Identifying subgroups of patients using latent class analysis: should we use a single-stage or a two-stage approach? A methodological study using a cohort of patients with low back pain
Identifying subgroups of patients using latent class analysis: should we use a single-stage or a two-stage approach? A methodological study using a cohort of patients with low back pain
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DOI：
10.1186/s12891-017-1411-x
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发表时间：
2017-02-01
影响因子：
2.3
通讯作者：
Kongsted, Alice
中科院分区：
文献类型：
--
作者：
Nielsen, Anne Molgaard;Kent, Peter;Kongsted, Alice
背景：腰痛（LBP）患者的异质性是公认的，已经提出了不同的亚分组方法。潜在类分析（LCA）是一种统计技术，越来越多地用于根据患者特征确定亚组。然而，由于LBP是一个复杂的多域条件，使用LCA的最优方法是未知的。因此，本文描述了两种LCA方法的探索，这可能有助于提高临床相关和可解释的LBP亚群的识别。方法：928例腰痛患者就诊于脊医，基线数据作为统计亚组的输入。在单阶段LCA中，所有变量同时建模以确定患者亚组。在两阶段LCA中，我们在健康的六个领域（活动、环境因素、疼痛、参与、身体损伤和心理）（第一阶段）中使用了我们先前发表的LCA的潜在类别成员，因为变量进入了两阶段LCA的第二阶段，以确定患者亚组。单阶段和两阶段LCA结果的描述是基于统计性能测量、临床可解释性（面部效度）的定性评估和亚组成员比较的组合。结果：对于单期LCA，首选7个患者亚组的模型溶液，对于两期LCA，首选9个患者亚组模型。两种方法都确定了相似但不相同的患者亚组，其特征为(i)轻度间歇性LBP， （ii）近期严重LBP和活动受限，（iii）近期严重LBP伴有活动和参与受限，（iv）与工作相关的LBP， (v) LBP和一些负面后果，以及（vi） LBP伴神经根累及。结论：两种方法都确定了临床可解释的患者亚组。这些亚组的潜在重要性需要通过探索它们是否可以在其他队列中被识别出来，并通过检查它们与患者预后的可能关联来调查。这可以为选择首选的LCA方法提供信息。
Background: Heterogeneity in patients with low back pain (LBP) is well recognised and different approaches to subgrouping have been proposed. Latent Class Analysis (LCA) is a statistical technique that is increasingly being used to identify subgroups based on patient characteristics. However, as LBP is a complex multi-domain condition, the optimal approach when using LCA is unknown. Therefore, this paper describes the exploration of two approaches to LCA that may help improve the identification of clinically relevant and interpretable LBP subgroups.Methods: From 928 LBP patients consulting a chiropractor, baseline data were used as input to the statistical subgrouping. In a single-stage LCA, all variables were modelled simultaneously to identify patient subgroups. In a twostage LCA, we used the latent class membership from our previously published LCA within each of six domains of health (activity, contextual factors, pain, participation, physical impairment and psychology) (first stage) as the variables entered into the second stage of the two-stage LCA to identify patient subgroups. The description of the results of the single-stage and two-stage LCA was based on a combination of statistical performance measures, qualitative evaluation of clinical interpretability (face validity) and a subgroup membership comparison.Results: For the single-stage LCA, a model solution with seven patient subgroups was preferred, and for the two-stage LCA, a nine patient subgroup model. Both approaches identified similar, but not identical, patient subgroups characterised by (i) mild intermittent LBP, (ii) recent severe LBP and activity limitations, (iii) very recent severe LBP with both activity and participation limitations, (iv) work-related LBP, (v) LBP and several negative consequences and (vi) LBP with nerve root involvement.Conclusions: Both approaches identified clinically interpretable patient subgroups. The potential importance of these subgroups needs to be investigated by exploring whether they can be identified in other cohorts and by examining their possible association with patient outcomes. This may inform the selection of a preferred LCA approach.