Liu Xiangxiang, Zhou Mingchao, Zhao Jingpu, Gao Yan, Wang Yao, Zhou Jing, Wan Li, Nie Guohui, Wang Yulong
Department of Rehabilitation, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China.
Department of Rehabilitation, Shenzhen Dapeng New District Nan'ao People's Hospital, Shenzhen, China.
Front Neurol. 2022 Feb 10;13:710852. doi: 10.3389/fneur.2022.710852. eCollection 2022.
The modified Rankin Scale (mRS) and Barthel Index (BI) are widely used to measure functional outcomes worldwide. The Longshi Scale (LS), a novel pictorial-based instrument, was designed to improve the simplicity and convenience of measuring functional outcomes in the Chinese context. However, the disagreements in functional outcomes assessed by the mRS, BI, and LS are misleading, particularly in stroke patients. This study aimed to identify the optimal cutoff scores of LS and BI according to the mRS in Chinese stroke patients with different levels of functional disability.
The mRS, BI, and LS were applied to evaluate functional independence and disability in 7364 stroke patients in a multi-center cross-sectional study. Stroke patients were categorized into bedridden, domestic, and community groups in advance using the LS, indicating severe, moderate, and mild functional disability, respectively. The optimal cut-off scores of the LS and BI according to the mRS were identified via sensitivity, specificity, and Youden's index and stratified by different levels of functional disability determined by LS. We also plotted the receiver operator characteristic (ROC) curves of sensitivity and specificity and determined the area under the curve (AUC).
In the bedridden group, LS and BI cutoff scores with the highest Youden's index were 5 and 10 for mRS 4, and the AUCs for the ROC curve were 0.848 and 0.863 for mRS 4. In the domestic group, LS and BI cutoff scores with the highest Youden's index were 5 and 65 for mRS 3, and the AUCs for the ROC curve were 0.796 and 0.826 for mRS 3. In the community group, LS cutoff scores with the highest sum of sensitivity and specificity were 9, 9, and 8 for mRS grades 0, 1, and 2, respectively, while the BI cutoff scores with the highest sum of sensitivity and specificity were 100, 100, and 95, respectively, while the AUCs for the ROC curve were 0.697 and 0.735 for mRS 2, 0.694 and 0.716 for mRS 1, and 0.628, and 0.660 for mRS 0.
The mRS is more precise to determine mild functional disability, whereas BI can provide more specific information on moderate and severe levels in stroke patients. Although LS was a less precise was to determine moderate and severe levels than BI, it is much simpler and more convenient to be applied to a large-scale population.
改良Rankin量表（mRS）和Barthel指数（BI）在全球范围内被广泛用于衡量功能结局。龙氏量表（LS）是一种新型的基于图片的工具，旨在提高在中国背景下测量功能结局的简便性和便利性。然而，mRS、BI和LS评估的功能结局存在差异，这容易产生误导，尤其是在中风患者中。本研究旨在根据mRS确定中国不同功能残疾水平的中风患者中LS和BI的最佳截断分数。
在一项多中心横断面研究中，应用mRS、BI和LS评估7364例中风患者的功能独立性和残疾情况。使用LS预先将中风患者分为卧床、居家和社区组，分别表示严重、中度和轻度功能残疾。通过敏感性、特异性和约登指数确定根据mRS的LS和BI的最佳截断分数，并根据LS确定的不同功能残疾水平进行分层。我们还绘制了敏感性和特异性的受试者工作特征（ROC）曲线，并确定了曲线下面积（AUC）。
在卧床组中，mRS 4时Youden指数最高的LS和BI截断分数分别为5和10，mRS 4的ROC曲线AUC分别为0.848和0.863。在居家组中，mRS 3时Youden指数最高的LS和BI截断分数分别为5和65，mRS 3的ROC曲线AUC分别为0.796和0.826。在社区组中，mRS 0、1和2级时敏感性和特异性总和最高的LS截断分数分别为9、9和8，而敏感性和特异性总和最高的BI截断分数分别为100、100和95，mRS 2的ROC曲线AUC分别为0.697和0.735，mRS 1的为则0.694和0.716，mRS 0的为0.628和0.660。
mRS在确定轻度功能残疾方面更精确，而BI可以提供关于中风患者中度和重度水平的更具体信息。虽然LS在确定中度和重度水平方面不如BI精确，但它应用于大规模人群要简单得多且更方便。
