Vance Roisin C, Healy Dan G, Galvin Rose, French Helen P
R.C. Vance, PT, MSc, Physiotherapy Department, Beaumont Hospital, Beaumont Road, Dublin 9, Leinster, Ireland, and School of Physiotherapy, Royal College of Surgeons, 123 St Stephen's Green, Dublin 2, Dublin, Leinster, Ireland.
D.G. Healy, MD, PhD, Neurology Department, Beaumont Hospital.
Phys Ther. 2015 Jan;95(1):95-102. doi: 10.2522/ptj.20130386. Epub 2014 Aug 21.
Falls are a common and disabling feature of Parkinson disease (PD). Early identification of patients at greatest risk of falling is a key goal of physical therapy assessment. The Timed "Up & Go" Test (TUG), a frequently used mobility assessment tool, has moderate sensitivity and specificity for identifying fall risk.
The study objective was to investigate whether adding a task (cognitive or manual) to the TUG (TUG-cognitive or TUG-manual, respectively) increases the utility of the test for identifying fall risk in people with PD.
This was a retrospective cohort study of people with PD (N=36).
Participants were compared on the basis of self-reported fall exposure in the preceding 6 months (those who had experienced falls ["fallers"] versus those who had not ["nonfallers"]). The time taken to complete the TUG, TUG-cognitive, and TUG-manual was measured for both groups. Between-group differences were calculated with the Mann-Whitney U test. The discriminative performance of the test at various cutoff values was examined, and estimates of sensitivity and specificity were based on receiver operating characteristic curve plots.
Fallers took significantly longer than nonfallers (n=19) to complete the TUG under all 3 conditions. The TUG-cognitive showed optimal discriminative performance (receiver operating characteristic area under the curve=0.82; 95% confidence interval [CI]=0.64, 0.92) at a cutoff of 14.7 seconds. The TUG-cognitive was more likely to correctly classify participants with a low risk of falling (positive likelihood ratio=2.9) (<14.7 seconds) and had higher estimates of sensitivity (0.76; 95% CI=0.52, 0.90) than of specificity (0.73; 95% CI=0.51, 0.88) at this threshold (negative likelihood ratio=0.32).
Retrospective classification of fallers and nonfallers was used.
The addition of a cognitive task to the TUG enhanced the identification of fall risk in people with PD. The TUG-cognitive should be considered a component of a multifaceted fall risk assessment in people with PD.
跌倒在帕金森病（PD）中很常见且会导致功能障碍。尽早识别跌倒风险最高的患者是物理治疗评估的关键目标。定时起立行走测试（TUG）是一种常用的运动能力评估工具，在识别跌倒风险方面具有中等的敏感性和特异性。
本研究旨在探讨在TUG测试中增加一项任务（认知或手动任务，分别为TUG-认知或TUG-手动）是否能提高该测试在识别PD患者跌倒风险方面的效用。
这是一项针对PD患者（N = 36）的回顾性队列研究。
根据参与者在过去6个月内自我报告的跌倒情况进行比较（经历过跌倒的人["跌倒者"]与未经历过跌倒的人["非跌倒者"]）。测量了两组完成TUG、TUG-认知和TUG-手动测试所需的时间。使用Mann-Whitney U检验计算组间差异。检查了测试在不同临界值下的判别性能，并基于受试者工作特征曲线绘制来估计敏感性和特异性。
在所有三种情况下，跌倒者完成TUG测试的时间均显著长于非跌倒者（n = 19）。TUG-认知在临界值为14.7秒时表现出最佳判别性能（曲线下受试者工作特征面积 = 0.82；95%置信区间[CI] = 0.64, 0.92）。在该阈值下，TUG-认知更有可能正确分类跌倒风险较低的参与者（阳性似然比 = 2.9）（<14.7秒），并且敏感性估计值（0.76；95% CI = 0.52, 0.90）高于特异性估计值（0.73；95% CI = 0.51, 0.88）（阴性似然比 = 0.32）。
采用了跌倒者和非跌倒者的回顾性分类。
在TUG测试中增加一项认知任务可增强对PD患者跌倒风险的识别。TUG-认知应被视为PD患者多方面跌倒风险评估的一个组成部分。
