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COPD患者4米步速:反应性和最小临床有效性差异值

来源:慢性阻塞性肺病网 手术刀 2014-06-04 |
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摘要:
本研究的目的是评估4MGS的反应性及预测最小临床有效差异值(MCID)。
 

4MGS能体现对于COPD患者在呼吸康复是有反应的

4MGS能体现对于COPD患者在呼吸康复是有反应的


    步速通常是一个预测社区老年人不良事件的指标,对于COPD患者而言,4米步速(4MGS)的可靠性及有效性近来得以证实。本研究的目的是评估4MGS的反应性及预测最小临床有效差异值(MCID)。
 

    本研究共纳入301例COPD患者,在呼吸康复训练前后,分别评估患者4MGS和增量穿梭步行(ISW)。在另外一项包含162例COPD患者的队列研究中,4MGS及ISW分别于开始的基线时间及一年后评估。4MGS的MCID的计算使用分布及基于锚节点的算法。
 
    经过康复锻炼,4MGS明显改善(平均增加0.08m/s, p<0.001)。在95%可信区间内,最小差异性可见改变为0.11 m/s。参照增量穿梭步行而计算的4MGS最小有效MCID预测值差异值为(锚定ISW)0.11 m/s,以及而参照自我感觉改善而计算的MGS最小有效MCID预测值差异值为0.08m/s(锚定自测改善)。对于严重的COPD患者,跟肺功能FEV1、呼吸困难指数、症状评分和ISW比较,康复后,4MGS的有效变化数值比例最大。12个月前后比较,4MGS均值下降0.04m/s,当参照大于最小有效差异的ISW降低值锚定非单一MCID下降的ISW时,4MGS的改变为-0.11m/s。
 
    4MGS能体现对于COPD患者在呼吸康复及长时间的动态纵向变化的改变是有反应的,可作为一个有潜能的简易的评估COPD患者功能的简易指标。对于评估严重的COPD患者的功能,4MGS可能部分有效更有价值。
 
 
    ABSTRACT Usual gait speed is a consistent predictor of adverse outcomes in community-dwelling elderly people. The reliability and validity of the 4-m gait speed (4MGS) has recently been demonstrated in patients with chronic obstructive pulmonary disease (COPD). The aims of this study were to assess the responsiveness of the 4MGS and to estimate the minimal clinically important difference (MCID).
 
    In 301 COPD patients, 4MGS and incremental shuttle walk (ISW) were measured before and after pulmonary rehabilitation. 4MGS and ISW were also measured at baseline and 1 year later in a separate cohort of 162 COPD patients. The MCID of 4MGS was estimated using distribution and anchor-based methods.
 
    4MGS improved significantly with pulmonary rehabilitation (mean change 0.08 m?s-1, p,0.001). The minimal detectable change at 95% confidence was 0.11 m?s-1. The MCID was estimated at 0.11 m?s-1 (anchored against ISW) and 0.08 m?s-1 (anchored against self-reported improvement). The effect size for 4MGS was greatest in frail individuals. After 12 months, mean 4MGS declined by 0.04 m?s-1. When anchored against a decline of more than the MCID for ISW, change in 4MGS was -0.11 m?s-1.
 
    The 4MGS is responsive to pulmonary rehabilitation and longitudinal change in COPD, and has potential as a simple functional assessment tool in COPD. The 4MGS may be particularly useful in frail individuals with COPD.

    文章原标题:The 4-metre gait speed in COPD: responsiveness and minimal clinically important difference

    文章翻译:广州呼研所顾问 丽医师    校正:郑则广教授

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