Pesser Niels, de Bruijn Britt I, Goeteyn Jens, Verhofstad Nicole, Houterman Saskia, van Sambeek Marc R H M, Thompson Robert W, van Nuenen Bart F L, Teijink Joep A W
Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; CAPHRI School for Public Health and Primary Care, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Department of Vascular Surgery, Catharina Hospital, Eindhoven, The Netherlands; Physical Therapy Sciences, Program in Clinical Health Sciences, University Medical Centre Utrecht, Utrecht, The Netherlands.
J Vasc Surg. 2022 Sep;76(3):821-829.e1. doi: 10.1016/j.jvs.2022.03.885. Epub 2022 May 11.
We developed a standardized elevated arm stress test (sEAST) meter to standardize patients' posture and measure additional grip and fatigue parameters. In the present prospective cohort study, we aimed to determine the reliability and validity of the sEAST in the diagnosis of neurogenic thoracic outlet syndrome (NTOS).
Patients evaluated for NTOS between October 2018 and February 2020 were included and performed the sEAST. The patients were classified into a proven NTOS group or a symptomatic control group using the reporting standards for NTOS and the outcome of thoracic outlet decompression surgery. Healthy persons were recruited as an asymptomatic control group. The test-retest reliability, area under the receiver operating characteristic curve, and positive and negative predictive values were calculated for each sEAST parameter.
A total of 426 patients with suspected NTOS and 147 healthy controls had performed the sEAST. The validity analysis was performed with data from 111 patients with proven NTOS, 94 symptomatic controls, and 147 asymptomatic controls. The reporting standards were inconclusive for 116 patients; 77 patients had been excluded because thoracic outlet decompression surgery had not been performed or was unsuccessful, and 28 because they had arterial or venous thoracic outlet syndrome. The area under the receiver operating characteristic curve for the proven NTOS group compared with the asymptomatic control and symptomatic control groups ranged from 0.59 to 0.77 and 0.54 to 0.63, respectively. The positive predictive value ranged from 46% to 65% and the negative predictive value from 51% to 66%. The test-retest reliability analysis for 80 patients with multiple sEAST measurements showed moderate to good (0.52-0.87) intraclass correlation coefficient values for the duration and grip strength parameters. However, the grip fatigue parameters demonstrated poor (0.46-0.16) intraclass correlation coefficient values.
The sEAST showed good test-retest reliability for the duration and grip strength parameters. However, the discriminative value of all sEAST parameters was low for NTOS diagnostics. The good test-retest reliability of the sEAST parameters indicates that they could be valuable outcome measures for comparison in a diagnostic care pathway.
我们开发了一种标准化的抬臂应力测试（sEAST）仪，以规范患者姿势并测量额外的握力和疲劳参数。在本前瞻性队列研究中，我们旨在确定sEAST在诊断神经源性胸廓出口综合征（NTOS）中的可靠性和有效性。
纳入2018年10月至2020年2月期间接受NTOS评估的患者并进行sEAST测试。根据NTOS报告标准和胸廓出口减压手术结果，将患者分为确诊NTOS组或症状性对照组。招募健康人作为无症状对照组。计算每个sEAST参数的重测信度、受试者操作特征曲线下面积以及阳性和阴性预测值。
共有426例疑似NTOS患者和147例健康对照进行了sEAST测试。对111例确诊NTOS患者、94例症状性对照和147例无症状对照的数据进行了有效性分析。116例患者的报告标准不明确；77例患者因未进行胸廓出口减压手术或手术不成功而被排除，28例因患有动脉或静脉胸廓出口综合征而被排除。确诊NTOS组与无症状对照组和症状性对照组相比，受试者操作特征曲线下面积分别为0.59至0.77和0.54至0.63。阳性预测值为46%至65%，阴性预测值为51%至66%。对80例进行多次sEAST测量的患者进行的重测信度分析显示，持续时间和握力参数的组内相关系数值为中度至良好（0.52 - 0.87）。然而，握力疲劳参数的组内相关系数值较差（0.46 - 0.16）。
sEAST在持续时间和握力参数方面显示出良好的重测信度。然而，所有sEAST参数对NTOS诊断的鉴别价值较低。sEAST参数良好的重测信度表明，它们可能是诊断护理路径中用于比较的有价值的结果指标。
