Longitudinal patient-oriented outcomes in neuropathy Importance of early detection and falls
Longitudinal patient-oriented outcomes in neuropathy Importance of early detection and falls
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DOI：
10.1212/wnl.0000000000001714
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发表时间：
2015-07-07
期刊：
影响因子：
9.9
通讯作者：
Feldman, Eva
中科院分区：
文献类型：
--
作者：
Callaghan, Brian;Kerber, Kevin;Feldman, Eva
目的：评价周围神经病变患者在诊断前后14年的纵向预后。方法：1996-2007年健康与退休研究(HRS)-医疗保险索赔关联数据库确定了bb0 = 65岁患者的周围神经病变病例（ICD-9代码）。使用来自HRS和Medicare索赔的详细人口统计信息，倾向评分方法确定了没有神经病变的匹配对照组。以患者为导向的结果，重点是自我报告的跌倒、疼痛和自我评估的健康状况（HRS访谈），在神经病变诊断前后确定。使用广义估计方程来评估病例和对照组之间纵向结果的差异。结果：我们确定了953例周围神经病变病例和953例倾向匹配的对照组。病例的平均（SD）年龄为77.4（6.7）岁，对照组为76.9（6.6）岁，42.1%患有糖尿病。在神经病变诊断前3.0年（病例vs对照组，32% vs 25%, p = 0.008），疼痛诊断前5.0年（36% vs 27%, p = 0.002），自我评价健康良好至优秀的健康诊断前5.0年（61% vs 74%, p < 0.0001），均存在差异。随着时间的推移，与对照组相比，神经病变病例中跌倒的比例增加得更快（p = 0.002），但在疼痛（p = 0.08）或自评健康（p = 0.9）方面没有观察到差异。结论：在老年人中，可以在周围神经病变诊断前3-5年检测到跌倒、疼痛和自评健康状况的差异，但与对照组相比，随着时间的推移，神经病变病例中只有跌倒恶化得更快。干预措施，以提高早期周围神经病变的检测是必要的，未来的临床试验应纳入跌倒作为一个关键的病人导向的结果。
Objective:To evaluate longitudinal patient-oriented outcomes in peripheral neuropathy over a 14-year time period including time before and after diagnosis.Methods:The 1996-2007 Health and Retirement Study (HRS)-Medicare Claims linked database identified incident peripheral neuropathy cases (ICD-9 codes) in patients >= 65 years. Using detailed demographic information from the HRS and Medicare claims, a propensity score method identified a matched control group without neuropathy. Patient-oriented outcomes, with an emphasis on self-reported falls, pain, and self-rated health (HRS interview), were determined before and after neuropathy diagnosis. Generalized estimating equations were used to assess differences in longitudinal outcomes between cases and controls.Results:We identified 953 peripheral neuropathy cases and 953 propensity-matched controls. The mean (SD) age was 77.4 (6.7) years for cases, 76.9 (6.6) years for controls, and 42.1% had diabetes. Differences were detected in falls 3.0 years before neuropathy diagnosis (case vs control; 32% vs 25%, p = 0.008), 5.0 years for pain (36% vs 27%, p = 0.002), and 5.0 years for good to excellent self-rated health (61% vs 74%, p < 0.0001). Over time, the proportion of fallers increased more rapidly in neuropathy cases compared to controls (p = 0.002), but no differences in pain (p = 0.08) or self-rated health (p = 0.9) were observed.Conclusions:In older persons, differences in falls, pain, and self-rated health can be detected 3-5 years prior to peripheral neuropathy diagnosis, but only falls deteriorates more rapidly over time in neuropathy cases compared to controls. Interventions to improve early peripheral neuropathy detection are needed, and future clinical trials should incorporate falls as a key patient-oriented outcome.