目的 比较Berg平衡量表(BBS)、平衡评价系统测试(BESTest)的两个简化版本Mini- BESTest和Brief-BESTest对慢性阻塞性肺疾病(COPD)患者跌倒风险的区分效果。方法 2016年9月至2017年3月,对22例有跌倒史的COPD患者和年龄与之匹配无跌倒史的66例COPD患者,采用BBS、Mini-BESTest和Brief-BESTest进行评定,进行配对Logistic回归、对数似然估计,计算数据分布的偏态系数。结果 BBS、Mini-BESTest和Brief-BESTest评分均有区分价值(OR<0.252, P<0.01);Brief-BESTest最大似然数最低(5.372),其次为Mini-BESTest (12.918)和BBS (17.644); Brief-BESTest和Mini-BESTest无天花板效应,BBS有天花板效应。结论 BBS、Mini-BESTest和Brief-BESTest均能预测COPD患者跌倒风险,Brief-BESTest预测能力最高;BBS在COPD患者中有天花板效应,Brief-BESTest和Mini-BESTest无天花板效应。
Objective To compare the differentiating effect of Berg Balance Scale (BBS), Mini-Balance Evaluation Systems Test (Mini-BESTest) and Brief-BESTest on the risk of falls in chronic obstructive pulmonary disease (COPD) patients. Methods From September, 2016 to March, 2017, 22 COPD patients with history of falls and other age-matched 66 COPD patients without history of falls were assessed with BBS, Mini-BESTest and Brief-BESTest. The data were compared with paired Logistic regression, Log-likelihood estimate, and the skewness coefficient were calculated. Results BBS, Mini-BESTest and Brief-BESTest all were valuable for differentiating the risk of falls in COPD patients. Log-likelihood estimate value was the least in Brif-BESTest (5.372), followed with Mini-BESTest (12.918) and BBS (17.644). There was not a ceiling effect in Brief-BESTest and Mini-BESTest, but there was in BBS. Conclusion All the BBS, Mini-BESTest and Brief-BESTest can predict the risk of falls in patients with COPD, and Brief-BESTest is the most predictive. There is a ceiling effect in BBS for COPD patients, but not in Brief-BESTest and Mini-BESTest.
[1] Vijayan VK.Chronic obstructive pulmonary disease[J]. Indian J Med Res, 2013, 137: 251-269.
[2] Asche CV, Leader S, Plauschinat C, et al.Adherence to current guidelines for chronic obstructive pulmonary disease (COPD) among patients treated with combination of long-acting bronchodilators or inhaled corticosteroids[J]. Int J Chron Obstruct Pulmon Dis, 2012, 7: 201-209.
[3] Agrawal A, Garg R, Sahu D, et al.Study the association of chronic obstructive pulmonary disease with early endothelial dysfunction and its impact on cardiovascular system by estimating urinary albumin creatinine ratio[J]. Lung India, 2017, 34(2): 138-143.
[4] Yentes JM, Rennard SI, Schmid KK, et al.Patients with COPD walk with altered step time and step width variability as compared to healthy controls[J]. Ann Am Thorac Soc, 2017, 14(6): 858-866.
[5] Decramer M, De Benedetto F, Del Ponte A, et al.Systemic effects of COPD[J]. Respir Med, 2005, 99(Suppl 2): S3-S10.
[6] Jahn K, Zwergal A, Schniepp R.Gait disturbances in old age: classification, diagnosis, and treatment from a neurological perspective[J]. Dtsch Arztebl Int, 2010, 107(17): 306-315.
[7] Ilgin D, Ozalevli S, Kilinc O, et al.Gait speed as a functional capacity indicator in patients with chronic obstructive pulmonary disease[J]. An Thor Med, 2011, 6(3): 141-146.
[8] Roig M, Eng JJ, MacIntyre DL, et al. Falls in people with chronic obstructive pulmonary disease: an observational cohort study[J]. Respir Med, 2011, 105(3): 461-469.
[9] Beauchamp MK, Sibley KM, Lakhani B, et al.Impairments in systems underlying control of balance in COPD[J]. Chest, 2012, 141(6): 1496-1503.
[10] Marques A, Cruz J, Quina S, et al.Reliability and minimal detectable change of the Timed Up & Go and the 10-Meter Walk tests in Patients with COPD[J]. COPD, 2016, 13(3): 279-287.
[11] Jácome C, Cruz J, Oliveira A, et al.Validity, reliability, and ability to identify fall status of the Berg Balance Scale, BESTest, Mini-BESTest, and Brief-BESTest in patients with COPD[J]. Phys Ther, 2016, 96(11): 1807-1815.
[12] Padgett PK, Jacobs JV, Kasser SL.Is the BESTest at its best? A suggested brief version based on interrater reliability, validity, internal consistency, and theoretical construct[J]. Phys Ther, 2012, 92(9): 1197-1207.
[13] Oguz S, Demirbuken I, Kavlak B, et al.The relationship between objective balance, perceived sense of balance, and fear of falling in stroke patients[J]. Top Stroke Rehabil, 2017, 24(7): 527-532.
[14] 蔺晓婷. 胃癌AJCC第6版与第7版分期的比较及其与预后评估的相关性研究[D]. 石家庄:河北医科大学, 2012.
[15] 王烨. 中文言语测试材料的天花板效应及AzBio言语测试材料的开发及等价性研究[D].北京:解放军医学院, 2015.
[16] Duncan RP, Leddy AL, Cavanaugh JT, et al.Comparative utility of the BESTest, mini-BESTest, and brief-BESTest for predicting falls in individuals with Parkinson disease: a cohort study[J]. Phys Ther, 2013, 93(4): 542-550.
[17] Huang M, Pang MY.Psychometric properties of Brief-Balance Evaluation Systems Test (Brief-BESTest) in evaluating balance performance in individuals with chronic stroke[J]. Brain Behav, 2017, 7(3): e00649.
[18] Marques A, Silva A, Oliveira A, et al.Validity and relative ability of 4 balance tests to identify fall status of older adults with type 2 diabetes[J]. J Geriatr Phys Ther, 2017, 40(4): 227-232.
[19] Porto EF, Pradella CO, Rocco CM, et al.Comparative postural control in COPD patients and healthy individus during dynamic and static activities[J]. J Cardiopulm Rehabil Prev, 2017, 37(2): 139-145.
[20] Spielmanns M, Boeselt T, Gloeckl R, et al.Low-volume whole-body vibration training improves exercise capacity in subjects with mild to severe COPD[J]. Respir Care, 2017, 62(3): 315-323.
[21] Voica AS, Oancea C, Tudorache E, et al.Chronic obstructive pulmonary disease phenotypes and balance impairment[J]. Int J Chron Obstruct Pulmon Dis, 2016, 11: 919-925.
[22] Marques A, Almeida S, Carvalho J, et al.Reliability, validity, and ability to identify fall status of the Balance Evaluation Systems Test, Mini-Balance Evaluation Systems Test, and Brief-Balance Evaluation Systems Test in older people living in the community[J]. Arch Phys Med Rehabil, 2016, 97(12): 2166-2173.
[23] Chan AC, Pang MY.Assessing balance function in patients with total knee arthroplasty[J]. Phys Ther, 2015, 95(10): 1397-1407.