Michael Milou R, van Veen Robin, Wieske Luuk, Merkies Ingemar S J, van Schaik Ivo N, Eftimov Filip
Department of Neurology, Amsterdam UMC, University of Amsterdam, Amsterdam Neuroscience, Amsterdam, the Netherlands.
Department of Psychiatry, OLVG Hospital, Amsterdam, the Netherlands.
J Peripher Nerv Syst. 2025 Jun;30(2):e70031. doi: 10.1111/jns.70031.
Validated objective measures for balance in immune mediated neuropathies are lacking. In this study, we investigated the clinimetric properties of posturography using a force platform, a quantitative assessment of postural control.
We assessed patients with chronic inflammatory demyelinating polyneuropathy (CIDP) and IgM-related polyneuropathy (IgM-PNP) using sway parameters (path, area and amplitude) measured at multiple time points. Validity was investigated by assessing differences in sway path between patients with and without reported balance symptoms and by assessing correlations of sway path with (established) impairment measures related to balance, disability and quality of life (QoL). Responsiveness was assessed by means of an anchor-based approach, using a patient anchor and two disability scales.
We included 52 CIDP and 13 IgM-PNP patients. In CIDP, sway path was 25% longer in patients reporting balance symptoms relative to patients without balance symptoms (p = 0.03). There was excellent reliability between consecutive measurements in both CIDP and IgM-PNP. Moderate to good correlations were observed between sway path and an ataxia scale (CIDP: Spearman's ρ = 0.46, 95% CI: 0.2-0.69; IgM-PNP: Spearman's ρ = 0.72, 95% CI: 0.28-0.96) while correlations with related disability measures and QoL were poor. Changes in sway parameters over time were not consistently associated with changes in other outcome measures.
Posturography measurements showed poor validity and responsiveness. Therefore, despite excellent reliability, using a force platform in clinical practice or trials for immune-mediated neuropathies cannot be recommended.
免疫介导性神经病中缺乏经过验证的平衡客观测量方法。在本研究中，我们使用测力平台研究了姿势描记法的临床测量特性，这是一种对姿势控制的定量评估方法。
我们使用在多个时间点测量的摆动参数（路径、面积和幅度）评估慢性炎性脱髓鞘性多发性神经病（CIDP）和IgM相关多发性神经病（IgM-PNP）患者。通过评估有和没有报告平衡症状的患者之间的摆动路径差异，以及评估摆动路径与（已确立的）与平衡、残疾和生活质量（QoL）相关的损伤测量指标之间的相关性来研究有效性。通过基于锚定的方法，使用患者锚定和两个残疾量表评估反应性。
我们纳入了52例CIDP患者和13例IgM-PNP患者。在CIDP中，报告有平衡症状的患者的摆动路径比没有平衡症状的患者长25%（p = 0.03）。CIDP和IgM-PNP的连续测量之间都具有出色的可靠性。摆动路径与共济失调量表之间观察到中度至良好的相关性（CIDP：Spearman's ρ = 0.46，95% CI：0.2-0.69；IgM-PNP：Spearman's ρ = 0.72，95% CI：0.28-0.96），而与相关残疾测量指标和QoL的相关性较差。摆动参数随时间的变化与其他结局测量指标的变化并非始终相关。
姿势描记法测量显示有效性和反应性较差。因此，尽管可靠性出色，但不建议在免疫介导性神经病的临床实践或试验中使用测力平台。
