运动障碍专家与专门从事帕金森病管理的护士之间在帕金森病运动功能评估中的评分者间变异性。

Inter-rater variability in motor function assessment in Parkinson's disease between experts in movement disorders and nurses specialising in PD management.

作者信息

de Deus Fonticoba T, Santos García D, Macías Arribí M

机构信息

Sección de Neurología, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, España.

出版信息

Neurologia (Engl Ed). 2019 Oct;34(8):520-526. doi: 10.1016/j.nrl.2017.03.005. Epub 2017 May 23.

DOI:10.1016/j.nrl.2017.03.005

PMID:28549752

Abstract

INTRODUCTION AND OBJECTIVE

In clinical practice, assessing patients with Parkinson's disease (PD) is a complex, time-consuming task. Our purpose is to provide a rigorous and objective evaluation of how motor function in PD patients is assessed by neurologists specialising in movement disorders, on the one hand, and by nurses specialising in PD management, on the other.

METHODS

We conducted an observational, cross-sectional, single-centre study of 50 patients with PD (52% men; mean age: 64.7 ± 8.7 years) who were assessed between 5 January 2016 and 20 July 2016. A neurologist and a nurse evaluated motor function in the early morning hours using the Unified Parkinson's Disease Rating Scale (UPDRS) parts III and IV and Hoehn & Yahr (H&Y) scale. Tests were administered in the same PD periods (in 48 patients during the 'off' time and in 2 patients during the 'on' time). Inter-rater variability was estimated with the intraclass correlation coefficient (ICC).

RESULTS

Forty-nine patients (98%) were classified in the same H&Y stage by both raters. Assessment times were similar for both raters. ICC for UPDRS-IV and UPDRS-III total scores were 0.955 (P<.0001) and 0.954 (P<.0001), respectively. The greatest variability was found for UPDRS-III item 29 (gait; ICC=0.746; P<.0001) and the lowest, for item 30 (postural stability; ICC=0.918; P<.0001).

CONCLUSIONS

Motor function assessment of PD patients by a trained nurse is equivalent to that made by an expert neurologist and takes the same time to complete.

摘要

引言与目的

在临床实践中，评估帕金森病（PD）患者是一项复杂且耗时的任务。我们的目的是一方面对专门从事运动障碍的神经科医生，另一方面对专门从事PD管理的护士如何评估PD患者的运动功能进行严格且客观的评价。

方法

我们对2016年1月5日至2016年7月20日期间评估的50例PD患者（52%为男性；平均年龄：64.7±8.7岁）进行了一项观察性、横断面、单中心研究。一名神经科医生和一名护士在清晨使用统一帕金森病评定量表（UPDRS）第三部分和第四部分以及霍恩&亚尔（H&Y）量表评估运动功能。测试在相同的PD阶段进行（48例患者在“关”期，2例患者在“开”期）。使用组内相关系数（ICC）估计评分者间的变异性。

结果

两位评分者将49例患者（98%）分类为相同的H&Y分期。两位评分者的评估时间相似。UPDRS-IV总分和UPDRS-III总分的ICC分别为0.955（P<0.0001）和0.954（P<0.0001）。UPDRS-III项目29（步态；ICC=0.746；P<0.0001）的变异性最大，项目30（姿势稳定性；ICC=0.918；P<0.0001）的变异性最小。