An analysis of 2-day cardiopulmonary exercise testing to assess unexplained fatigue.
An analysis of 2-day cardiopulmonary exercise testing to assess unexplained fatigue.
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DOI：
10.14814/phy2.14564
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发表时间：
2020-09
影响因子：
2.5
通讯作者：
Falvo MJ
中科院分区：
文献类型：
--
作者：
Lindheimer JB;Alexander T;Qian W;Klein-Adams JC;Lange G;H Natelson B;Cook DB;Hill HZ;Falvo MJ
间隔24小时进行的两次连续最大心肺运动试验（CPET）（2天CPET方案）越来越多地用于评估肌痛性脑脊髓炎/慢性疲劳综合征（ME/CFS）患者的运动后不适（PEM）和相关残疾。该方案可扩展至具有与ME/CFS相似特征的其他疲劳性疾病;然而，2天CPET方案可靠性和最小变化需要被认为具有临床意义（即，超过测量的标准误差）没有很好地表征。为了解决这一差距，我们通过量化7个CPET参数的可重复性，确定其临床显著变化的阈值，并确定GWI退伍军人和对照组之间的变化是否不同，评估了海湾战争疾病（GWI）的2天CPET方案。排除那些未达到峰值努力标准的人（n = 15），我们计算了通气无氧阈值（增值税）的组内相关系数（ICC）、最小真实的差异（SRD%）和重复测量方差分析（RM-方差分析）。15名患有GWI的退伍军人和8名对照组的运动峰值。对于GWI退伍军人，ICC峰值范围为中度至极好（平均值[范围]; 0.84 [0.65 - 0.92]），在VAT时降低（0.68 [0.37 - 0.78]）。在CPET变量中，GWI退伍军人在运动峰值时的SRD%（18.8 [8.8 - 28.8]）通常低于VAT（28.1 [9.5 - 34.8]）。RM-ANOVA未检测到任何显著的组-时间相互作用（所有p > 0.05）。本文报告的方法和结果为评价2天CPET可靠性提供了一个框架，并强调了在解释结果时仔细考虑目标人群中测量误差的重要性。间隔24小时进行的两次连续最大心肺运动试验（CPET）（称为2天CPET方案）越来越多地被推广为疾病诊断和特发性疲劳条件下残疾测量的重要临床工具;然而，认为具有临床意义所需的可靠性和最小值尚未得到很好的表征。本研究重点考虑了测量的标准误差，介绍了一个评估重复性和建立2天CPET参考值的框架。
Two consecutive maximal cardiopulmonary exercise tests (CPETs) performed 24 hr apart (2‐day CPET protocol) are increasingly used to evaluate post‐exertional malaise (PEM) and related disability among individuals with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). This protocol may extend to other fatiguing illnesses with similar characteristics to ME/CFS; however, 2‐day CPET protocol reliability and minimum change required to be considered clinically meaningful (i.e., exceeding the standard error of the measure) are not well characterized. To address this gap, we evaluated the 2‐day CPET protocol in Gulf War Illness (GWI) by quantifying repeatability of seven CPET parameters, establishing their thresholds of clinically significant change, and determining whether changes differed between veterans with GWI and controls. Excluding those not attaining peak effort criteria (n = 15), we calculated intraclass correlation coefficients (ICCs), the smallest real difference (SRD%), and repeated measures analysis of variance (RM‐ANOVA) at the ventilatory anaerobic threshold (VAT) and peak exercise in 15 veterans with GWI and eight controls. ICC values at peak ranged from moderate to excellent for veterans with GWI (mean [range]; 0.84 [0.65 – 0.92]) and were reduced at the VAT (0.68 [0.37 – 0.78]). Across CPET variables, the SRD% at peak exercise for veterans with GWI (18.8 [8.8 – 28.8]) was generally lower than at the VAT (28.1 [9.5 – 34.8]). RM‐ANOVAs did not detect any significant group‐by‐time interactions (all p > .05). The methods and findings reported here provide a framework for evaluating 2‐day CPET reliability, and reinforce the importance of carefully considering measurement error in the population of interest when interpreting findings. Two consecutive maximal cardiopulmonary exercise tests (CPETs) performed 24 hr apart (referred to as 2‐day CPET protocol) are increasingly promoted as an important clinical tool for illness diagnosis and measurement of disability in conditions with idiopathic fatigue; however, reliability and minimum values necessary to be considered clinically meaningful are not well characterized. With an emphasis on taking standard error of the measure into account, this study introduces a framework for evaluating repeatability and establishing reference values in the 2‐day CPET.