Discriminative ability and clinical utility of the Timed Up and Go (TUG) in identifying falls risk in people with multiple sclerosis: a prospective cohort study

Objective: To investigate discriminative ability and clinical utility of the Timed Up and Go under single- and dual-task conditions between fallers and non-fallers in multiple sclerosis (MS). Design: Prospective cohort study. Setting: Neurology service in a tertiary hospital. Subjects: Participants were 101 people with MS and Expanded Disability Status Scale score of 3–6.5. One participant withdrew after the baseline assessment, and hence the data were analysed for 100 participants. Interventions: No specific intervention. Main Measures: Timed Up and Go and Timed Up and Go-Cognitive. Three-month prospective diaries recorded falls. Results: Mean age was 52.6 (SD 10.7) and 66 were female. Majority of the participants had progressive MS (72) and 73 used a walking aid; 56 participants recorded 791 falls. The area under the receiver operating characteristic curve values for Timed Up and Go and Timed Up and Go-Cognitive in distinguishing fallers (person with ⩾1 fall) from non-fallers are 0.60 and 0.57, respectively, and in distinguishing multiple fallers (⩾2 falls) the values are 0.46 and 0.43. A Timed Up and Go score of ⩾9 seconds has a sensitivity of 0.82 and a specificity of 0.34 to identify fallers and a sensitivity of 0.79 and a specificity of 0.27 to identify multiple fallers. A Timed Up and Go-Cognitive score of ⩾11 seconds has a sensitivity of 0.77 and a specificity of 0.30 to identify fallers and a sensitivity of 0.71 and a specificity of 0.26 to identify multiple fallers. Conclusion: The Timed Up and Go and Timed Up and Go-Cognitive do not demonstrate sufficient clinical utility or discriminative ability for assessing falls risk in MS.

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The ability of clinical balance measures to identify falls risk in multiple sclerosis: a systematic review and meta-analysis

Clinical Rehabilitation ◽

10.1177/0269215517748714 ◽

2017 ◽

Vol 32 (5) ◽

pp. 571-582 ◽

Cited By ~ 12

Author(s):

Gillian Quinn ◽

Laura Comber ◽

Rose Galvin ◽

Susan Coote

Keyword(s):

Multiple Sclerosis ◽

Quality Assessment ◽

Meta Analysis ◽

Characteristic Curve ◽

Predictive Ability ◽

Timed Up And Go ◽

Discriminative Ability ◽

Cross Sectional ◽

Falls Risk ◽

Clinical Measures

Objective: To determine the ability of clinical measures of balance to distinguish fallers from non-fallers and to determine their predictive validity in identifying those at risk of falls. Data sources: AMED, CINAHL, Medline, Scopus, PubMed Central and Google Scholar. First search: July 2015. Final search: October 2017. Review methods: Inclusion criteria were studies of adults with a definite multiple sclerosis diagnosis, a clinical balance assessment and method of falls recording. Data were extracted independently by two reviewers. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 scale and the modified Newcastle–Ottawa Quality Assessment Scale. Statistical analysis was conducted for the cross-sectional studies using Review Manager 5. The mean difference with 95% confidence interval in balance outcomes between fallers and non-fallers was used as the mode of analysis. Results: We included 33 studies (19 cross-sectional, 5 randomised controlled trials, 9 prospective) with a total of 3901 participants, of which 1917 (49%) were classified as fallers. The balance measures most commonly reported were the Berg Balance Scale, Timed Up and Go and Falls Efficacy Scale International. Meta-analysis demonstrated fallers perform significantly worse than non-fallers on all measures analysed except the Timed Up and Go Cognitive ( p < 0.05), but discriminative ability of the measures is commonly not reported. Of those reported, the Activities-specific Balance Confidence Scale had the highest area under the receiver operating characteristic curve value (0.92), but without reporting corresponding measures of clinical utility. Conclusion: Clinical measures of balance differ significantly between fallers and non-fallers but have poor predictive ability for falls risk in people with multiple sclerosis.

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Failure of falls risk screening tools to predict outcome: a prospective cohort study

Emergency Medicine Journal ◽

10.1136/emermed-2016-206233 ◽

2017 ◽

Vol 35 (1) ◽

pp. 28-32 ◽

Cited By ~ 1

Author(s):

Kristie J Harper ◽

Annette D Barton ◽

Glenn Arendts ◽

Deborah G Edwards ◽

Antonio C Petta ◽

...

Keyword(s):

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Screening Tool ◽

Characteristic Curve ◽

Community Setting ◽

Predictive Ability ◽

Assessment Tools ◽

Screening Tools ◽

Falls Risk

ObjectiveTo compare the Falls Risk for Older Persons—Community Setting Screening Tool (FROP Com Screen) with the Two-Item Screening Tool in older adults presenting to the ED.MethodsA prospective cohort study, comparing the efficacy of the two falls risk assessment tools by applying them simultaneously in a sample of hospital ED presentations.ResultsTwo hundred and one patients over 65 years old were recruited. Thirty-six per cent reported falls in the 6-month follow-up period. The area under the receiver operating characteristic curve was 0.57 (95% CI 0.48 to 0.66) for the FROP Com Screen and 0.54 (95% CI 0.45 to 0.63) for the Two-Item Screening Tool. FROP Com Screen had a sensitivity of 39% (95% CI 0.27 to 0.51) and a specificity of 70% (95% CI 0.61 to 0.78), while the Two-Item Screening Tool had a sensitivity of 48% (95% CI 0.36 to 0.60) and a specificity of 57% (95% CI 0.47 to 0.66).ConclusionBoth tools have limited predictive ability in the ED setting.

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Risk factors for falling for people with Multiple Sclerosis identified in a prospective cohort study

Clinical Rehabilitation ◽

10.1177/0269215520973197 ◽

2020 ◽

pp. 026921552097319

Author(s):

Gillian Quinn ◽

Laura Comber ◽

Chris McGuigan ◽

Ailish Hannigan ◽

Rose Galvin ◽

...

Keyword(s):

Risk Factors ◽

Multiple Sclerosis ◽

Cohort Study ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Self Report ◽

Timed Up And Go ◽

Bladder Control ◽

Visual Problems ◽

Risk Factors For Falling

Objective: To identify risk factors for falling for people with Multiple Sclerosis. Design: Prospective cohort study. Setting: Neurology service in a tertiary hospital. Subjects: Participants were 101 people with Multiple Sclerosis and Expanded Disability Status Score of 3-6.5. One participant withdrew after the baseline assessment; data were analysed for 100 participants. Interventions: No intervention. Main measures: Outcome was rate of falls, and predictors were Timed Up and Go, Symbol Digit Modalities test, demographics and 15 self-report questions about various symptoms including fatigue, concentration, dual tasking, bladder and bowel control. Three-month prospective diaries recorded falls. Results: There were 791 falls reported over the 3-month period from a total of 56 fallers. Falls rate per person-year was 32.08 falls. Following multivariable regression analysis, the model with the greatest levels of clinical utility and discriminative ability (sensitivity 88% and area under the receiving operating curve statistic = 0.72, 95% CI 0.62–0.82), included the variables of history of a fall, not having visual problems, problems with bladder control and a slower speed on the Timed Up and Go. Conclusion: This study confirms the high incidence of falls for people with Multiple Sclerosis and provides a risk prediction model including fall history, problems with bladder control, not having visual problems and a slower Timed Up and Go speed that may be used to identify those at greater risk and in need of tailored falls prevention intervention.

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Prenatal Sociodemographic Factors Predicting Maltreatment of Children up to 3 Years Old: A Prospective Cohort Study Using Administrative Data in Japan

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18052505 ◽

2021 ◽

Vol 18 (5) ◽

pp. 2505

Author(s):

Aya Isumi ◽

Kunihiko Takahashi ◽

Takeo Fujiwara

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Child Maltreatment ◽

Survey Data ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Characteristic Curve ◽

Risk Scores ◽

Prenatal Risk ◽

Prenatal Risk Factors

Identifying risk factors from pregnancy is essential for preventing child maltreatment. However, few studies have explored prenatal risk factors assessed at pregnancy registration. This study aimed to identify prenatal risk factors for child maltreatment during the first three years of life using population-level survey data from pregnancy notification forms. This prospective cohort study targeted all mothers and their infants enrolled for a 3- to 4-month-old health check between October 2013 and February 2014 in five municipalities in Aichi Prefecture, Japan, and followed them until the child turned 3 years old. Administrative records of registration with Regional Councils for Children Requiring Care (RCCRC), which is suggestive of child maltreatment cases, were linked with survey data from pregnancy notification forms registered at municipalities (n = 893). Exact logistic regression was used for analysis. A total of 11 children (1.2%) were registered with RCCRC by 3 years of age. Unmarried marital status, history of artificial abortion, and smoking during pregnancy were significantly associated with child maltreatment. Prenatal risk scores calculated as the sum of these prenatal risk factors, ranging from 0 to 7, showed high predictive power (area under receiver operating characteristic curve 0.805; 95% confidence interval (CI), 0.660–0.950) at a cut-off score of 2 (sensitivity = 72.7%, specificity = 83.2%). These findings suggest that variables from pregnancy notification forms may be predictors of the risk for child maltreatment by the age of three.

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Predictive value of the neutrophil to lymphocyte ratio for disease deterioration and serious adverse outcomes in patients with COVID-19: a prospective cohort study

BMC Infectious Diseases ◽

10.1186/s12879-021-05796-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhi-Yong Zeng ◽

Shao-Dan Feng ◽

Gong-Ping Chen ◽

Jiang-Nan Wu

Keyword(s):

Cohort Study ◽

Hospital Admission ◽

Clinical Outcomes ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Characteristic Curve ◽

Adverse Outcomes ◽

Neutrophil To Lymphocyte Ratio ◽

Predictive Values ◽

Lymphocyte Ratio

Abstract Background Early identification of patients who are at high risk of poor clinical outcomes is of great importance in saving the lives of patients with novel coronavirus disease 2019 (COVID-19) in the context of limited medical resources. Objective To evaluate the value of the neutrophil to lymphocyte ratio (NLR), calculated at hospital admission and in isolation, for the prediction of the subsequent presence of disease progression and serious clinical outcomes (e.g., shock, death). Methods We designed a prospective cohort study of 352 hospitalized patients with COVID-19 between January 9 and February 26, 2020, in Yichang City, Hubei Province. Patients with an NLR equal to or higher than the cutoff value derived from the receiver operating characteristic curve method were classified as the exposed group. The primary outcome was disease deterioration, defined as an increase of the clinical disease severity classification during hospitalization (e.g., moderate to severe/critical; severe to critical). The secondary outcomes were shock and death during the treatment. Results During the follow-up period, 51 (14.5%) patients’ conditions deteriorated, 15 patients (4.3%) had complicated septic shock, and 15 patients (4.3%) died. The NLR was higher in patients with deterioration than in those without deterioration (median: 5.33 vs. 2.14, P < 0.001), and higher in patients with serious clinical outcomes than in those without serious clinical outcomes (shock vs. no shock: 6.19 vs. 2.25, P < 0.001; death vs. survival: 7.19 vs. 2.25, P < 0.001). The NLR measured at hospital admission had high value in predicting subsequent disease deterioration, shock and death (all the areas under the curve > 0.80). The sensitivity of an NLR ≥ 2.6937 for predicting subsequent disease deterioration, shock and death was 82.0% (95% confidence interval, 69.0 to 91.0), 93.3% (68.0 to 100), and 92.9% (66.0 to 100), and the corresponding negative predictive values were 95.7% (93.0 to 99.2), 99.5% (98.6 to 100) and 99.5% (98.6 to 100), respectively. Conclusions The NLR measured at admission and in isolation can be used to effectively predict the subsequent presence of disease deterioration and serious clinical outcomes in patients with COVID-19.

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