Sensitivity to changes in disability after stroke: A comparison of four scales useful in clinical trials
Sensitivity to changes in disability after stroke: A comparison of four scales useful in clinical trials
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DOI：
10.1682/jrrd.2003.01.0001
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发表时间：
2003-01-01
影响因子：
--
通讯作者：
Diringer, MN
中科院分区：
文献类型：
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作者：
Dromerick, AW;Edwards, DF;Diringer, MN
尽管目前大多数中风干预试验都使用残疾量表来确定结果，但人们对这些量表变化的敏感性知之甚少。使用更敏感的测量方法将提高康复治疗试验的统计功效。我们将四种著名的残疾量表应用于一组中风康复住院患者，以比较对变化的敏感性。连续 95 名接受中风康复服务的患者在入院和出院时接受了残疾评估。将两种全球量表（改良兰金量表（MRS）和国际卒中试验测量（ISTM））与两种日常生活活动（ADL）量表（巴塞尔指数（BI）和功能独立测量（FIM））进行了比较。我们确定了每种量表检测到临床上显着的残疾变化的患者数量。进行了标准化响应平均值（SRM）和受试者工作特征（ROC）分析。 MRS 检测到 55 名受试者发生了变化，其中包括所有在 ISTM 上发生变化的受试者； ISTM 仅检测到 23 名受试者发生变化。 BI 检测到 71 名受试者的变化，但表现出上限效应，26% 的受试者得分 >95。 FIM 最灵敏，检测到 91 名受试者的变化；没有患者取得最高分。 FIM 的 SRM 优于 BI（2.18 比 1.72），ROC 分析显示 BI 的 C 统计量为 0.82，MRS 为 0.59，ISTM 为 0.51。与 ADL 量表相比，全球量表对残疾变化的敏感度要低得多。尽管 ADL 量表的实施可能需要更长的时间，但其敏感性的提高可能会允许更少的受试者入组，从而使其在治疗试验中更有用。
Although most current stroke intervention trials use disability scales to determine outcome, little is known about the sensitivity to change of these scales. The use of a more sensitive measure would increase the statistical power of rehabilitation treatment trials. We applied four well-known disability scales to a group of stroke rehabilitation inpatients to compare sensitivity to change. Ninety-five consecutive admissions to a stroke rehabilitation service were assessed for disability on admission and discharge. Two global scales, the Modified Rankin Scale (MRS) and the International Stroke Trial Measure (ISTM), were compared with two activities of daily living (ADL) scales, the Barthel Index (BI) and the Functional Independence Measure (FIM). We determined the number of patients that each scale detected a clinically significant change in disability. Standardized response means (SRM) and receiver operating characteristic (ROC) analyses were performed. The MRS detected change in 55 subjects, including all who changed on the ISTM; the ISTM detected change in only 23 subjects. The BI detected change in 71 subjects but demonstrated ceiling effects with 26% of subjects scoring >95. The FIM was most sensitive, detecting change in 91 subjects; no patient achieved a maximum score. The SRM of the FIM was superior to that of the BI (2.18 versus 1.72), and ROC analysis revealed C-statistics of 0.82 for the BI, 0.59 for the MRS, and 0.51 for the ISTM. Global scales were much less sensitive to changes in disability than were ADL scales. Though ADL scales may take longer to administer, their increased sensitivity may make them more useful in treatment trials by allowing fewer subjects to be enrolled.