Dijagnostička tačnost A-testa i tačke preseka za procenu ishoda i planiranje rane i produžene rehabilitacije bolesnika operativno lečenih zbog preloma i osteoartritisa kuka
Sažetak
Uvod/Cilj. A-test se koristi u svakodnevnoj kliničkoj praksi za praćenje ortopedskih bolesnika tokom rane rehabilitacije. Cilj ove studije bio je da se utvrdi tačnosti A-testa i odrede tačke preseka na kojima A-test odvaja bolesnike od onih bez funkcionalne nesposobnosti na kraju rane rehabilitacije. Takođe, da bi se napravio plan produžene rehabilitacije, cilj nam je bio da utvrdimo da li A-test ima tu diskriminatornu sposobnost (i na kojim tačkama preseka) i tokom prvih dana rane rehabilitacije. Metode. Ova studija usmerena na ispitivanje mernog instrumenta sprovedena je na Ortopedskom odeljenju tokom râne rehabilitacije (1–5. postoperativni dan) na 60 bolesnika nakon artroplastike kuka zbog osteoartritisa i 60 bolesnika nakon operativno lečenog preloma kuka. Za merenja smo koristili A-test i the University of Iowa Level of Assistance Scale (ILAS) kao zlatni standard. Statistička analiza obuhvatala je ROC krivu i površinu ispod krive (AUC) sa 95% intervalom pouzdanosti za rezultate A-testa od 1. do 5. dana rehabilitacije senzitivnost, specifičnost, stopu lažno pozitivne i lažno negativne greške, pozitivnu i negativnu prediktivnu vrednost, odnos pozitivnog i negativnog odnosa verovatnoće, tačnost, tačku na ROC krivi najbližu (0.1) i Youden index za sve tačke preseka. Rezultati. Vrednosti AUC iznosile su: 0,825 (0,744−0,905) za 1. dan rehabilitacije, 0,922 (0,872−0,972) za 2. dan, 0,980 (0,959−1,000) za 3. dan, 0,989 (0,973−1,004) za 4. dan i 0,999 (0,996−1,001) za 5. dan rehabilitacije. Optimalna tačka preseka za rezultate A-testa bila je: 7/8 za 1. dan, 29/30 za 4. dan i 34/35 za 5. dan rehabilitacije. Drugog i 3. dana rehabilitacije A-test imao je dve tačke preseka, a nižom tačkom se pouzdano odvajaju bolesnici sa funkcionalnom nesposobnošću, dok se višom tačkom odbacuje postojanje funkcionalne nesposobnosti. Drugog dana rehabilitacije tačke preseka bile su 12/13 i 17/18, a 3. dana 13/14 i 18/19. Zaključak. A-test ima karakteristike dijagnostički tačnog testa koji može da odvoji bolesnike sa i bez funkcionalne nesposobnosti u svim fazama rane rehabilitacije bolesnika koji su operativno lečeni zbog oboljenja ili preloma kuka. Na osnovu rezultata A-testa tokom prvih dana rane rehabilitacije moguće je napraviti plan za produženu rehabilitaciju.
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