Development and validation of a clinical prediction rule for walking independence in hospitalized older adults with a vertebral compression fracture.

IF 1.5 Q3 REHABILITATION Physiotherapy Research International Pub Date : 2024-10-01 DOI:10.1002/pri.2117

Yoichi Kaizu, Shuntaro Tamura, Taiki Iwamura, Shota Saito, Sota Kobayashi, Ren Takeda, Hiroki Iwamoto, Kazuhiro Miyata

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引用次数: 0

Abstract

Objective: No reports on factors or Clinical prediction rules (CPRs) associated with walking independence among patients with vertebral compression fractures (VCFs) are available. Evidence regarding epidemiological walking independence rates is also sparse. Here, we sought to (i) obtain epidemiological data on the probability of inpatients with VCFs achieving walking independence, and (ii) develop and validate a CPR to determine walking independence in hospitalized patients with VCFs.

Patients and methods: We conducted a retrospective cross-sectional observational study of patients aged ≥60 years who were hospitalized for VCF at four hospitals in Japan in 2019-2022. The outcome was walking independence at discharge. We performed a binomial logistic regression analysis to assess predictors of walking independence. Five independent variables were entered: age, American Society of Anesthesiologists physical status, cognitive function, Berg Balance Scale (BBS), and 10-m walking test. Among the independent variables that were significant, we converted the continuous variables to binary data by calculating cut-off values and then created the CPR. The area under the curve (AUC) was calculated as the measure of the CPR's diagnostic accuracy, and internal validation was conducted by bootstrapping.

Results: Of the 240 patients, 188 (78.3%) achieved walking independence. Cognitive function and the BBS score (with a cut-off of 45 points) were identified as significant predictors. We created a CPR using these two items (0-2 points). The CPR's AUC was 0.92 (0.874-0.967), and internal validation by bootstrapping yielded a mean AUC of 0.919 with a slope of 0.965.

Conclusion: The walking independence rate of patients with a VCF during hospitalization was 78.3%, with cognitive function and BBS being predictors. The developed CPR performed well enough to retrospectively predict walking independence in VCF patients. The BBS cut-off value and the CPR may serve as useful indicators for clinicians to predict VCF patients' walking independence.

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开发并验证椎体压缩性骨折住院老年人独立行走的临床预测规则。

目的：目前还没有关于椎体压缩性骨折（VCF）患者独立行走的相关因素或临床预测规则（CPR）的报告。有关流行病学中独立行走率的证据也很稀少。在此，我们试图(i)获得有关椎体压缩性骨折住院患者实现独立行走概率的流行病学数据，(ii)开发并验证确定椎体压缩性骨折住院患者独立行走的CPR：我们开展了一项回顾性横断面观察研究，研究对象是2019-2022年在日本四家医院住院治疗的≥60岁的VCF患者。研究结果为出院时的行走独立性。我们进行了二项逻辑回归分析，以评估独立行走的预测因素。我们输入了五个自变量：年龄、美国麻醉医师协会身体状况、认知功能、Berg 平衡量表（BBS）和 10 米步行测试。在具有重要意义的自变量中，我们通过计算截断值将连续变量转换为二元数据，然后创建了 CPR。计算曲线下面积（AUC）来衡量CPR的诊断准确性，并通过引导法进行内部验证：结果：在 240 名患者中，188 人（78.3%）实现了独立行走。认知功能和 BBS 评分（临界值为 45 分）被认为是重要的预测因素。我们使用这两个项目（0-2 分）创建了 CPR。CPR 的 AUC 为 0.92 (0.874-0.967)，通过 bootstrapping 内部验证得出的平均 AUC 为 0.919，斜率为 0.965：认知功能和 BBS 是预测住院期间 VCF 患者行走独立率的指标，其预测率为 78.3%。所开发的CPR在回顾性预测VCF患者的行走独立性方面表现良好。BBS 临界值和 CPR 可作为临床医生预测 VCF 患者行走独立性的有用指标。

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来源期刊

Physiotherapy Research International REHABILITATION-

CiteScore

3.30

自引率

5.90%

发文量

期刊介绍： Physiotherapy Research International is an international peer reviewed journal dedicated to the exchange of knowledge that is directly relevant to specialist areas of physiotherapy theory, practice, and research. Our aim is to promote a high level of scholarship and build on the current evidence base to inform the advancement of the physiotherapy profession. We publish original research on a wide range of topics e.g. Primary research testing new physiotherapy treatments; methodological research; measurement and outcome research and qualitative research of interest to researchers, clinicians and educators. Further, we aim to publish high quality papers that represent the range of cultures and settings where physiotherapy services are delivered. We attract a wide readership from physiotherapists and others working in diverse clinical and academic settings. We aim to promote an international debate amongst the profession about current best evidence based practice. Papers are directed primarily towards the physiotherapy profession, but can be relevant to a wide range of professional groups. The growth of interdisciplinary research is also key to our aims and scope, and we encourage relevant submissions from other professional groups. The journal actively encourages submissions which utilise a breadth of different methodologies and research designs to facilitate addressing key questions related to the physiotherapy practice. PRI seeks to encourage good quality topical debates on a range of relevant issues and promote critical reflection on decision making and implementation of physiotherapy interventions.