Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong.
Centre for Eye and Vision Research (CEVR), The Hong Kong Polytechnic University, Kowloon, Hong Kong.
PM R. 2023 Jun;15(6):742-750. doi: 10.1002/pmrj.12826. Epub 2022 Jul 8.
Balance deficits are common in cerebellar ataxia. Determining which balance outcome measures are psychometrically strong for this population remains an unmet need.
To evaluate the validity and responsiveness of two clinic-based balance measures (Berg Balance Scale [BBS] and balance sub-component of the Scale for the Assessment and Rating of Ataxia [SARA-bal]) and two laboratory-based balance measures (Sensory Organization Test [SOT] and Limits of Stability [LOS]) in cerebellar ataxia.
Prospective cohort study.
Institutional study assessing 40 participants with cerebellar ataxia at baseline, and 6 and 12 months.
Balance was assessed using the BBS, SARA-bal, SOT, and LOS; disease severity was assessed using the SARA; and Patients' Global Impression of Change (PGIC) was used to estimate responsiveness to disease progress at 6 and 12 months.
BBS and SARA-bal (Spearman's correlation coefficient, ρS = -0.89, p < .01) demonstrated strong criterion validity. Convergent validity was moderate to high (ρS range: -0.75 to 0.92) and external validity was low (ρS range: -0.75 to 0.11). Composite SOT scores (SOT-COM; ρS = 0.29, p < .01) and maximal excursion (MXE-LOS) in the forward (F) and right (R) directions of the LOS (ρS = 0.18, p < .01) demonstrated moderate to low criterion and convergent validity. The area under the receiver-operating characteristic curve (AUC ) and its effect size (standard response mean [SRM]) for categorizing "stable" and "worsened" patients at 6 and 12 months were satisfactory for the BBS (AUC : 0.75; SRM-Stable: 1.06; SRM-Worsened: 1.16), SARA-bal (AUC : 0.76; SRM-Stable: 0.86; SRM-Worsened: 0.85), and MXE-LOS(R) (AUC : 0.29; SRM-Stable: 0.41; SRM-Worsened: 1.39).
BBS and SARA-bal have moderate to strong criterion and convergent validity and adequate responsiveness to balance changes. Both laboratory-based measures (SOT and LOS) demonstrated a high floor effect. The SOT-COM and MXE-LOS(R) demonstrated moderate to low criterion validity, with only the MXE-LOS(R) displaying adequate responsiveness to balance changes after 6 and 12 months.
小脑性共济失调患者常存在平衡缺陷。确定哪些平衡结果测量指标在该人群中具有良好的心理测量学特性仍然是一个未满足的需求。
评估两种基于临床的平衡测量方法（Berg 平衡量表[BBS]和共济失调评定量表[Scale for the Assessment and Rating of Ataxia，SARA]的平衡子量表[SARA-bal]）以及两种基于实验室的平衡测量方法（感觉组织测试[Sensory Organization Test，SOT]和稳定性极限测试[Limits of Stability，LOS]）在小脑性共济失调中的有效性和反应度。
前瞻性队列研究。
机构评估 40 名小脑性共济失调患者的基线、6 个月和 12 个月的平衡情况；采用 SARA 评估疾病严重程度；采用患者整体印象变化量表（Patients' Global Impression of Change，PGIC）评估 6 个月和 12 个月时疾病进展的反应度。
使用 BBS、SARA-bal、SOT 和 LOS 评估平衡；使用 SARA 评估疾病严重程度；使用患者整体印象变化量表（Patients' Global Impression of Change，PGIC）评估 6 个月和 12 个月时的反应度。
BBS 和 SARA-bal（Spearman 相关系数，ρS=-0.89，p<0.01）具有较强的标准效度。聚合效度为中度到高度（ρS 范围：-0.75 至 0.92），外部效度较低（ρS 范围：-0.75 至 0.11）。综合 SOT 评分（SOT-COM；ρS=0.29，p<0.01）和 LOS 最大偏移（MXE-LOS）在 LOS 的前向（F）和右侧（R）方向（ρS=0.18，p<0.01）表现出中度到低度的标准和聚合效度。6 个月和 12 个月时用于分类“稳定”和“恶化”患者的受试者工作特征曲线（receiver operating characteristic curve，ROC）下面积（area under the curve，AUC）及其效应量（标准反应均值[standard response mean，SRM]）对于 BBS（AUC：0.75；SRM-Stable：1.06；SRM-Worsened：1.16）、SARA-bal（AUC：0.76；SRM-Stable：0.86；SRM-Worsened：0.85）和 MXE-LOS（R）（AUC：0.29；SRM-Stable：0.41；SRM-Worsened：1.39）是令人满意的。
BBS 和 SARA-bal 具有中度到高度的标准和聚合效度，对平衡变化具有足够的反应度。两种基于实验室的测量方法（SOT 和 LOS）都表现出较高的地板效应。SOT-COM 和 MXE-LOS（R）表现出中度到低度的标准效度，只有 MXE-LOS（R）在 6 个月和 12 个月后显示出对平衡变化的足够反应度。
