Institute of Bone and Joint Research, the Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Australia.
Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Australia.
Spine J. 2019 Aug;19(8):1378-1396. doi: 10.1016/j.spinee.2019.04.004. Epub 2019 Apr 12.
Selecting a walking outcome measure for neurogenic claudication requires knowledge of its measurement properties.
To systematically review and appraise the literature on the measurement properties of walking outcome measures for patients with neurogenic claudication.
A systematic review and meta-analysis.
A systematic search was conducted on the following seven databases: PubMed, PsychINFO, Web of Science, Embase, CINAHL, MEDLINE, and Cochrane Central Register of Controlled Trials. Clinical studies that assessed a measurement property of a walking outcome measure for patients with neurogenic claudication were selected. The methodological quality of studies was assessed using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. Measurement property results were assessed using the adapted criteria from Terwee et al. (2007).
Twelve studies that evaluated 15 separate walking outcome measures were included. Out of the 12 studies included, half had poor methodological quality. Four measures had acceptable test-retest reliability: the self-paced walking test (intraclass correlation coefficient, or ICC was 0.98, 95% CI: 0.95-0.99), Physical Function Scale (PFS) (pooled analysis ICC = 0.79, 95% CI: 0.77-0.89), PFS walk item (ICC = 0.81, 95% CI: 0.68-0.89), and Oswestry Disability Index (ODI) walk item (ICC = 0.86, 95% CI: 0.76-0.92). Responsiveness was assessed on five walking outcome measures, and three had adequate responsiveness: the ODI walk item (Area under the Curve, or AUC, was 0.76, SD 0.15), Treadmill test (AUC = 0.70), and PFS (AUC = 0.77, SD 0.14). A meta-analysis demonstrated the PFS had adequate test retest reliability (pooled ICC = 0.79, 95% CI: 0.77-0.89) and internal consistency (pooled Cronbach's αlpha (α) = 0.84, 95% CI: 0.81-0.86), but not criterion validity (pooled correlation coefficient = -0.59, 95% CI: -0.71, -0.45). Measures that recorded adequate criterion validity were the ODI walk item (pooled correlation coefficient = -0.71, 95% CI: -0.80, -0.58), Treadmill test (pooled correlation coefficient = 0.86, 95% CI: 0.78-0.91), and self predicted walking item (pooled correlation coefficient = 0.74, 95% CI: 0.63-0.82).
The results of our systematic review demonstrated that high-quality studies that asses the measurement properties of walking outcome measures for patients with neurogenic claudication are lacking. There was only limited evidence available for each walking measure, which prevented any single outcome from being confirmed as the gold standard measure of neurogenic claudication. Clinicians and researchers are recommended to use the self-paced walking test and ODI walk item until further evidence is available. Future research should focus on producing high-quality studies with excellent methodology and larger sample sizes.
选择用于神经源性跛行的步行结果测量需要了解其测量特性。
系统回顾和评估用于神经源性跛行患者的步行结果测量的文献的测量特性。
系统回顾和荟萃分析。
对以下七个数据库进行了系统搜索：PubMed、PsychINFO、Web of Science、Embase、CINAHL、MEDLINE 和 Cochrane 对照试验中心注册。选择评估神经源性跛行患者步行结果测量的测量特性的临床研究。使用共识基础健康测量仪器选择标准（COSMIN）检查表评估研究的方法学质量。使用 Terwee 等人（2007 年）改编的标准评估测量特性结果。
共纳入了 12 项研究，评估了 15 种不同的步行结果测量。纳入的 12 项研究中，有一半的研究质量较差。四项措施具有可接受的测试-重测可靠性：自我定速步行测试（组内相关系数或 ICC 为 0.98，95%CI：0.95-0.99）、物理功能量表（PFS）（汇总分析 ICC = 0.79，95%CI：0.77-0.89）、PFS 步行项目（ICC = 0.81，95%CI：0.68-0.89）和 Oswestry 残疾指数（ODI）步行项目（ICC = 0.86，95%CI：0.76-0.92）。五项步行结果测量评估了反应性，其中三项具有足够的反应性：ODI 步行项目（曲线下面积，或 AUC 为 0.76，SD 0.15）、跑步机测试（AUC = 0.70）和 PFS（AUC = 0.77，SD 0.14）。荟萃分析表明，PFS 具有可接受的测试重测可靠性（汇总 ICC = 0.79，95%CI：0.77-0.89）和内部一致性（汇总 Cronbach's αlpha（α）= 0.84，95%CI：0.81-0.86），但不具有标准效度（汇总相关系数 = -0.59，95%CI：-0.71，-0.45）。具有足够标准效度的测量是 ODI 步行项目（汇总相关系数 = -0.71，95%CI：-0.80，-0.58）、跑步机测试（汇总相关系数 = 0.86，95%CI：0.78-0.91）和自我预测步行项目（汇总相关系数 = 0.74，95%CI：0.63-0.82）。
我们的系统评价结果表明，用于评估神经源性跛行患者步行结果测量的高质量研究缺乏。每个步行测量都只有有限的证据，这使得任何单一的测量结果都无法被确认为神经源性跛行的金标准测量。建议临床医生和研究人员在进一步的证据出现之前使用自我定速步行测试和 ODI 步行项目。未来的研究应重点制定具有高质量方法学和更大样本量的研究。
