Progression on the Multiple Sclerosis Functional Composite in multiple sclerosis: what is the optimal cut-off for the three components?
Progression on the Multiple Sclerosis Functional Composite in multiple sclerosis: what is the optimal cut-off for the three components?
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DOI：
10.1177/1352458510370464
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发表时间：
2010-07-01
影响因子：
5.8
通讯作者：
Uitdehaag, B. M. J.
中科院分区：
文献类型：
--
作者：
Bosma, L. V. A. E.;Kragt, J. J.;Uitdehaag, B. M. J.
对于定时25英尺步行（T25FW）和9孔立柱试验（9HPT），多发性硬化功能复合评分（MSFC）的组成部分，20%变化的截止点先前已被定义为功能下降的有意义终点。然而，最近引入了MSFC组件的15%变化。本研究的目的是确定所有MSFC组分的最佳临界值，以指示原发性进展型（PP）多发性硬化（MS）人群的临床疾病进展。对161例PPMS患者进行间隔2年的T25FW、9HPT和起搏听觉序列加法试验（PASAT）检查。计算测试分数的绝对和相对差异。对于每个相对变化的临界点，计算进展（恶化超过临界值）和改善（改善超过临界值）的患者比例。此外，我们还计算了“改善”与“进展”患者的比例。创建折线图，显示：进展患者百分比、改善患者百分比以及改善与进展患者的比率。通过搜索改善与进展患者比例最低的截止点，同时捕获大量进展，确定最佳截止点。对于T25 FW和9 HPT，在15%和20%的临界值之间，改善和恶化的患者之间的比率明显下降。对于PASAT，改善和恶化的患者比例持续较差。总之，T25 FW和9 HPT的临界值均为20%，信噪比优于较低值（例如15%），因此更适合评估疾病进展。无法确定令人满意的PASAT临界点。
For the Timed 25-Foot Walk (T25FW) and 9-Hole Peg Test (9HPT), components of the Multiple Sclerosis Functional Composite (MSFC), cut-off points of 20% change have previously been defined as meaningful endpoints of functional decline. Recently, however, a 15% change of MSFC components was introduced. The objective of this study was to determine optimal cut-offs for all MSFC components to indicate clinical disease progression in a primary progressive (PP) multiple sclerosis (MS) population. T25FW, 9HPT and the Paced Auditory Serial Addition Test (PASAT) were performed in 161 patients with PPMS with a 2-year interval. Absolute and relative differences in test scores were calculated. For each cut-off point of relative change, proportions of patients who progressed (deterioration beyond cut-off value) and improved (improvement beyond cut-off value) were calculated. Further, we calculated the ratio of 'improved' versus 'progressed' patients. Line graphs were created indicating: percentage progressed patients, percentage improved patients, and ratio of improved versus progressed patients. The optimal cut-off was determined by searching the cutoff point with the lowest ratio of improved versus progressed patients, while at the same time capturing a substantial amount of progression. For both T25FW and 9HPT, the ratio between patients that improved and worsened clearly decreased between the cut-offs of 15% and 20%. For the PASAT, the ratio between patients improved and worsened was persistently poor. In conclusion, a cut-off of 20% for both T25FW and 9HPT has a better signal-to-noise ratio than lower values (e.g. 15%) and is therefore preferable for the assessment of disease progression. No satisfactory cut-off point for the PASAT could be determined.