Semmes-Weinstein单丝试验和拇指定位试验在脑卒中患者中的效度和信度
Validity and Reliability of the Semmes-Weinstein Monofilament Test and the Thumb Localizing Test in Patients With Stroke.
作者信息
Suda Mabu, Kawakami Michiyuki, Okuyama Kohei, Ishii Ryota, Oshima Osamu, Hijikata Nanako, Nakamura Takuya, Oka Asako, Kondo Kunitsugu, Liu Meigen
机构信息
Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.
Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Japan.
出版信息
Front Neurol. 2021 Jan 27;11:625917. doi: 10.3389/fneur.2020.625917. eCollection 2020.
Somatosensory impairment is common in patients who have had a stroke and can affect their motor function and activities of daily living (ADL). Therefore, detecting and treating somatosensory impairments properly is considered to be very important, and various examinations have been developed. However, the reliability and validity of few of them have been verified due to differences in the procedure of each examiner or poor quantification by the examination itself. We hypothesized that, with fixed procedures two convenient clinical examinations, the Semmes-Weinstein Monofilament Test (SWMT) and the Thumb Localizing Test (TLT), could provide reliable assessments of light touch sensation and proprioception. The purpose of this study was to verify the reliability and validity of these two examinations as indices of somatosensory impairment of the upper extremity (UE) in patients with chronic post-stroke hemiparesis. Fifty patients with chronic stroke (median time after onset of stroke, 848 [474-1708] days, mean age 57 [standard deviation 14] years) were enrolled at Keio University Hospital from 2017 to 2018. Examiners learned the original method of the SWMT and the TLT rigorously and shared it with each other. The TLT procedure was partially modified by dividing the location of the patient's thumb into four spaces. Two examiners evaluated the SWMT and the TLT for 2 days, and intra-rater and inter-rater reliabilities were calculated using weighted kappa statistics. In addition to this, the evaluator size score of the SWMT was assessed with Bland-Altman analysis to evaluate systematic bias. The Stroke Impairment Assessment Set (SIAS) sensory items were used to assess validity, and Spearman's rank correlation coefficients were calculated. Intra/inter-rater agreements of the SWMT grade score were 0.89 (thumb, 95%CI: 0.83-0.95)/ 0.75 (0.60-0.91) and 0.80 (index finger, 0.67-0.93)/0.79 (0.66-0.92), and of the TLT they were 0.83 (navel level proximal space, 0.71-0.95)/ 0.83 (0.73-0.92), 0.90 (navel level distal space, 0.85-0.96)/ 0.80 (0.69-0.90), 0.80 (shoulder level proximal space, 0.68-0.92)/ 0.77 (0.65-0.89), and 0.87 (shoulder level distal space, 0.80-0.93)/ 0.80 (0.68-0.92) ( < 0.001, each item). All of them showed substantial agreement, but the MDC of the SWMT evaluator size was 1.28 to 1.79 in the inter-rater test and 1.94-2.06 in the intra-rater test. The SWMT grade score showed a strong correlation with the SIAS light touch sensation item ( = 0.65, < 0.001), as did the TLT with the SIAS position sense item ( = -0.70-0.62, < 0.001 each space). The reliability and validity of the SWMT and the TLT were verified. These tests can be used as reliable sensory examinations of the UE in patients with chronic stroke, and especially for the SWMT, it is more reliable for screening.
体感障碍在中风患者中很常见,会影响他们的运动功能和日常生活活动(ADL)。因此,正确检测和治疗体感障碍被认为非常重要,并且已经开发了各种检查方法。然而,由于每个检查者的操作程序不同或检查本身的量化不佳,其中很少有方法的可靠性和有效性得到验证。我们假设,通过固定程序的两种便捷临床检查,即Semmes-Weinstein单丝试验(SWMT)和拇指定位试验(TLT),可以对轻触觉和本体感觉进行可靠评估。本研究的目的是验证这两种检查作为慢性中风后偏瘫患者上肢(UE)体感障碍指标的可靠性和有效性。2017年至2018年,50例慢性中风患者(中风发病后的中位时间为848 [474 - 1708]天,平均年龄57 [标准差14]岁)在庆应义塾大学医院入组。检查者严格学习了SWMT和TLT的原始方法并相互分享。TLT程序进行了部分修改,将患者拇指的位置分为四个区域。两名检查者对SWMT和TLT进行了为期2天的评估,并使用加权kappa统计量计算了评分者内和评分者间的可靠性。除此之外,通过Bland-Altman分析评估SWMT的评估者大小评分,以评估系统偏差。使用中风损伤评估量表(SIAS)的感觉项目来评估有效性,并计算Spearman等级相关系数。SWMT等级评分的评分者内/间一致性在拇指处为0.89(95%CI:0.83 - 0.95)/ 0.75(0.60 - 0.91),在食指处为0.80(0.67 - 0.93)/0.79(0.66 - 0.92);TLT在脐水平近端区域为0.83(0.71 - 0.95)/ 0.83(0.73 - 0.92),在脐水平远端区域为0.90(0.85 - 0.96)/ 0.80(0.69 - 0.90),在肩部水平近端区域为0.80(0.68 - 0.92)/ 0.77(0.65 - 0.89),在肩部水平远端区域为0.87(0.80 - 0.93)/ 0.80(0.68 - 0.92)(每项<0.001)。所有结果均显示出高度一致性,但SWMT评估者大小的最小可检测变化(MDC)在评分者间测试中为1.28至1.79,在评分者内测试中为1.94 - 2.06。SWMT等级评分与SIAS轻触觉项目显示出强相关性(= 0.65,< 0.001),TLT与SIAS位置觉项目在每个区域也显示出强相关性(= -0.70 - 0.62,每个区域< 0.001)。SWMT和TLT的可靠性和有效性得到了验证。这些测试可作为慢性中风患者UE可靠的感觉检查,特别是对于SWMT,在筛查方面更可靠。