From the Departments of Anesthesia and Critical Care (D.S.R., P.N.) Public Health Sciences (D.H.) the Sections of Geriatrics and Palliative Medicine (M.H.-S.) Cardiology (R.P.W.) the Pritzker School of Medicine (A.H.), University of Chicago, Chicago Illinois the Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, Illinois (R.A.).
Anesthesiology. 2019 Nov;131(5):992-1003. doi: 10.1097/ALN.0000000000002911.
Functional capacity assessment is a core component of current perioperative cardiovascular evaluation and management guidelines for noncardiac surgery. The authors investigated the ability of standardized physical function questions to predict whether participants engaged in moderate physical activity as measured by hip accelerometers.
Participant responses to physical functioning questions and whether they engaged in moderate physical activity were extracted from the National Health and Nutrition Examination Survey (2003 to 2004 and 2005 to 2006). Physical activity intensity was measured using hip accelerometers. Adult participants with at least one Revised Cardiac Risk Index condition were included in the analysis. Standardized physical function questions were evaluated using a classification and regression tree analysis. Training and test datasets were randomly generated to create and test the analysis.
Five hundred and twenty-two participants were asked the physical functioning questions and 378 of 522 (72.4%) had a bout of moderate-vigorous activity. Classification and regression tree analysis identified a "no difficulty" response to walking up 10 stairs and the ability to walk two to three blocks as the most sensitive questions to predict the presence of a 2-min bout of moderate activity. Participants with positive responses to both questions had a positive likelihood ratio of 3.7 and a posttest probability greater than 90% of a 2-min bout of moderate-vigorous activity. The sensitivity and specificity of positive responses to physical functioning questions in the pruned tree were 0.97 (95% CI, 0.94 to 0.98) and 0.16 (95% CI, 0.10 to 0.23) for training data, and 0.88 (95% CI, 0.75 to 0.96) and 0.10 (95% CI, 0.00 to 0.45) for the test data. Participants with at least one 2-min bout of moderate activity had a greater percentage of overall daily active time (35.4 ± 0.5 vs. 26.7 ± 1.2; P = 0.001) than those without.
Standardized physical function questions are highly sensitive but poorly specific to identify patients who achieve moderate physical activity. Additional strategies to evaluate functional capacity should be considered.
功能能力评估是当前非心脏手术围手术期心血管评估和管理指南的核心组成部分。作者研究了标准化身体功能问题预测参与者是否进行中度体力活动的能力，这种活动是通过髋关节加速度计来衡量的。
从全国健康和营养检查调查（2003 年至 2004 年和 2005 年至 2006 年）中提取参与者对身体功能问题的回答以及他们是否进行中度体力活动的信息。使用髋关节加速度计测量体力活动强度。分析包括至少有一个修订后的心脏风险指数的成年参与者。使用分类和回归树分析评估标准化身体功能问题。使用随机生成的训练和测试数据集来创建和测试分析。
522 名参与者被问及身体功能问题，其中 522 名中的 378 名（72.4%）进行了中度剧烈活动。分类和回归树分析确定，“无困难”地爬上 10 级楼梯和能够走两到三个街区的能力是预测 2 分钟中度活动的最敏感问题。对这两个问题都有阳性反应的参与者的阳性似然比为 3.7，并且进行 2 分钟中度至剧烈活动的后验概率大于 90%。修剪树中对身体功能问题的阳性反应的灵敏度和特异性在训练数据中分别为 0.97（95%CI，0.94 至 0.98）和 0.16（95%CI，0.10 至 0.23），在测试数据中分别为 0.88（95%CI，0.75 至 0.96）和 0.10（95%CI，0.00 至 0.45）。进行至少 2 分钟中度活动的参与者的总日常活动时间百分比（35.4±0.5 比 26.7±1.2；P=0.001）大于未进行的参与者。
标准化身体功能问题对识别进行中度体力活动的患者具有高度的敏感性，但特异性较差。应该考虑使用其他策略来评估功能能力。
