Oeijen, K. van (2014) Patiënten met Chronische Idiopatische Axonale Polyneuropathie: beoordeling van de balans. thesis, Medicine.
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Abstract
Objective: Patients with Chronic Idiopathic Axonal Polyneuropathy (CIAP) often report balance impairment. However, in earlier research patients with CIAP achieved the maximal scores on the Berg Balance Scale (BBS). Balance problems in patients with CIAP are caused by both sensory distortions and loss of muscle strength, , but as the muscle weakness in CIAP is often relative small, and patients often complain of balance problems in situations were visual control is impaired, sensory ataxia seems to be the main cause of it. The visual system is excluded in only one item of the BBS. The objective of this study is to examine whether extending the BBS with four additional items (BBSplus), in which the visual system is excluded, will lead to a better representation of balance problems in patients with CIAP. In addition this study will look at the relationship between scores on the BBsplus and variables of function and activity. In addition this study assesses whether the BBSplus can be used to follow deterioration of balance in time. Research design and methods: This study was an extension within a prospective longitudinal observational study in 92 newly diagnosed CIAP patients. Physical function was measured (using maximal isometric muscle strength, sensory functioning, Shuttle Walk Test (SWT), BBS, BBSplus, and physical activity), and patients were asked to complete a questionnaire (Rand-36) for four times in four years. The Modified Rankin Score (MRS) and the existence of ‘experienced balance problems’ were determined. This variable was used as the golden standard. Data was statistical analysed using crosstabs, tests for correlation, and dependent t-tests (or a wilocoxon signed ranktest) using SPSS. Results: Ceiling effects disappear by using the BBSplus (1.1%) instead of the BBS (34.8%). Sensitivity increases (BBSplus 21.3%, BBS 6.4%), and specificity remains the same (both 86.4%). The BBSplus has good internal consistency, cronbach’s alpha 0.95. A strong positive correlation (Rho 0.491 (p<0,5) exists between muscle strength and BBSplus score. The positive correlation between sensory functioning, and BBSplus score is weaker (Rho 0.296 (p.<.00). The other tests also showed significant correlations. In four years, patients show a significant decline in BBSscore and other variables tested. Conclusion: The BBSplus gives a better representation of the balance problems in patients with CIAP. Ceiling effects disappear, sensitivity incraeses and specificity remains the same. BBSplus score has a stronger correlation with muscle strength compared with loss of sensory functioning. Therefore this study cannot confirm the hypothesis that sensory ataxia is the main cause of balance impairment. Deterioration of the BBSplus score in time can be seen. Further research, with a better golden standard for balance, should determine whether the BBSplus can monitor an actual decline in balance. Further research is necessary to confirm the BBSplus as a valid instrument for balance in patients with CIAP and normative values must be obtained in the future.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Riemersma, Drs. M. |
| Supervisor name: | Teunissen, Dr. L.L. and Neurologie, St. Antonius ziekenhuis |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 11:05 |
| Last Modified: | 25 Jun 2020 11:05 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/2456 |
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