Physical Therapy, Georgia Health Sciences University, Augusta, GA, USA.
Int J Clin Pract. 2012 Jul;66(7):718-21. doi: 10.1111/j.1742-1241.2012.02927.x.
People with idiopathic Parkinson's disease (PD) develop postural instability in the later stages of the ailment. Postural instability has traditionally been quantified with the Pull test even though its face validity is limited. We previously established cut-off scores for a three-part rapid assessment of postural instability (RAPID) questionnaire as a non-physical complement to the physical test. In the current study, the questionnaire was administered to a new group of PD subjects to evaluate the diagnostic value of the instrument.
Sensitivity and specificity values were calculated for single and combined sections of the questionnaire by using the Pull test as the gold standard for assessing the presence of postural instability.
The questionnaire when used in its entirety gave the highest sensitivity (.71), whereas specificity was highest in the activities of daily living (.74) and fear of falling sections (.74). Net specificity decreased to .44 when the scores from the three sections of the questionnaire were combined.
The high sensitivity of the RAPID questionnaire suggests that it may be used as an adjunct to the Pull test or solely if it is not convenient or contraindicated. The questionnaire may also be adapted for use via the telephone or internet. The limitation of the Pull test in revealing postural instability may explain the low specificity of the questionnaire, i.e. the questionnaire correctly identifies patients as unstable when the Pull test indicates normal postural control. It is hoped that the rapid identification of postural instability in PD may lead to increased awareness of the disease progression and fewer falls.
特发性帕金森病（PD）患者在疾病后期会出现姿势不稳。尽管姿势稳定性传统上是通过拉力测试来量化的，但它的表面效度有限。我们之前已经为快速评估姿势不稳定性（RAPID）问卷的三部分建立了截定点，作为物理测试的非物理补充。在当前的研究中，我们向一组新的 PD 患者发放了问卷，以评估该工具的诊断价值。
通过拉力测试作为评估姿势不稳定的金标准，计算问卷单节和多节的敏感性和特异性值。
问卷整体使用时具有最高的敏感性（0.71），而在日常生活活动（0.74）和跌倒恐惧部分（0.74）中特异性最高。当将问卷的三个部分的分数组合在一起时，净特异性降低到 0.44。
RAPID 问卷的高敏感性表明，它可以作为拉力测试的辅助手段，如果不方便或不适用，也可以单独使用。该问卷也可以通过电话或互联网进行改编使用。拉力测试在揭示姿势不稳定方面的局限性可能解释了问卷的低特异性，即当拉力测试表明正常的姿势控制时，问卷正确地识别出患者不稳定。我们希望 PD 中姿势不稳定的快速识别可以提高对疾病进展的认识，并减少跌倒。
