步态失衡测试：一种用于筛查头晕和失衡成人的新方法。
The Gait Disorientation Test: A New Method for Screening Adults With Dizziness and Imbalance.
机构信息
School of Medicine and Public Health, Department of Surgery, University of Wisconsin-Madison, Madison, WI; Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI.
Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI.
出版信息
Arch Phys Med Rehabil. 2021 Apr;102(4):582-590. doi: 10.1016/j.apmr.2020.11.010. Epub 2020 Dec 15.
OBJECTIVE
To develop and evaluate a new method for identifying gait disorientation due to vestibular dysfunction.
DESIGN
The gait disorientation test (GDT) involves a timed comparison of the ability to walk 6.096 m with eyes open versus eyes closed. In this prospective study, participants were grouped based on vestibular function. All participants completed a clinical examination, self-report- and performance-based measures relevant to vestibular rehabilitation, and the tasks for the GDT. Vestibular-impaired participants underwent the criterion standard, videonystagmography and/or rotational chair testing.
SETTING
Ambulatory clinic, tertiary referral center.
PARTICIPANTS
Participants (N=40) (20 vestibular-impaired, 30 women, 49.9±16.1years old) were enrolled from a convenience/referral sample of 52 adults.
MAIN OUTCOME AND MEASURE(S): We determined test-retest reliability using the intraclass correlation coefficient model 3,1; calculated the minimal detectable change (MDC); examined concurrent validity through Spearman correlation coefficients; assessed criterion validity with the area under the curve (AUC) from receiver operator characteristic analysis; and computed the sensitivity, specificity, diagnostic odds ratio (DOR), likelihood ratios for positive (LR+) and negative (LR-) tests, and posttest probabilities of a diagnosis of vestibulopathy. The 95% confidence interval demonstrates measurement uncertainty.
RESULTS
Test-retest reliability was 0.887 (0.815, 0.932). The MDC was 3.7 seconds. Correlations with other measures ranged from 0.59 (0.34, 0.76) to -0.85 (-0.92, -0.74). The AUC was 0.910 (0.822, 0.998), using a threshold of 4.5 seconds. The sensitivity and specificity were 0.75 (0.51, 0.91) and 0.95 (0.75, 1), respectively. The DOR=57 (6, 541.47), LR+ =15 (2.18, 103.0), and LR- =0.26 (0.12, 0.9). Positive posttest probabilities were 89%-94%.
CONCLUSIONS AND RELEVANCE
The GDT has good reliability, excellent discriminative ability, strong convergent validity, and promising clinical utility.
目的
开发并评估一种新的方法，用于识别因前庭功能障碍导致的步态定向障碍。
设计
步态定向测试（GDT）涉及比较睁眼和闭眼状态下 6.096 米行走能力的计时测试。在这项前瞻性研究中，参与者根据前庭功能分组。所有参与者都完成了临床检查、与前庭康复相关的自我报告和表现评估，以及 GDT 任务。前庭功能障碍参与者接受了标准的视频眼震图和/或转椅测试。
地点
门诊诊所，三级转诊中心。
参与者
参与者（N=40）（20 名前庭功能障碍者，30 名女性，49.9±16.1 岁）是从 52 名成人的便利/转诊样本中招募的。
主要结果和测量指标
我们使用组内相关系数模型 3,1 确定测试-重测信度；计算最小可检测变化（MDC）；通过 Spearman 相关系数评估同时效度；使用接收器操作特征分析的曲线下面积（AUC）评估标准效度；计算诊断为前庭病的敏感性、特异性、诊断优势比（DOR）、阳性（LR+）和阴性（LR-）测试的似然比，以及诊断后概率。95%置信区间表示测量不确定性。
结果
测试-重测信度为 0.887（0.815，0.932）。MDC 为 3.7 秒。与其他测量指标的相关性范围为 0.59（0.34，0.76）至-0.85（-0.92，-0.74）。AUC 为 0.910（0.822，0.998），阈值为 4.5 秒。敏感性和特异性分别为 0.75（0.51，0.91）和 0.95（0.75，1）。DOR=57（6，541.47），LR+=15（2.18，103.0），LR-=0.26（0.12，0.9）。阳性后验概率为 89%-94%。
结论和相关性
GDT 具有良好的可靠性、出色的判别能力、较强的收敛效度和有前景的临床实用性。
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