Oswestry功能障碍指数评定腰椎滑脱症患者的反应度和最小有意义变化研究

Study on oswestry dysfunction index in assessing the responsiveness and minimal significance change in patients with lumbar spondylolisthesis

目的研究Oswestry功能障碍指数(ODI)评定腰椎滑脱(lumbar spondylolisthesis,SPL)相关的特征性腰背痛患者中的反应度和最小有意义变化。方法对140例符合入组标准的症状性SPL患者进行ODI、数字评分量表(numerical rating scale,NRS)评分,并进行平板支撑测试(prone bridge test,PBT)和仰卧推起成桥测试(supine bridge test,SBT)。采用7级Likert量表评价整体感知疗效,采用最小可检测变化(Minimum detectable change,MDC)、效应大小(effect size,ES)、标准化反应均数(standardized response mean,SRM)和ROC曲线评估反应度。结果治疗后NRS、ODI均明显降低,与治疗前比较,差异有统计学意义(t=28.356,18.119;P=0.000,0.000),PBT、SBT与治疗前比明显升高,差异有统计学意义(t=27.257,23.970;P=0.000,0.000)。ODI的MDC为5.74,ES为1.00,SRM为1.00。ROC曲线分析结果显示,曲线下面积(AUC)为0.75的区域具有鉴别能力,二分类结局的最佳Cut-off值为7.52,灵敏度和特异度分别为90.25%、56.78%。Spearman秩相关系数显示ODI和PBT与SBT之间呈显著负相关关系(r=-0.47、-0.50,P<0.05),ODI与年龄、NRS和整体感知疗效(global perceived effect,GPE)之间呈正相关性(r=0.23,0.64,0.38,P<0.05)。结论在经过保守治疗的腰椎滑脱患者中,ODI被证明对检测变化有良好的反应度。

Objective To study the Oswestry dysfunction index（ODI） in assessing the responsiveness and minimal significance change in lumbar spondylolisthesis（SPL）-related characteristic lumbago patients. Methods The ODI and numerical rating scale（NRS） scores were performed in 140 patients with symptomatic SPL meeting the inclusion criteria.And the flat support test（PBT） and supine bridge test（supine bridge test, SBT） were taken. The 7-level Likert scale was used to evaluate the overall perceived efficacy. The minimum detectable change（MDC）, effect size（ES）, standardized response mean（SRM） and ROC curve were used to evaluate the responsiveness. Results NRS and ODI were significantly lower after treatment compared with before treatment, and the difference was statistically significant（t=28.356, 18.119; P=0.000,0.000）. PBT and SBT after treatment were significantly higher than those before treatment（t=27.257, 23.970; P=0.000, 0.000）. The MDC, ES and SRM of ODI were 5.74,1.00 and 1.00, respectively. The results of ROC curve analysis showed that the region of area under the curve（AUC） of 0.75 had the ability to identify. The optimal Cut-off value of Dichotomous outcome was 7.52 and the sensitivity and specificity were 90.25% and 56.78%, respectively. Spearman rank correlation coefficient showed that ODI was negatively correlated with PBT and SBT（r=-0.47,-0.50, P〈0.05）. ODI was positively correlated with age, NRS and global perceived effect（GPE）（r=0.23, 0.64, 0.38, P〈0.05）. Conclusion It is proven that ODI has a good responsiveness to detection changes in patients with conservative treatment of lumbar spondylolisthesis.