Vukomanović Aleksandra, Đurović Aleksandar, Brdareski Zorica
Vojnosanit Pregl. 2016 Dec;73(12):1139-48. doi: 10.2298/VSP150819056V.
BACKGROUND/AIM: The A-test is used in daily clinical practice for monitoring functional recovery of orthopedic patients during early rehabilitation. The aim of this study was to determine the accuracy of A-test and cutoff point at which the test can separate patients with and without functional disability at the end of early rehabilitation. Also, it was important to determine whether A-test has that discriminative ability (and at which cutoff points) in the first days of early rehabilitation in order to have time to plan post acute rehabilitation.
This measurement-focused study was conducted in the Orthopedic Ward during early inpatient rehabilitation (1st−5th day after the operation) of 60 patients with hip osteoarthritis (HO) that underwent arthroplasty and 60 surgically treated patients with hip fracture (HF). For measurements we used the A-test and the University of Iowa Level of Assistance Scale (ILAS) as the gold standard. For statistical analysis we used the receiver operating characteristic (ROC) curve and the area under the curve (AUC) with 95% confidence interval for the results of A-test from the first to the fifth day of rehabilitation, sensitivity, specificity, the rate of false positive and false negative errors, positive and negative predictive value, ratio of positive and negative likelihood ratio, accuracy, point to the ROC curve closest to 0.1 and Youden index for all the cutoff points.
The AUC was 0.825 (0.744−0.905) for the first day of rehabilitation, 0.922 (0.872−0.972) for the second day of rehabilitation, 0.980 (0.959−1.000) for the third day of rehabilitation, 0.989 (0.973−1.004) for the fourth day, and 0.999 (0.996−1.001) for the fifth day of rehabilitation. The optimal cutoff for the results of A-test was: 7/8 for the first day, 29/30 for the fourth day, and 34/35 for the fifth day of rehabilitation. On the second and the third day A-test had two cutoff points, the lower point safely separated the patients with functional disability, while the upper point ruled out functional disability. On the 2nd rehabilitation day the cutoff points were 12/13 and 17/18, on the 3rd rehabilitation day cutoff points were 13/14 and 18/19.
The A-test has all characteristics of an accurate tool which can be used for separating patients with and without functional disability at all stages of early rehabilitation after surgically treated hip disease or fracture. Based on the results of A-test within the first days of early rehabilitation, it is possible to make a plan for postacute rehabilitation.
背景/目的：A 测试在日常临床实践中用于监测骨科患者早期康复期间的功能恢复情况。本研究的目的是确定 A 测试的准确性以及在早期康复结束时该测试能够区分有无功能障碍患者的临界值。此外，确定 A 测试在早期康复的头几天是否具有这种鉴别能力（以及在哪些临界值）以便有时间规划急性后期康复也很重要。
这项以测量为重点的研究在骨科病房对 60 例接受关节置换术的髋骨关节炎（HO）患者和 60 例接受手术治疗的髋部骨折（HF）患者进行早期住院康复（术后第 1 - 5 天）时开展。测量时我们使用 A 测试，并将爱荷华大学协助水平量表（ILAS）作为金标准。对于统计分析，我们使用康复第 1 天至第 5 天 A 测试结果的受试者工作特征（ROC）曲线和曲线下面积（AUC）以及 95%置信区间、敏感性、特异性、假阳性和假阴性错误率、阳性和阴性预测值、阳性和阴性似然比、准确性，指向最接近 0.1 的 ROC 曲线点以及所有临界值的约登指数。
康复第 1 天的 AUC 为 0.825（0.744 - 0.905），第 2 天为 0.922（0.872 - 0.972），第 3 天为 0.980（0.959 - 1.000），第 4 天为 0.989（0.973 - 1.004），第 5 天为 0.999（0.996 - 1.001）。A 测试结果的最佳临界值为：康复第 1 天为 7/8，第 4 天为 29/30，第 5 天为 34/35。在第 2 天和第 3 天，A 测试有两个临界值，较低的点能可靠地区分有功能障碍的患者，而较高的点可排除功能障碍。在康复第 2 天，临界值为 12/13 和 17/18，在康复第 3 天，临界值为 13/14 和 18/19。
A 测试具有准确工具的所有特征，可用于区分手术治疗髋部疾病或骨折后早期康复各阶段有无功能障碍的患者。根据早期康复头几天的 A 测试结果，有可能制定急性后期康复计划。
