timed up-and-go 和 2 分钟步行测试在轻度残疾的多发性硬化症患者中的可靠性、反应性及与感知疲劳的相关性。
Timed Up-and-Go and 2-Minute Walk Test in patients with multiple sclerosis with mild disability: reliability, responsiveness and link with perceived fatigue.
机构信息
Department of Health Sciences, Institute of Experimental and Clinical Research, Neuromusculoskeletal Lab (NMSK), Catholic University of Louvain, Brussels, Belgium -
Department of Physical Medicine and Rehabilitation, Saint-Luc University Clinic, Brussels, Belgium -
出版信息
Eur J Phys Rehabil Med. 2019 Aug;55(4):450-455. doi: 10.23736/S1973-9087.18.05366-2. Epub 2018 Oct 4.
BACKGROUND
Mobility limitations are frequent in patients with multiple sclerosis (MS), and could already be present in patients with so-called mild neurological disability (Expanded Disability Status Scale≤4). Assessing mobility in these patients is therefore of paramount importance. Timed Up-and-Go Test (TUG) and 2-Minute Walk Test (2MWT) are two clinically feasible tests which reliability and responsiveness are unknown among these patients. Whether fatigue, which is the number one symptom among these patients, is linked to these limitations remains unknown.
AIM
The aim of this study was to explore the intrarater reliability and minimal detectable change (MDC95), as an index of responsiveness, of TUG and 2MWT. To explore their link with perceived fatigue among patients with MS.
DESIGN
Cross-sectional observational study, including two measures.
SETTING
Two university hospital outpatient centers.
POPULATION
Patients (N.=63, 49 seen twice) with MS with mild disability (Expanded Disability Status Scale≤4).
METHODS
2MWT and TUG were performed twice in one occasion, and repeated 2 weeks later. Modified fatigue impact scale (MFIS) was used to assess fatigue. Intraclass coefficient correlations were calculated for immediate and 2-week reliability. MDC95 were computed. Correlations between mobility indices and fatigue were explored using Spearman's ρ.
RESULTS
Mobility was impaired in comparison to normative values (2MWT: -4.9% from normative distance; TUG: +32% from normative time). The immediate reliability was excellent for both the 2MWT (ICC=0.98) and TUG (ICC=0.98). Reliability at 2 weeks was excellent for 2MWT (ICC=0.95) and very good for TUG (ICC=0.90). MDC95 were respectively 20m (2MWT) and 1.3s (TUG). Both measures were significantly weakly correlated to total MFIS (ρ=-0.37 and 0.39, respectively; P<0.01).
CONCLUSIONS
The 2MWT and TUG are highly reliable and responsive in the assessment of respectively the walking capacity and general mobility of patients with MS with mild disability. Mobility impairments are linked to perceived fatigue among these patients.
CLINICAL REHABILITATION IMPACT
TUG and 2MWT are easy to administer and could be reliably used in so called mildly disabled patients with MS to assess mobility limitation.
背景
多发性硬化症（MS）患者经常出现行动受限，即使在所谓轻度神经功能障碍（扩展残疾状况量表≤4）患者中也可能存在。因此，评估这些患者的活动能力至关重要。计时起立行走测试（TUG）和 2 分钟步行测试（2MWT）是两种临床可行的测试，但在这些患者中，其可靠性和反应性尚不清楚。在这些患者中，作为首要症状的疲劳是否与这些限制有关仍不清楚。
目的
本研究旨在探讨 TUG 和 2MWT 的内部测试者信度和最小可检测变化（MDC95），作为反应性的指标。探讨它们与 MS 轻度残疾患者感知疲劳的关系。
设计
横断面观察性研究，包括两项措施。
地点
两所大学医院的门诊中心。
人群
MS 轻度残疾患者（扩展残疾状况量表≤4，N=63，49 例患者接受了两次测试）。
方法
在一次就诊中进行 2MWT 和 TUG 两次测试，并在 2 周后重复。使用改良疲劳影响量表（MFIS）评估疲劳。计算即时和 2 周的可靠性的组内系数相关性。计算 MDC95。使用 Spearman ρ 探索移动性指标与疲劳之间的相关性。
结果
与参考值相比，活动能力受损（2MWT：与参考距离相差 4.9%；TUG：与参考时间相差 32%）。2MWT（ICC=0.98）和 TUG（ICC=0.98）的即时可靠性均非常好。2 周时的可靠性 2MWT（ICC=0.95）非常好，TUG（ICC=0.90）也很好。MDC95 分别为 20m（2MWT）和 1.3s（TUG）。这两个指标与总 MFIS 均呈弱相关（ρ=-0.37 和 0.39，P<0.01）。
结论
2MWT 和 TUG 在评估 MS 轻度残疾患者的步行能力和一般活动能力方面具有高度可靠性和反应性。在这些患者中，活动能力受损与感知疲劳有关。
临床康复影响
TUG 和 2MWT 易于管理，可用于评估所谓的轻度残疾 MS 患者的活动受限情况。
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