University of Technology Sydney, Graduate School of Health, Discipline of Physiotherapy, Sydney, Australia; Utrecht University, University Medical Center Utrecht, Physical Therapy Sciences, program in Clinical Health Sciences, Utrecht, the Netherlands.
University of Technology Sydney, Graduate School of Health, Discipline of Physiotherapy, Sydney, Australia.
J Clin Epidemiol. 2021 Sep;137:73-82. doi: 10.1016/j.jclinepi.2021.03.022. Epub 2021 Mar 31.
To externally validate recent prognostic models that predict independent gait following stroke.
A systematic search identified recent models (<10 years) that predicted independent gait in adult stroke patients, using easily obtainable predictors. Predictors from the original models were assigned proxies when required, and model performance was evaluated in the validation cohort (n = 957). Models were updated to determine if performance could be improved.
Three prognostic models met our criteria, all with high Risk of Bias. Validation data was only available for the Australian model. This model used National Institute of Health Stroke Scale (NIHSS) and age to predict independent gait, using Motor Assessment Scale (MAS) walking item. For validation, Scandinavian Stroke Scale (SSS) was a proxy for NIHSS, and Functional Independence Measure (FIM) locomotion item was a proxy for MAS. The Area Under the Curve was 0.77 (0.74-0.80) and had good calibration in the validation dataset. Adjustment of the intercept and regression coefficients slightly improved discrimination. By adding paretic leg strength, the model further improved (AUC 0.82).
External validation of the Australian model with proxies showed fair discrimination and good calibration. Updating the model by adding paretic leg strength further improved model performance.
对外验证近期预测脑卒中后独立行走的预后模型。
系统检索确定了近期（<10 年）使用易于获得的预测因素预测成人脑卒中患者独立行走的模型。当需要时，为原始模型中的预测因子指定了替代物，并在验证队列（n=957）中评估了模型性能。更新了模型以确定是否可以提高性能。
有 3 个符合标准的预后模型，均具有较高的偏倚风险。只有澳大利亚模型的验证数据可用。该模型使用国立卫生研究院卒中量表（NIHSS）和年龄来预测独立行走，使用运动评估量表（MAS）行走项目。在验证中，斯堪的纳维亚卒中量表（SSS）是 NIHSS 的替代物，功能独立性测量（FIM）运动项目是 MAS 的替代物。曲线下面积为 0.77（0.74-0.80），在验证数据集中有较好的校准。调整截距和回归系数可略微提高判别能力。通过添加患侧腿力量，该模型进一步得到改善（AUC 0.82）。
使用替代物对澳大利亚模型进行外部验证表明，该模型具有良好的判别能力和校准能力。通过添加患侧腿力量，进一步提高了模型的性能。
