Davis Alexander, Yasar Sevil, Emerman Iris, Gulyani Seema, Khingelova Kristina, Rao Aruna, Manthripragada Lacie, Luciano Mark, Moghekar Abhay
Department of Neurology, Johns Hopkins University School of Medicine, 5200 Eastern Ave CTR STE 5100, Baltimore, MD, 21224, USA.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
BMC Neurol. 2020 Apr 16;20(1):140. doi: 10.1186/s12883-020-01719-y.
Presently, for patients presenting with suspected Normal Pressure Hydrocephalus (NPH) who undergo temporary drainage of cerebrospinal fluid (CSF) there is no defined model to differentiate chance improvement form clinical significance change at the individual patient level. To address this lack of information we computed standard regression based clinical change models for the 10 Meter Walk Test, Timed Up & Go, Dual Timed Up & Go, 6-Minute Walk Test, Mini-Balance Evaluation Systems Test, Montreal Cognitive Assessment, and Symbol Digit Modalities using data from patients with suspected NPH that underwent temporary drainage of CSF. These clinically significant change modes can classify clinically significant improvement following temporary drainage of CSF at the individual patient level. This allows for physicians to differentiate a clinically significant improvement in symptoms from chance improvement.
Data was collected from 323 patients, over the age of 60, with suspected NPH that underwent temporary drainage of CSF with corresponding gait and cognitive testing. McSweeney Standardized Regression Based Clinical Change Models were computed for standard gait and cognitive measures: Timed Up & Go, Dual Timed Up & Go, 10 Meter Walk Test, MiniBESTest, 6-Minute Walk Test, Montreal Cognitive Assessment, and Symbol Digit Modalities Test. To assess the discriminate validity of the measures we used correlations, Chi, and regression analyses.
The clinical change models explained 69-91.8% of the variability in post-drain performance (p < 0.001). As patient scores became more impaired, the percent change required for improvement to be clinically significant increased for all measures. We found that the measures were not discriminate, the Timed Up & Go was highly related to the 10 Meter Walk Test (r = 0.85, R = 0.769-0.738, p < 0.001), MiniBESTest (r = - 0.67, R = 0.589-0.734, p < 0.001), and 6 Minute Walk Test (r = - 0.77, R = 0.71-0.734, p < 0.001).
Standardized Regression Based Clinically Significant Change Models allow for physicians to use an evidence-based approach to differentiate clinically significant change from chance improvement at the individual patient level. The Timed Up & Go was shown to be predictive of detailed measures of gait velocity, balance, and endurance.
目前，对于疑似正常压力脑积水（NPH）且接受脑脊液（CSF）临时引流的患者，在个体患者层面上，尚无明确模型来区分偶然改善与具有临床意义的变化。为解决这一信息缺失问题，我们利用疑似NPH且接受CSF临时引流患者的数据，计算了基于标准回归的10米步行试验、定时起立行走测试、双重定时起立行走测试、6分钟步行试验、简易平衡评估系统测试、蒙特利尔认知评估和符号数字模式测试的临床变化模型。这些具有临床意义的变化模型能够在个体患者层面上对CSF临时引流后的具有临床意义的改善进行分类。这使得医生能够区分症状的具有临床意义的改善与偶然改善。
收集了323名60岁以上疑似NPH且接受CSF临时引流并进行相应步态和认知测试的患者的数据。针对标准步态和认知测量指标（定时起立行走测试、双重定时起立行走测试、10米步行试验、简易平衡评估系统测试、6分钟步行试验、蒙特利尔认知评估和符号数字模式测试）计算了基于麦克休尼标准化回归的临床变化模型。为评估这些测量指标的区分效度，我们进行了相关性分析、卡方分析和回归分析。
临床变化模型解释了引流后表现中69% - 91.8%的变异性（p < 0.001）。随着患者得分受损程度增加，所有测量指标中具有临床意义的改善所需的百分比变化也增加。我们发现这些测量指标缺乏区分性，定时起立行走测试与10米步行试验高度相关（r = 0.85，R = 0.769 - 0.738，p < 0.001）、与简易平衡评估系统测试相关（r = -0.67，R = 0.589 - 0.734，p < 0.001）以及与6分钟步行试验相关（r = -0.77，R = 0.71 - 0.734，p < 0.001）。
基于标准化回归的具有临床意义的变化模型使医生能够采用循证方法在个体患者层面上区分具有临床意义的变化与偶然改善。定时起立行走测试被证明可预测步态速度、平衡和耐力的详细测量指标。
