Department of Neurology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
J Neural Transm (Vienna). 2024 Nov;131(11):1295-1305. doi: 10.1007/s00702-024-02783-1. Epub 2024 Jul 15.
Several screening tools are available to assist general neurologists in the timely identification of patients with advanced Parkinson's disease (PD) who may be eligible for referral for a device-aided therapy (DAT). However, it should be noted that not all of these clinical decision rules have been developed and validated in a thorough and consistent manner. Furthermore, only a limited number of head-to-head comparisons have been performed. Available studies suggest that D-DATS has a higher positive predictive value and higher specificity than the 5-2-1 criteria, while the sensitivity of both screening tools is similar. However, unanswered questions remain regarding the validity of the decision rules, such as whether the diagnostic performance measures from validation studies are generalizable to other populations. Ultimately, the question is whether a screening tool will effectively and efficiently improve the quality of life of patients with PD. To address this key question, an impact analysis should be performed. The authors intend to set up a multinational cluster randomised controlled trial to compare the D-DATS and 5-2-1 criteria on the downstream consequences of implementing these screening tools, with a particular focus on the impact on disability and quality of life.
有几种筛选工具可帮助一般神经科医生及时识别可能有资格接受设备辅助治疗 (DAT) 的晚期帕金森病 (PD) 患者。然而，需要指出的是，并非所有这些临床决策规则都是以全面和一致的方式制定和验证的。此外，仅进行了有限数量的头对头比较。现有研究表明，D-DATS 的阳性预测值和特异性均高于 5-2-1 标准，而两种筛选工具的敏感性相似。然而，关于决策规则的有效性仍存在一些悬而未决的问题，例如验证研究中的诊断性能指标是否可以推广到其他人群。最终的问题是筛选工具是否能够有效地提高 PD 患者的生活质量。为了解决这个关键问题，应该进行影响分析。作者打算设立一项多国家的集群随机对照试验，比较 D-DATS 和 5-2-1 标准在实施这些筛选工具后的下游后果，特别关注对残疾和生活质量的影响。
