从中程评分来看，患者确定疾病步骤量表反映了多发性硬化症患者在行走功能障碍方面存在不同程度的差异。
Middle-range scores from the patient determined disease steps scale reflect varying levels of walking dysfunction in multiple sclerosis.
机构信息
Department of Kinesiology and Nutrition, University of Illinois at Chicago, 1919 West Taylor St, Applied Health Sciences Building, Room 506J, Chicago, IL, 60612, USA.
Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, USA.
出版信息
BMC Neurol. 2024 Oct 10;24(1):383. doi: 10.1186/s12883-024-03871-1.
BACKGROUND
Multiple sclerosis (MS) is a leading cause of neurological disability among young and middle-aged adults worldwide, and disability is measured using a variety of approaches, including patient reported outcome measures (PROMs) such as the Patient Determined Disease Steps (PDDS) scale. There is limited evidence for the validity of inferences from the middle-range of scores on the PDDS (i.e., 3 "gait disability" - 6 "bilateral support"), but that range of scores seemingly represents moderate disability characterized by varying levels of walking dysfunction.
PURPOSE
The current study examined whether the middle-range of scores from the PDDS reflect varying levels of walking dysfunction among people with MS.
METHOD
Participants (N = 374) completed the Patient Determined Disease Steps (PDDS) scale, Multiple Sclerosis Walking Scale-12 (MSWS-12), timed 25-foot walk (T25FW), six-minute walk (6 MW), Modified Fatigue Impact Scale (MFIS), and Multiple Sclerosis Impact Scale-29 (MSIS-29), and underwent a neurological exam for generating an Expanded Disability Status Scale (EDSS) score as part of screening and baseline data collection for a clinical trial of exercise training in MS. We undertook a series of linear trend analyses that examined differences in the outcomes of EDSS, T25FW, 6 MW, MSWS-12, MFIS subscales, and MSIS-29 subscales across the 4 levels of PDDS scores (i.e., 3-6).
RESULTS
There were statistically significant and strong linear trends for EDSS (F = 306.1, p < .0001, η = 0.48), T25FW (F = 161.0, p < .0001, η = 0.32), 6 MW (F = 178.9, p < .0001, η = 0.34), and MSWS-12 (F = 97.0, p < .0001, η = 0.24). There was a strong correlation between PDDS and EDSS scores (r = 0.695, 95% CI = 0.643, 0.748). Both PDDS and EDSS scores had strong correlations with walking outcomes, yet weaker correlations with measures of fatigue and QOL.
CONCLUSION
The PDDS could serve as a simple, inexpensive, and rapidly administered PROM for remote screening and early detection of walking dysfunction for initial eligibility into clinical trials and practice for managing mobility-specific disability in MS.
REGISTRATION
The study was registered on ClinicalTrials.gov on March 19, 2018 (NCT03468868).
背景
多发性硬化症（MS）是全球导致年轻和中年人群神经残疾的主要原因，残疾通过多种方法进行评估，包括患者报告的结果测量（PROM），如患者确定疾病步骤（PDDS）量表。PDDS 量表（即 3“步态残疾”-6“双侧支撑”）中得分的中间范围的有效性证据有限，但该得分范围似乎代表了以不同程度的行走功能障碍为特征的中度残疾。
目的
本研究旨在探讨 PDDS 量表的中间范围是否反映了 MS 患者行走功能障碍的不同程度。
方法
参与者（N=374）完成了 PDDS 量表、多发性硬化症行走量表-12（MSWS-12）、25 英尺步行计时（T25FW）、6 分钟步行（6MW）、改良疲劳影响量表（MFIS）和多发性硬化症影响量表-29（MSIS-29），并接受了神经学检查，以生成扩展残疾状态量表（EDSS）评分，作为一项针对多发性硬化症运动训练的临床试验的筛选和基线数据收集的一部分。我们进行了一系列线性趋势分析，以研究 PDDS 评分的 4 个水平（即 3-6）在 EDSS、T25FW、6MW、MSWS-12、MFIS 子量表和 MSIS-29 子量表方面的差异。
结果
EDSS（F=306.1，p<0.0001，η=0.48）、T25FW（F=161.0，p<0.0001，η=0.32）、6MW（F=178.9，p<0.0001，η=0.34）和 MSWS-12（F=97.0，p<0.0001，η=0.24）的线性趋势均具有统计学意义和强度。PDDS 与 EDSS 评分之间存在很强的相关性（r=0.695，95%CI=0.643，0.748）。PDDS 和 EDSS 评分均与步行结果具有很强的相关性，但与疲劳和生活质量的测量值相关性较弱。
结论
PDDS 可以作为一种简单、廉价且快速管理的 PROM，用于远程筛选和早期发现行走功能障碍，以初步确定临床试验和管理 MS 中特定于移动性的残疾的入选资格。
注册
该研究于 2018 年 3 月 19 日在 ClinicalTrials.gov 上注册（NCT03468868）。
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