National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
Acta Neurochir (Wien). 2024 Sep 28;166(1):386. doi: 10.1007/s00701-024-06275-9.
Gait disturbance is one of the features of normal pressure hydrocephalus (NPH) and decompensated long-standing overt ventriculomegaly (LOVA). The timed-up-and-go (TUG) test and the timed-10-m-walking test (10MWT) are frequently used assessments tools for gait and balance disturbances in NPH and LOVA, as well as several other disorders. We aimed to make smart-phone apps which perform both the 10MWT and the TUG-test and record the results for individual patients, thus making it possible for patients to have an objective assessment of their progress. Patients with a suitable smart phone can perform repeat assessments in their home environment, providing a measure of progress for them and for their clinical team.
10MWT and TUG-test were performed by 50 healthy adults, 67 NPH and 10 LOVA patients, as well as 5 elderly patients as part of falls risk assessment using the Watkins2.0 app. The 10MWT was assessed with timed slow-pace and fast-pace. Statistical analysis used SPSS (version 25.0, IBM) by paired t-test, comparing the healthy and the NPH cohorts. Level of precision of the app as compared to a clinical observer using a stopwatch was evaluated using receiver operating characteristics curve.
As compared to a clinical observer using a stopwatch, in 10MWT the app showed 100% accuracy in the measure of time taken to cover distance in whole seconds, 95% accuracy in the number of steps taken with an error ± 1-3 steps, and 97% accuracy in the measure of total distance covered with error of ± 0.25-0.50 m. The TUG test has 100% accuracy in time taken to complete the test in whole seconds, 97% accuracy in the number of steps with an error of ± 1-2 steps and 87.5% accuracy in the distance covered with error of ± 0.50 m. In the measure of time, the app was found to have equal sensitivity as an observer. In measure of number of steps and distance, the app demonstrated high sensitivity and precision (AUC > 0.9). The app also showed significant level of discrimination between healthy and gait-impaired individuals.
'Watkins' and 'Watkins2.0' are efficient apps for objective performance of 10MWT and the TUG-test in NPH and LOVA patients and has application in several other pathologies characterised by gait and balance disturbance.
步态障碍是正常压力脑积水（NPH）和代偿性长期明显脑室扩大（LOVA）的特征之一。计时起立行走测试（TUG）和 10 米步行测试（10MWT）常用于评估 NPH 和 LOVA 以及其他几种疾病的步态和平衡障碍。我们旨在制作可执行 10MWT 和 TUG 测试并记录个别患者结果的智能手机应用程序，从而使患者能够对其进展进行客观评估。有合适智能手机的患者可以在家庭环境中进行重复评估，为他们和他们的临床团队提供进展的衡量标准。
50 名健康成年人、67 名 NPH 患者和 10 名 LOVA 患者以及 5 名作为跌倒风险评估一部分的老年患者使用 Watkins2.0 应用程序进行了 10MWT 和 TUG 测试。10MWT 以计时慢步和快步进行评估。使用 SPSS（版本 25.0，IBM）进行统计学分析，采用配对 t 检验比较健康组和 NPH 组。使用接受者操作特征曲线评估与使用秒表的临床观察者相比，应用程序的精度。
与使用秒表的临床观察者相比，在 10MWT 中，应用程序在测量整个秒数内覆盖距离的时间方面具有 100%的准确性，在测量步数方面具有 95%的准确性，误差为±1-3 步，在测量总距离方面具有 97%的准确性，误差为±0.25-0.50m。TUG 测试在整个秒数内完成测试的时间方面具有 100%的准确性，在步数方面具有 97%的准确性，误差为±1-2 步，在距离方面具有 87.5%的准确性，误差为±0.50m。在测量时间方面，应用程序的灵敏度与观察者相同。在测量步数和距离方面，应用程序表现出高灵敏度和精度（AUC>0.9）。该应用程序还在健康和步态受损个体之间表现出显著的区分水平。
'Watkins'和'Watkins2.0'是用于 NPH 和 LOVA 患者进行 10MWT 和 TUG 测试的高效应用程序，并且在其他几种以步态和平衡障碍为特征的疾病中有应用。
