Digitizing Tablet and Fahn-Tolosa-Marín Ratings of Archimedes Spirals have Comparable Minimum Detectable Change in Essential Tremor.
Digitizing Tablet and Fahn-Tolosa-Marín Ratings of Archimedes Spirals have Comparable Minimum Detectable Change in Essential Tremor.
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DOI：
10.7916/d89s20h7
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发表时间：
2017
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影响因子：
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通讯作者：
Ellenbogen A
中科院分区：
文献类型：
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作者：
Elble RJ;Ellenbogen A
绘制阿基米德螺线是一种流行的和有效的方法来评估行动震颤在上肢。我们对Fahn-Tolosa-Marín（FTM）评级和特发性震颤的平板测量进行了首次盲法比较，以确定数字化平板在检测特发性震颤变化方面是否优于0-4评级，这些变化超过了震颤幅度的随机变异性。14名男性和4名女性（年龄60±8.7岁[平均值±SD]）患有轻度至重度原发性震颤，连续两天用每只手绘制FTM的大螺旋和小螺旋。这些图纸同时用数字化板数字化。在一个独立的实验室中，通过频谱分析计算每张数字化图纸中的震颤，该实验室对临床评级不知情。对四个螺旋中的平均峰间震颤位移（cm）和平均FTM评级进行统计学比较。FTM评分（ICC 0.90，95% CI 0.76-0.96）和片剂（ICC 0.97，95% CI 0.91-0.99）的重测组内相关性（ICC）（双向随机单次测量，绝对一致性）极佳。Log 10震颤幅度（T）与FTM呈强相关（logT=αFTM + β，α FTM = 0.6，β FTM = 1.27，r=0.94）。片剂和FTM的最小可检测变化分别为初始评估的51%和67%。数字化平板电脑比临床评级精确得多，但震颤的自然变异性减轻了这一优势。然而，数字化平板电脑是一种强大的量化震颤的方法，可以代替临床评级或与临床评级结合使用。
Drawing Archimedes spirals is a popular and valid method of assessing action tremor in the upper limbs. We performed the first blinded comparison of Fahn–Tolosa–Marín (FTM) ratings and tablet measures of essential tremor to determine if a digitizing tablet is better than 0–4 ratings in detecting changes in essential tremor that exceed random variability in tremor amplitude. The large and small spirals of FTM were drawn with each hand on two consecutive days by 14 men and four women (age 60±8.7 years [mean±SD]) with mild to severe essential tremor. The drawings were simultaneously digitized with a digitizing tablet. Tremor in each digitized drawing was computed with spectral analysis in an independent laboratory, blinded to the clinical ratings. The mean peak-to-peak tremor displacement (cm) in the four spirals and mean FTM ratings were compared statistically. Test–retest intraclass correlations (ICCs) (two-way random single measures, absolute agreement) were excellent for the FTM ratings (ICC 0.90, 95% CI 0.76–0.96) and tablet (ICC 0.97, 95% CI 0.91–0.99). Log10 tremor amplitude (T) and FTM were strongly correlated (logT=αFTM + β, α≈0.6, β≈–1.27, r=0.94). The minimum detectable change for the tablet and FTM were 51% and 67% of the initial assessment. Digitizing tablets are much more precise than clinical ratings, but this advantage is mitigated by the natural variability in tremor. Nevertheless, the digitizing tablet is a robust method of quantifying tremor that can be used in lieu of or in combination with clinical ratings.