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Early and delayed assessments of quantitative gait measures to improve the tap test as a predictor of shunt effectiveness in idiopathic normal pressure hydrocephalus

View Article: PubMed Central - PubMed

ABSTRACT

Background: To improve the diagnostic performance of the cerebrospinal fluid (CSF) tap test (TT), early and delayed assessments of gait were performed after the removal of 30 ml of CSF in patients with probable idiopathic normal pressure hydrocephalus. Assessments of gait included the 3-m timed up and go test (TUG), and the 10-m walk in time (10Ti) and in step (10St) tests.

Methods: Quantitative data for the TUG, the 10Ti, and the 10St were obtained before CSF removal and on days 1 and 4 after removal of 30 ml CSF. CSF shunt surgery was performed in 61 patients within one month after the TT. The gait outcome was assessed 3 months after surgery. The area under the curve (AUC), sensitivity, specificity, and cutoff values were computed for the TUG, the 10Ti, and the 10St on day 1 and day 4 using receiver operating characteristic (ROC) curve analysis.

Results: The positive response rate in three measures on day 4 was equal to or higher than the values on day 1. Times were reduced significantly in the TUG and the 10mTi tests between baseline and both days 1 and 4 after TT. No significant differences were noted in the number of steps for the 10St test. The percent change in TUG on day 1 had the highest AUC value among all other variables (0.808). Although this was not statistically different from other variables in the TUG and the 10Ti, it had a good balance of high sensitivity (78.3%) and high specificity (80.0%), with a cutoff value of 11.3%. The change in the measured value in the day 1 TUG had the second highest AUC value at 0.770. The variables on day 4 tended to have high specificities of around 90%, although their sensitivities were low.

Conclusions: The percent change of TUG on day 1 showed the highest diagnostic accuracy. Delayed assessments on day 4 were not superior to those on day 1. Thus, the TUG on day 1 is useful as a simple quantitative measure for predicting shunt effectiveness.

No MeSH data available.


Positive response in any of three assessment measures. Positive response in any of three assessment measures on day1 (black line), day 4 (red line) or either day 1 or day 4 (blue line) showed high sensitivity but their specificities were low
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Fig4: Positive response in any of three assessment measures. Positive response in any of three assessment measures on day1 (black line), day 4 (red line) or either day 1 or day 4 (blue line) showed high sensitivity but their specificities were low

Mentions: Among these measures, the percent change in the TUG on day 1 had the highest AUC value (0.808) and a sensitivity of 78.8% and a specificity of 80.0%. The cut-off value for the TUG was 11.3%. Although this AUC value was significantly different from most variables of 10St, no statistical differences were noted between the variables of the TUG and the 10Ti. The second highest AUC (0.770) was noted for the change in the measured value of the TUG on day 1. The TUG on day 1 had a sensitivity of 76.6%, a specificity of 75.0%, and a cutoff value of 2.0 s. Overall, the sensitivity of the TT ranged from 34.1 to 78.3%, while its specificity ranged from 50.0 to 93.8% (Table 2). Thus, the TT tended to have a relatively low sensitivity and a high specificity. The variables on day 4 tended to have high specificities of around 90%, although their sensitivities were low. Among these variables, the 10Ti had fairly high AUCs of above 0.7. When a positive response was defined as positive in any one of the three assessment measures, the sensitivities became very high but specificities became low and their AUCs did not exceed the AUC of the TUG on day 1 (Fig. 4).Fig. 4


Early and delayed assessments of quantitative gait measures to improve the tap test as a predictor of shunt effectiveness in idiopathic normal pressure hydrocephalus
Positive response in any of three assessment measures. Positive response in any of three assessment measures on day1 (black line), day 4 (red line) or either day 1 or day 4 (blue line) showed high sensitivity but their specificities were low
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5120418&req=5

Fig4: Positive response in any of three assessment measures. Positive response in any of three assessment measures on day1 (black line), day 4 (red line) or either day 1 or day 4 (blue line) showed high sensitivity but their specificities were low
Mentions: Among these measures, the percent change in the TUG on day 1 had the highest AUC value (0.808) and a sensitivity of 78.8% and a specificity of 80.0%. The cut-off value for the TUG was 11.3%. Although this AUC value was significantly different from most variables of 10St, no statistical differences were noted between the variables of the TUG and the 10Ti. The second highest AUC (0.770) was noted for the change in the measured value of the TUG on day 1. The TUG on day 1 had a sensitivity of 76.6%, a specificity of 75.0%, and a cutoff value of 2.0 s. Overall, the sensitivity of the TT ranged from 34.1 to 78.3%, while its specificity ranged from 50.0 to 93.8% (Table 2). Thus, the TT tended to have a relatively low sensitivity and a high specificity. The variables on day 4 tended to have high specificities of around 90%, although their sensitivities were low. Among these variables, the 10Ti had fairly high AUCs of above 0.7. When a positive response was defined as positive in any one of the three assessment measures, the sensitivities became very high but specificities became low and their AUCs did not exceed the AUC of the TUG on day 1 (Fig. 4).Fig. 4

View Article: PubMed Central - PubMed

ABSTRACT

Background: To improve the diagnostic performance of the cerebrospinal fluid (CSF) tap test (TT), early and delayed assessments of gait were performed after the removal of 30 ml of CSF in patients with probable idiopathic normal pressure hydrocephalus. Assessments of gait included the 3-m timed up and go test (TUG), and the 10-m walk in time (10Ti) and in step (10St) tests.

Methods: Quantitative data for the TUG, the 10Ti, and the 10St were obtained before CSF removal and on days 1 and 4 after removal of 30 ml CSF. CSF shunt surgery was performed in 61 patients within one month after the TT. The gait outcome was assessed 3 months after surgery. The area under the curve (AUC), sensitivity, specificity, and cutoff values were computed for the TUG, the 10Ti, and the 10St on day 1 and day 4 using receiver operating characteristic (ROC) curve analysis.

Results: The positive response rate in three measures on day 4 was equal to or higher than the values on day 1. Times were reduced significantly in the TUG and the 10mTi tests between baseline and both days 1 and 4 after TT. No significant differences were noted in the number of steps for the 10St test. The percent change in TUG on day 1 had the highest AUC value among all other variables (0.808). Although this was not statistically different from other variables in the TUG and the 10Ti, it had a good balance of high sensitivity (78.3%) and high specificity (80.0%), with a cutoff value of 11.3%. The change in the measured value in the day 1 TUG had the second highest AUC value at 0.770. The variables on day 4 tended to have high specificities of around 90%, although their sensitivities were low.

Conclusions: The percent change of TUG on day 1 showed the highest diagnostic accuracy. Delayed assessments on day 4 were not superior to those on day 1. Thus, the TUG on day 1 is useful as a simple quantitative measure for predicting shunt effectiveness.

No MeSH data available.