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计时起立行走测试(TUG)在识别多发性硬化症患者跌倒风险中的鉴别能力和临床实用性:一项前瞻性队列研究。

Discriminative ability and clinical utility of the Timed Up and Go (TUG) in identifying falls risk in people with multiple sclerosis: a prospective cohort study.

机构信息

1 School of Allied Health, Faculty of Education & Health Sciences, Health Research Institute, University of Limerick, Limerick, Ireland.

2 St. Vincent's University Hospital, Dublin, Ireland.

出版信息

Clin Rehabil. 2019 Feb;33(2):317-326. doi: 10.1177/0269215518793481. Epub 2018 Aug 14.

Abstract

OBJECTIVE

: To investigate discriminative ability and clinical utility of the Timed Up and Go under single- and dual-task conditions between fallers and non-fallers in multiple sclerosis (MS).

DESIGN

: Prospective cohort study.

SETTING

: Neurology service in a tertiary hospital.

SUBJECTS

: Participants were 101 people with MS and Expanded Disability Status Scale score of 3-6.5. One participant withdrew after the baseline assessment, and hence the data were analysed for 100 participants.

INTERVENTIONS

: No specific intervention.

MAIN MEASURES

: Timed Up and Go and Timed Up and Go-Cognitive. Three-month prospective diaries recorded falls.

RESULTS

: Mean age was 52.6 (SD 10.7) and 66 were female. Majority of the participants had progressive MS (72) and 73 used a walking aid; 56 participants recorded 791 falls. The area under the receiver operating characteristic curve values for Timed Up and Go and Timed Up and Go-Cognitive in distinguishing fallers (person with ⩾1 fall) from non-fallers are 0.60 and 0.57, respectively, and in distinguishing multiple fallers (⩾2 falls) the values are 0.46 and 0.43. A Timed Up and Go score of ⩾9 seconds has a sensitivity of 0.82 and a specificity of 0.34 to identify fallers and a sensitivity of 0.79 and a specificity of 0.27 to identify multiple fallers. A Timed Up and Go-Cognitive score of ⩾11 seconds has a sensitivity of 0.77 and a specificity of 0.30 to identify fallers and a sensitivity of 0.71 and a specificity of 0.26 to identify multiple fallers.

CONCLUSION

: The Timed Up and Go and Timed Up and Go-Cognitive do not demonstrate sufficient clinical utility or discriminative ability for assessing falls risk in MS.

摘要

目的

研究多发性硬化症(MS)患者在单任务和双任务条件下,计时起立行走测试(Timed Up and Go,TUG)的区分能力和临床应用,比较跌倒者和非跌倒者之间的差异。

设计

前瞻性队列研究。

地点

三级医院神经内科。

受试者

共纳入 101 名 MS 患者,扩展残疾状况量表(Expanded Disability Status Scale,EDSS)评分为 3-6.5 分。1 名患者在基线评估后退出,因此对 100 名参与者的数据进行了分析。

干预措施

无特殊干预。

主要观察指标

计时起立行走测试(Timed Up and Go,TUG)和计时起立行走测试-认知测试(Timed Up and Go-Cognitive,TUG-C)。3 个月前瞻性日记记录跌倒情况。

结果

平均年龄为 52.6(10.7)岁,66 名女性。大多数参与者为进展型 MS(72 例),73 例使用助行器;56 例参与者记录了 791 次跌倒。TUG 和 TUG-C 区分跌倒者(发生 ⩾1 次跌倒的患者)和非跌倒者的受试者工作特征曲线(receiver operating characteristic curve,ROC)下面积分别为 0.60 和 0.57,区分多次跌倒者(发生 ⩾2 次跌倒的患者)的下面积分别为 0.46 和 0.43。TUG 得分 ⩾9 秒时,对跌倒者的敏感度为 0.82,特异度为 0.34;对多次跌倒者的敏感度为 0.79,特异度为 0.27。TUG-C 得分 ⩾11 秒时,对跌倒者的敏感度为 0.77,特异度为 0.30;对多次跌倒者的敏感度为 0.71,特异度为 0.26。

结论

TUG 和 TUG-C 对评估 MS 患者的跌倒风险没有足够的临床效用或区分能力。

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