JNNP:脑卒中患者上肢功能恢复的计算机化预测模型

2021-01-26 MedSci原创 MedSci原创

预测中风后运动恢复对于设定可行的治疗目标、选择有效的治疗方法和长期管理非常重要。此外,预测结果可以帮助临床试验设计,以选择最有利于治疗的患者。已有大量的脑卒中后上肢运动恢复预测模型被开发出来 。这些模

预测中风后运动恢复对于设定可行的治疗目标、选择有效的治疗方法和长期管理非常重要。此外,预测结果可以帮助临床试验设计,以选择最有利于治疗的患者。已有大量的脑卒中后上肢运动恢复预测模型被开发出来 。这些模型大多基于临床标志物,如控制肩外展和手指伸展。其他模型包括神经生理学标记物,如皮质脊髓通路的完整性。在卒中后48小时评估的决定因素用于预测卒中后6个月的恢复。首先,预测的准确性取决于在卒中后预定时间点评估患者的能力。

在目前的研究中,用于评估中风后前6个月上肢能力的恢复情况,上肢能力是指用动作研究测试(ARAT)分数测量的完成诸如拿起杯子、搬运物体、操纵小物体等横向任务的能力。随后,研究了这种动态模型如何评价患者的时间依赖性临床改善。在比较了几种模型替代方案后,交叉验证了预测的准确性,并开发了一个在线患者特定模型,其中预测结果可用于卒中单元和整个护理环节,用于预测上肢能力的恢复情况。

结合了四项卒中后早期前瞻性队列研究中首次缺血性前循环卒中患者上肢功能恢复的数据,所有数据集都包含中风后ARAT评分的重复测量。4D-EEG患者在卒中后3周内被招募。4D-EEG研究在中风后第一周以及5、12和26周后进行测量。在显性研究中,患者在卒中后1、2、3、5、12和26周进行测量,在EPOS研究中,患者在前3天、第5天和第9天以及6个月后进行测量。所有研究均包括中风发病后72小时内出现单侧或偏瘫的成年患者,无致残病史,沟通、记忆或理解能力无严重缺陷,不妨碍正常测量。用ARAT测量的14个上肢容量作为模型的因变量。ARAT共有19项任务,分为四个子领域:抓、握、捏和粗大运动。ARAT评分范围从0到最高57分,ARAT具有良好的倾斜仪性能。神经功能缺损采用美国国立卫生研究院卒中量表(NIHSS;范围0-42)进行评估。

将所有患者纳入至少三次重复测量,将这些患者纳入交叉验证,以提供对预测准确性的估计。通过比较不同模型的预测精度,从述模型中选择最优模型。为了使临床医生和研究人员能够对个别中风患者使用预测模型,开发了一个在线可视化系统,用于实时预测上肢发育的恢复情况以及68%和95%的预测间隔,表示预测的不确定性。

Figure 1

性数据集包括450名首次缺血性脑卒中患者,其中52%为男性,基线检查时的平均年龄为65岁,平均随访天数为166天。对患者进行连续评估,中位数为6次(25%分位数:4次;75%分位数:8次)。中风后早期ARAT平均值为14(SD 19);大量中风后早期ARAT得分为0或1分的患者的ARAT分布出现偏差,并且ARAT得分在整个评分范围内的分布不太均匀(Q1=0,中位数为1,Q3为29,最大得分为56)。交叉验证肩外展和手指伸展(SAFE)模型预测6个月ARAT评分的时间依赖性准确性。准确度定义为交叉验证预测的中风后6个月ARAT评分与同时测量的ARAT评分之间的绝对差异,显示为中位数(IQR:Q1=25%和Q3=75%)准确度显示为连续测量次数的函数,用于预测6个月时的结果,其中最后一次测量通常在中风后6个月进行,一次在中风后3个月进行,另一次在中风后2天到6周之间进行。,基线ARAT评分较低、中等和较高的患者亚组的预测误差。初始ARAT评分较高的患者在每个时间点的6个月预测误差相对较小,而初始ARAT评分较低的患者在基线时误差较大,但在卒中后显著降低。

总之,模型可以预测中风后6个月内患者的上肢容量恢复情况。该模型可以灵活地使用所有可用的连续评估数据,在中风后的任何期望时刻创建预测,独立或与电子健康记录系统连接。

Selles RAndrinopoulou ENijland R, et al Computerised patient-specific prediction of the recovery profile of upper limb capacity within stroke services: the next step

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  5. [GetPortalCommentsPageByObjectIdResponse(id=1716415, encodeId=56311e16415e6, content=<a href='/topic/show?id=d68d911542f' target=_blank style='color:#2F92EE;'>#计算机#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91154, encryptionId=d68d911542f, topicName=计算机)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=def632217870, createdName=bioon14, createdTime=Sat May 08 04:54:57 CST 2021, time=2021-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1679157, encodeId=da1e16e91573e, content=<a href='/topic/show?id=7a2684e600b' target=_blank style='color:#2F92EE;'>#脑卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84760, encryptionId=7a2684e600b, topicName=脑卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=091e27733095, createdName=weihongyv, createdTime=Thu Oct 14 15:54:57 CST 2021, time=2021-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720367, encodeId=5be51e20367d7, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Sun Aug 22 03:54:57 CST 2021, time=2021-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1262804, encodeId=9ad1126280427, content=<a href='/topic/show?id=52941002359d' target=_blank style='color:#2F92EE;'>#预测模型#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100235, encryptionId=52941002359d, topicName=预测模型)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3ff68, createdName=维他命, createdTime=Thu Jan 28 14:54:57 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1599347, encodeId=71d5159934e89, content=<a href='/topic/show?id=5eb4329159a' target=_blank style='color:#2F92EE;'>#功能恢复#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32915, encryptionId=5eb4329159a, topicName=功能恢复)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1e9518693674, createdName=mnda, createdTime=Thu Jan 28 14:54:57 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026756, encodeId=ac711026e56c4, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Wed Jan 27 02:54:57 CST 2021, time=2021-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047885, encodeId=859e104e8852c, content=梅斯里提供了很多疾病的模型计算公式,赞一个!, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Wed Jan 27 02:54:57 CST 2021, time=2021-01-27, status=1, ipAttribution=)]
    2021-01-28 mnda
  6. [GetPortalCommentsPageByObjectIdResponse(id=1716415, encodeId=56311e16415e6, content=<a href='/topic/show?id=d68d911542f' target=_blank style='color:#2F92EE;'>#计算机#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91154, encryptionId=d68d911542f, topicName=计算机)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=def632217870, createdName=bioon14, createdTime=Sat May 08 04:54:57 CST 2021, time=2021-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1679157, encodeId=da1e16e91573e, content=<a href='/topic/show?id=7a2684e600b' target=_blank style='color:#2F92EE;'>#脑卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84760, encryptionId=7a2684e600b, topicName=脑卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=091e27733095, createdName=weihongyv, createdTime=Thu Oct 14 15:54:57 CST 2021, time=2021-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720367, encodeId=5be51e20367d7, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Sun Aug 22 03:54:57 CST 2021, time=2021-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1262804, encodeId=9ad1126280427, content=<a href='/topic/show?id=52941002359d' target=_blank style='color:#2F92EE;'>#预测模型#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100235, encryptionId=52941002359d, topicName=预测模型)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3ff68, createdName=维他命, createdTime=Thu Jan 28 14:54:57 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1599347, encodeId=71d5159934e89, content=<a href='/topic/show?id=5eb4329159a' target=_blank style='color:#2F92EE;'>#功能恢复#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32915, encryptionId=5eb4329159a, topicName=功能恢复)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1e9518693674, createdName=mnda, createdTime=Thu Jan 28 14:54:57 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026756, encodeId=ac711026e56c4, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Wed Jan 27 02:54:57 CST 2021, time=2021-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047885, encodeId=859e104e8852c, content=梅斯里提供了很多疾病的模型计算公式,赞一个!, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Wed Jan 27 02:54:57 CST 2021, time=2021-01-27, status=1, ipAttribution=)]
    2021-01-27 健健

    卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1716415, encodeId=56311e16415e6, content=<a href='/topic/show?id=d68d911542f' target=_blank style='color:#2F92EE;'>#计算机#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=45, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=91154, encryptionId=d68d911542f, topicName=计算机)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=def632217870, createdName=bioon14, createdTime=Sat May 08 04:54:57 CST 2021, time=2021-05-08, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1679157, encodeId=da1e16e91573e, content=<a href='/topic/show?id=7a2684e600b' target=_blank style='color:#2F92EE;'>#脑卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=35, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=84760, encryptionId=7a2684e600b, topicName=脑卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=091e27733095, createdName=weihongyv, createdTime=Thu Oct 14 15:54:57 CST 2021, time=2021-10-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1720367, encodeId=5be51e20367d7, content=<a href='/topic/show?id=915c3604e6b' target=_blank style='color:#2F92EE;'>#卒中患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=36047, encryptionId=915c3604e6b, topicName=卒中患者)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=940232842333, createdName=wangyang7969, createdTime=Sun Aug 22 03:54:57 CST 2021, time=2021-08-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1262804, encodeId=9ad1126280427, content=<a href='/topic/show?id=52941002359d' target=_blank style='color:#2F92EE;'>#预测模型#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100235, encryptionId=52941002359d, topicName=预测模型)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c3ff68, createdName=维他命, createdTime=Thu Jan 28 14:54:57 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1599347, encodeId=71d5159934e89, content=<a href='/topic/show?id=5eb4329159a' target=_blank style='color:#2F92EE;'>#功能恢复#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=32915, encryptionId=5eb4329159a, topicName=功能恢复)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=1e9518693674, createdName=mnda, createdTime=Thu Jan 28 14:54:57 CST 2021, time=2021-01-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1026756, encodeId=ac711026e56c4, content=卒中虽然是临床上常见病,溶栓,取栓等血管内治疗也很成熟,但是仍然有很多未知问题有待认知!, beContent=null, objectType=article, channel=null, level=null, likeNumber=51, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=健健, createdTime=Wed Jan 27 02:54:57 CST 2021, time=2021-01-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1047885, encodeId=859e104e8852c, content=梅斯里提供了很多疾病的模型计算公式,赞一个!, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=CHANGE, createdTime=Wed Jan 27 02:54:57 CST 2021, time=2021-01-27, status=1, ipAttribution=)]
    2021-01-27 CHANGE

    梅斯里提供了很多疾病的模型计算公式,赞一个!

    0

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