Department of Clinical Neurological Sciences, Rm B7-140B, University Hospital, London Health Sciences Centre, 339 Windermere Road, London, ON, N6A 5A5, Canada.
School of Kinesiology, Western University, London, ON, Canada.
Clin Auton Res. 2020 Feb;30(1):69-77. doi: 10.1007/s10286-018-00586-5. Epub 2019 Jan 2.
To assess the ability of the Orthostatic Discriminant and Severity Scale (ODSS) to distinguish symptoms of orthostatic intolerance from non-orthostatic symptoms.
Clinical evaluations and questionnaire responses were collected in 73 healthy controls and 132 patients referred to the Autonomic Disorders Clinic from September 1, 2016, through April 30, 2018, for queries regarding autonomic dysfunction. A receiver operating characteristic (ROC) curve analysis was used to interpret sensitivity and specificity and to determine cutoff scores for symptom assessment. Inter-item reliability was assessed using Cronbach's alpha. To calculate positive and negative predictive powers, patient data were collected in a single-blinded fashion where the researcher collecting questionnaire data was blinded to the clinical evaluation and diagnosis. Predictive powers were calculated using a chi-squared cross-tabulation.
The orthostatic and non-orthostatic symptoms scores produced ROC curves with an area under the curve of 0.89 and 0.79, respectively. The orthostatic scores yielded a positive and negative predictive power value of 73% and 81%, respectively. Combined, the ODSS identified patients with and without orthostatic symptoms with an overall accuracy of 76%. The reliability of the ODSS was significant, with a Cronbach's alpha of 0.88, and all dichotomous items were deemed worthy of retention following an inter-item reliability assessment.
The ODSS demonstrated a strong ability to distinguish patients with and without orthostatic intolerance and demonstrated sensitivity and specificity equivalent to that of other standardized measures. Overall, the ODSS produces symptom scores that are both reliable and useful for both research and clinical practice.
评估直立性判别和严重程度量表（ODSS）区分直立不耐受症状与非直立症状的能力。
2016 年 9 月 1 日至 2018 年 4 月 30 日，从自主神经疾病诊所转诊的 73 名健康对照者和 132 名患者接受了临床评估和问卷调查。使用受试者工作特征（ROC）曲线分析来解释敏感性和特异性，并确定症状评估的截断分数。使用 Cronbach's alpha 评估项目间的可靠性。为了计算阳性和阴性预测能力，采用单盲方式收集患者数据，即收集问卷数据的研究人员对临床评估和诊断不知情。使用卡方交叉表计算预测能力。
直立和非直立症状评分产生的 ROC 曲线下面积分别为 0.89 和 0.79。直立评分的阳性和阴性预测值分别为 73%和 81%。ODSS 联合使用时，可识别出有和无直立症状的患者，总体准确率为 76%。ODSS 的可靠性显著，Cronbach's alpha 为 0.88，在进行项目间可靠性评估后，所有二分项目均被认为值得保留。
ODSS 能够很好地区分有和无直立不耐受的患者，其敏感性和特异性与其他标准化测量方法相当。总的来说，ODSS 产生的症状评分既可靠又可用于研究和临床实践。
