magistrsko delo
Doroteja Okorn (Author), Tina Grapar Žargi (Reviewer), Lea Leonardis (Mentor)

Abstract

Uvod: Sindrom razcepljene roke se pri bolnikih z amiotrofično lateralno sklerozo (ALS) kaže z bolj prizadeto lateralno stranjo dlani, medtem ko je medialna stran dlani manj prizadeta. Stopnjo disociirane atrofije kvantificirajo indeksi razcepljene roke – indeks valov M (IVM), indeks valov F (IVF), nevrofiziološki indeks (NI) in indeks dinamometrije (ID). Namen: Proučiti diagnostično natančnost indeksov ter vpliv (ne)upoštevanja vrednosti 0. Proučiti povezanost med indeksi in povezanost indeksov z delom dopolnjene funkcijske ocenjevalne lestvice za ALS (ALSFRS-R) za oceno funkcije rok ter pogostost sindroma razcepljene roke. Preveriti prognostično uporabnost IVM in povezanost indeksov s prognostičnimi biomarkerji. Metode dela: V raziskavo smo vključili 42 bolnikov in 43 zdravih preiskovancev. Pri vseh preiskovancih smo opravili obojestranske meritve prevajanj po motoričnem nitju medianega in ulnarnega živca ter dinamometrične meritve. Izračunali smo IVM, IVF, NI in ID. Za oceno diagnostične natančnosti smo uporabili krivulje karakteristike delovanja sprejemnika, za oceno povezanosti med spremenljivkami Pearsonov ali Spearmanov korelacijski test, za analizo preživetja Kaplan-Meierjevo analizo in log-rank test ter za analizo dejavnikov, povezanih s časom preživetja, Coxov regresijski model sorazmernih tveganj. Rezultati: IVM je imel odlično (AUC = 0,91), NI (AUC = 0,87) in ID (AUC = 0,80) visoko ter IVF zmerno (AUC = 0,71) diagnostično natančnost. V primeru upoštevanja vrednosti 0 sta bili ploščina pod krivuljo in občutljivost pri vseh indeksih višji. Pri bolnikih je bila povezanost med indeksi zmerna do zelo visoka (rs = 0,58–0,95; p < 0,0001) in z delom ALSFRS-R za oceno funkcije rok nizka do zmerna (rs = 0,34–0,57; p < 0,05). Sindrom je bil prisoten pri 79,5–95,2 % bolnikov. Mediana preživetja je znašala 43 mesecev. S časom preživetja so bili povezani starost ob pojavu simptomov (HR = 1,12; p = 0,0237), strmina regresijskega poltraka (HR = 0,15; p = 0,0023) in prognostični IVM (HR = 2,89; p = 0,0211). Najvišjo povezanost z indeksi je imel NIADM (rs = 0,76–0,81; p < 0,0001). Razprava in zaključek: Najvišjo diagnostično natančnost je imel IVM. Upoštevanje vrednosti 0 je izboljšalo diagnostično natančnost in občutljivost vseh indeksov. S časom preživetja so bili povezani starost ob pojavu simptomov, strmina regresijskega poltraka in prognostični IVM.

Keywords

magistrska dela;fizioterapija;bolezen motoričnega nevrona;amplituda vala M;perzistenca valov F;nevrofiziološki indeks;ročna dinamometrija;

Data

Language: Slovenian
Year of publishing:
Typology: 2.09 - Master's Thesis
Organization: UL ZF - University College of Health Studies
Publisher: [D. Okorn]
UDC: 615.8
COBISS: 197334275 Link will open in a new window
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Other data

Secondary language: English
Secondary title: Diagnostic and prognostic usefulness of split hand indices in patients with amyotrophic lateral sclerosis
Secondary abstract: Introduction: Split-hand sign in amyotrophic lateral sclerosis (ALS) is characterized by preferential wasting of the lateral, with relative preservation of the medial hand. Split-hand indices (SI) can be based on compound muscle action potentials (SICMAP), F-wave persistences (SIFP), neurophysiological indices (SINI) and hand-held dynamometry (SIHHD). Purpose: To evaluate the diagnostic accuracy of the SI, the divide by 0 problem and correlation among the SI and between the SI and the ALS Functional Rating Scale-Revised (ALSFRS-R) upper-limb score. To determine the proportion of patients with split-hand syndrome, the prognostic usefulness of the SICMAP and correlation between the SI and prognostic biomarkers. Methods: We included 42 patients and 43 healthy participants. Bilateral motor nerve conduction study for ulnar and median nerve and HHD were carried out to calculate SICMAP, SIFP, SINI and SIHHD. We used receiver operating characteristic curves to determine the diagnostic accuracy, Spearman's and Pearson's correlation coefficients to examine relationship between the variables, Kaplan-Meier analysis and log-rank test for survival analysis and Cox' proportional hazards model to identify the independent predictors of survival. Results: SICMAP had an excellent (AUC = 0,91), SINI (AUC = 0,87) and SIHHD (AUC = 0,80) good and SIFP moderate (AUC = 0,71) diagnostic accuracy. AUC and sensitivity were higher when acknowledging the SI value of 0. ALS patients had moderate to very strong correlation among the SI (rs = 0,58–0,95; p < 0,0001) and weak to moderate correlation between the SI and ALSFRS-R upper limb score (rs = 0,34–0,57; p < 0,05). Split-hand sign was present in 79,5–95,2 % of patients. Median survival time was 43 months with three predictors of survival being age at disease onset (HR = 1,12; p = 0,0237), regression coefficient slope (HR = 0,15; p = 0,0023) and split-hand prognostic index (SHpi) (HR = 2,89; p = 0,0211). NIADM had the highest correlation with the SI (rs = 0,76–0,81; p < 0,0001). Discussion and conclusion: SICMAP had the highest diagnostic accuracy. Acknowledging the SI value of 0 improved diagnostic accuracy and sensitivity. Age at disease onset, regression coefficient slope and SHpi were identified predictors of survival.
Secondary keywords: master's theses;physiotherapy;motor neuron disease;compound muscle action potential;F-wave persistence;neurophysiological index;hand-held dynamometry;
Type (COBISS): Master's thesis/paper
Study programme: 0
Thesis comment: Univ. v Ljubljani, Zdravstvena fak., Oddelek za fizioterapijo
Pages: 81 str., [3] str. pril.
ID: 24230181