Parcetich Kevin M, Miner Daniel G, Paul Arco, Wildman Lane
Department of Physical Therapy, Radford University Carilion, 101 Elm Ave., 8 Floor, Roanoke, VA 24013, United States of America.
Dialogues Health. 2022 Sep 15;1:100043. doi: 10.1016/j.dialog.2022.100043. eCollection 2022 Dec.
This study investigated the diagnostic accuracy of different clusters of performance based outcome measures (PBOMs) recommended by two consensus-based guidelines: Stopping Elderly Accidents, Deaths, and Injuries (STEADI), and those recommended by a systematic review completed by the American Physical Therapy Association and Academy of Geriatric Physical Therapy (APTA-SR, APTA-SR3). 33 community-dwelling older adults (25 females, 8 males) aged mean 79.45 ± 7.64 years participated in this study. Participants completed a fall history questionnaire and were evaluated via a battery of PBOMs for comparative analysis. The diagnostic accuracy of each PBOM cluster was analyzed retrospectively (previous 1 year fall history) and prospectively (6 month follow up). Retrospective analysis revealed the APTA-SR3 had the highest clinical utility and diagnostic accuracy: Sp 88.24% (63.56-98.54), Sn 62.5% (35.43-84.8), LR+ 2.35 (1.22-4.53), LR- 0.19 (0.05-0.73), accuracy 70.22% (51.83-84.81). Prospective analysis revealed the cluster of the APTA-SR and APTA-SR3 had identical diagnostic accuracy: Sn 100% (39.76-100), Sp 43.75% (19.75-70.12), LR+ 1.78 (1.15-2.74), LR- 0 (0), accuracy 60.62% (36.63-81.36). The APTA-SR 3 cluster demonstrated the highest diagnostic accuracy and in this study was the most effective and efficient group of PBOMs to identify fall risk in community dwelling older adults.
本研究调查了基于两项基于共识的指南推荐的不同组基于表现的结局指标（PBOMs）的诊断准确性：预防老年人意外、死亡和受伤（STEADI），以及美国物理治疗协会和老年物理治疗学会完成的一项系统评价推荐的指标（APTA-SR、APTA-SR3）。33名社区居住的老年人（25名女性，8名男性）参与了本研究，平均年龄为79.45±7.64岁。参与者完成了一份跌倒史问卷，并通过一系列PBOMs进行评估以进行比较分析。对每个PBOMs组的诊断准确性进行了回顾性分析（过去1年的跌倒史）和前瞻性分析（6个月随访）。回顾性分析显示，APTA-SR3具有最高的临床效用和诊断准确性：特异度88.24%（63.56-98.54），敏感度62.5%（35.43-84.8），阳性似然比2.35（1.22-4.53），阴性似然比0.19（0.05-0.73），准确率70.22%（51.83-84.81）。前瞻性分析显示，APTA-SR和APTA-SR3组具有相同的诊断准确性：敏感度100%（39.76-100），特异度43.75%（19.75-70.12），阳性似然比1.78（1.15-2.74），阴性似然比0（0），准确率60.62%（36.63-81.36）。APTA-SR3组显示出最高的诊断准确性，在本研究中是识别社区居住老年人跌倒风险最有效和高效的PBOMs组。
