帕金森病运动功能评分量表及一致性和敏感性检验

Motor dysfunction rating scale for Parkinson's disease and its measurement of interrater agreement and sensitivity

目的 提出并详细描述一种对帕金森病 (PD)患者运动功能障碍的临床评分。方法 运用统计学方法对这一评分量表的一致性和敏感性进行检验 ,对 2 0例PD患者的帕金森病运动功能评分量表 (MDR SPD)评分结果做Kappa检验 ,对 2 0例PD患者治疗前后的评分结果进行t检验。 结果 该量表 16个项目的Kappa检验 ,最低K =0 .6 6 ,最高K =0 .97;t检验示治疗前后评分结果差异有显著性 (P <0 .0 1)。结论 MDRSPD可重复性较好 ,且能敏感地反映出病情变化 ,是一种使用方便的、较为精确和稳定的量表化方法 ,可用于PD患者的病情严重程度和治疗疗效的评定。

Objective To propose a clinical motor dysfunction rating scale for Parkinson's disease (MDRSPD) and make its evaluation.Methods The rating scale was designed based on the Unified Parkinson's Disease Rating Scale and the Webster Rating Scale. It includes 15 items:resting tremor (left right and one lower extremity), rigidity, posture, facial expression, arm swing, writing, arising from chair, gait, speech, postural stability, rapid alternating movements of hands, self-care and swallowing. Each item is scored on a 0 (the signs and symptoms being absent)-4(the most severe dysfunction) scales. The scores of 20 PD patients graded by 5 neurologists were tested with Kappa values to evaluate the degree of agreement among different raters (i.e.reliability).The scores of pre-and post-treatment were tested with Student's t -test to examine their abilities of detecting the changes of motor dysfunction in the PD patients (i.e.sensitivity).Results It proves to be reliable for interrater agreement (K=0.66～0.97) and sensitive ( P <0.001) to detect clinically relevant changes.Conclusion MDRSPD appeared to be an accurate, stable, simple and convenient quantitative means of evaluating the motor dysfunction in PD patients. It would be useful in monitoring the effects of therapy in PD cases.