Imperial College London, London, UK.
Swiss Paraplegic Research, Nottwil, Switzerland.
Acta Neurol Scand. 2018 Jul;138(1):47-54. doi: 10.1111/ane.12910. Epub 2018 Feb 21.
Spasticity is a common and disabling feature of amyotrophic lateral sclerosis (ALS). There are currently no validated ALS-specific measures of spasticity. The aim of this study was to develop and use a self-report outcome measure for spasticity in ALS.
Following semi-structured interviews with 11 ALS patients, a draft scale was administered across ALS clinics in the UK. Internal validity of the scale was examined using the Rasch model. The numerical rating scale (NRS) for spasticity and Leeds Spasticity scale (LSS) were co-administered. The final scale was used in a path model of spasticity and quality of life.
A total of 465 patients (mean age 64.7 years (SD 10), 59% male) with ALS participated. Spasticity was reported by 80% of subjects. A pool of 71 items representing main themes of physical symptoms, negative impact and modifying factors was subject to an iterative process of item reduction by Rasch analysis resulting in a 20-item scale-the Spasticity Index for ALS (SI-ALS)-which was unidimensional and free from differential item functioning. Moderate correlations were found with LSS and NRS-spasticity. Incorporating the latent estimate of spasticity into a path model, greater spasticity reduced quality of life and motor function; higher motor function was associated with better quality of life.
The SI-ALS is a disease-specific self-report scale, which provides a robust interval-level measure of spasticity in ALS. Spasticity has a substantial impact on quality of life in ALS.
痉挛是肌萎缩侧索硬化症（ALS）的常见且致残特征。目前尚无针对 ALS 痉挛的经过验证的特定评估方法。本研究的目的是开发和使用用于 ALS 痉挛的自我报告结局评估方法。
在对 11 名 ALS 患者进行半结构化访谈后，在英国的 ALS 诊所中使用了一份草案量表。使用 Rasch 模型检查量表的内部有效性。同时还共同使用了数字评定量表（NRS）和利兹痉挛量表（LSS）。最终量表用于痉挛和生活质量的路径模型中。
共有 465 名（平均年龄 64.7 岁（标准差 10），59%为男性）ALS 患者参与了研究。80%的患者报告有痉挛。一个包含 71 个项目的池，代表身体症状、负面影响和调节因素的主要主题，经过 Rasch 分析的迭代过程，以减少项目数量，最终形成一个 20 项的量表-肌萎缩侧索硬化症痉挛指数（SI-ALS），该量表是单维的，没有项目间功能差异。与 LSS 和 NRS 痉挛评分的相关性适中。将痉挛的潜在估计值纳入路径模型中，痉挛程度越高则生活质量和运动功能越低；运动功能越高则生活质量越好。
SI-ALS 是一种疾病特异性的自我报告量表，为 ALS 中的痉挛提供了可靠的区间水平评估方法。痉挛对 ALS 患者的生活质量有重大影响。
