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ALS患者行为评估:使用疾病特异性工具的重要性

Assessing behaviour in ALS: the importance of using disease-specific tools
课程网址: http://videolectures.net/encals2017_pinto_grau_assessing_behaviou...  
主讲教师: Marta Pinto-Grau
开课单位: 都柏林圣三一大学
开课时间: 2017-07-21
课程语种: 英语
中文简介:
背景:行为改变是肌萎缩侧索硬化症(ALS)的一个核心方面。一般行为评估,如额叶系统行为量表(FrSBe),已广泛用于评估ALS患者的行为,尽管这些测量往往高估了变化的存在,因为没有考虑运动功能障碍对行为的影响。ALS特异性行为量表已被开发出来,用于纠正此类混杂因素。Beaumont行为量表(BBI)是一份41项代理报告问卷,评估ALS中观察到的所有行为。BBI显示出较高的内部一致性(克朗巴赫α=0.891)。目的:本研究旨在比较两项BBI验证研究,一项使用FrSBe作为金标准,另一项将其与另一种ALS特异性工具ALS-FTD-Q进行比较。方法:对85例ALS患者的样本进行了BBI验证,并在另外60名患者的样本中与ALS-FTD-Q进行了比较。结果:在两项研究中,BBI都表现出良好的结构效度。在BBI和FrSBe(r=0.760,p<0.0001)以及BBI和ALS-FTD-Q(r=0.807,p<0.0001)之间观察到高度显著的正相关,表明有足够的收敛效度。在这两项研究中,未观察到BBI和非行为测量之间的相关性,这表明了良好的判别效度。截止分数≥7对于是否存在行为改变,来自年龄、性别和教育程度匹配的健康对照样本(n=78)。当对照FrSBe进行验证时,该截止值显示出较高的敏感性(88%)和特异性(79%)。与ALS-FTD-Q相比,观察到高灵敏度(100%),但特异性降低(70%)。对归类为“假阳性”的案例所认可的行为方面的进一步分析表明,最常报告的变化包括ALS-FTD-Q未测量的行为方面,如社会兴趣减弱、对感官刺激过度敏感以及语法错误的存在。结论:不能纠正运动障碍的一般行为工具往往高估ALS患者的行为改变。不包括ALS所有行为特征的疾病特异性工具往往低估ALS的存在。BBI克服了这两个限制,应被视为评估ALS行为的金标准。
课程简介: Background: Behavioural changes are a core aspect of Amyotrophic Lateral Sclerosis (ALS). General behavioural assessments, such as the Frontal Systems Behaviour Scale (FrSBe), have been widely used to assess behaviour in ALS, although these measures tend to overestimate the presence of changes as the influence of motor dysfunction on behaviour is not considered. ALS-specific behavioural scales correcting for such confounders have been developed. The Beaumont Behavioural Inventory (BBI) is a 41-item proxy-report questionnaire which assesses the whole spectrum of behaviours observed in ALS. The BBI has shown high internal consistency (Cronbach’s alpha=0.891). Objective: This work aims to compare two BBI validation studies, one using the FrSBe as the gold standard, and the other comparing it against another ALS-specific tool, the ALS-FTD-Q. Methods: The BBI has been validated against the FrSBe in a sample of 85 ALS patients, and has also been compared to the ALS-FTD-Q in an additional sample of 60 patients. Results: In both studies, the BBI demonstrated good construct validity. Highly significant positive correlations were observed between the BBI and the FrSBe (r=0.760, p<.0001), and the BBI and the ALS-FTD-Q (r=.807, p<.0001), indicating adequate convergent validity. In both studies, no correlations were observed between the BBI and non-behavioural measures, which indicated good discriminant validity. A cut-off score of ≥7 for the presence of behavioural changes was derived from an age-, gender-, and education-matched healthy control sample (n=78). When validated against the FrSBe, this cut-off showed high sensitivity (88%) and specificity (79%). When compared to the ALS-FTD-Q, high sensitivity was observed (100%), but specificity was decreased (70%). Further analysis of behavioural aspects endorsed by cases classified as ‘false positives’ showed that changes most frequently reported included behavioural aspects not measured by the ALS-FTD-Q, such as diminished social interest, excessive sensitivity to sensory stimuli, and the presence of grammatical mistakes. Conclusions: General behavioural instruments that do not correct for motor disability tend to overestimate the presence of behavioural changes in ALS. Disease-specific instruments that do not include the whole range of behaviours characteristic of ALS tend to underestimate its presence. The BBI overcomes both limitations and should be considered the gold standard to assess behaviour in ALS.
关 键 词: 肌萎缩侧索硬化症; 行为改变; 疾病特异性工具
课程来源: 视频讲座网
数据采集: 2021-12-24:zkj
最后编审: 2024-01-22:liyy
阅读次数: 59