A comparison of clinical and objective measures of freezing of gait in Parkinson's disease
A comparison of clinical and objective measures of freezing of gait in Parkinson's disease
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DOI：
10.1016/j.parkreldis.2012.03.001
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发表时间：
2012-06-01
影响因子：
4.1
通讯作者：
Moore, Steven T.
中科院分区：
文献类型：
--
作者：
Morris, Tiffany R.;Cho, Catherine;Moore, Steven T.
步态冻结，一种阵发性运动阻滞，在帕金森病的后期很常见。目前评估冻结严重程度的“黄金标准”是基于临床识别（最多3名评分员）的视频片段数量。本研究的目的是系统地评估多个帕金森病中心的“金标准”，并将这些临床评级与下肢加速度数据的客观测量进行比较。视频记录是在10名帕金森病患者（有临床冷冻史）在“关闭”状态下进行定时上升和前进任务期间获得的。患者在每个小腿的侧面装有加速度计。从四个帕金森病中心招募了十名经验丰富的临床医生，以独立评估冻结事件的数量和持续时间的视频。临床视频评估冻结事件数量的可靠性为中等（组内相关系数0.63）。冻结时间百分比（冻结事件的累积持续时间/行走任务的总持续时间）显示评分者之间的一致性更高（0.73）。与平均临床医生评级的冻结严重程度的加速度计衍生措施的协议是强大的发作次数（0.78）和冻结时间百分比非常强（0.93）。结果证明了冷冻客观测量的可行性，并且冷冻时间百分比是比临床和客观测量的冷冻事件数量更可靠的严重性度量。临床医生之间的较大变异性表明，在比较各中心的主观评级时应谨慎。(C)2012爱思唯尔有限公司保留所有权利。
Freezing of gait, a paroxysmal motor block, is common in the latter stages of Parkinson's disease. The current 'gold standard' of assessing the severity of freezing is based on clinical identification (by up to 3 raters) of the number of episodes from video. The aims of this study were to systematically assess this 'gold standard' across multiple Parkinson's disease centers, and to compare these clinical ratings with objective measures derived from lower limb acceleration data. Video recordings were acquired during a timed up-and-go task from 10 Parkinson's disease patients (with a clinical history of freezing) in the 'off' state. Patients were instrumented with accelerometers on the lateral aspect of each shank. Ten experienced clinicians were recruited from four Parkinson's disease centers to independently assess the videos for number and duration of freezing events. The reliability of clinical video assessment for number of freezing events was moderate (intraclass correlation coefficient 0.63). Percent time frozen (cumulative duration of freezing episodes/total duration of the walking task) demonstrated stronger agreement between raters (0.73). Agreement of accelerometry-derived measures of freezing severity with mean clinician ratings was strong for number of episodes (0.78) and very strong for percent time frozen (0.93). The results demonstrate the viability of objective measures of freezing, and that percent time frozen is a more reliable metric of severity than number of freezing events for both clinical and objective measures. The large variability between clinicians suggests that caution should be used when comparing subjective ratings across centers. (C) 2012 Elsevier Ltd. All rights reserved.