Problemy z równowagą
Rokowania, prognozy i postęp choroby
Zaburzenia równowagi stanowią istotne wyzwanie kliniczne ze względu na ich wpływ na funkcjonalność pacjentów i ryzyko upadków. Test stania na jednej nodze, choć powszechnie stosowany, wykazuje ograniczoną wartość prognostyczną (AUC 0,577-0,600), która poprawia się po uwzględnieniu historii upadków (AUC 0,604-0,634). Skala Równowagi Berga (BBS) jest bardziej wiarygodnym narzędziem, umożliwiającym kategoryzację funkcjonalną pacjentów (0-20 pkt – chodzenie z pomocą ortopedyczną, 21-40 pkt – chodzenie z asystą, 41-56 pkt – samodzielne chodzenie) oraz przewidywanie długości hospitalizacji i wyników rehabilitacji. Minimalna klinicznie istotna różnica (MCID) dla BBS u pacjentów po udarze wynosi 13,5 punktów. Mini-BESTest również wykazuje wysoką trafność i wiarygodność, szczególnie u osób po ciężkich chorobach, z istotnym efektem terapeutycznym (średni wzrost wyniku do 16,3±8,2 pkt, efekt wielkości 0,819). Czynniki takie jak siła mięśniowa, funkcje poznawcze, polineuropatia/miopatia związana z chorobą krytyczną, choroby mózgowe oraz depresja mają istotny wpływ na funkcję równowagi.
- Prognozy zaburzeń równowagi (Problemy z równowagą Prognosis)
- Wartość prognostyczna testów równowagi
- Skala równowagi Berga jako narzędzie prognostyczne
- Mini-BESTest w prognozowaniu zaburzeń równowagi
- Prognozy zaburzeń równowagi w szczególnych grupach pacjentów
- Uczenie maszynowe w prognozowaniu zaburzeń równowagi
- Modele predykcyjne w innych obszarach medycyny
- Zalecenia dotyczące podstawowego zestawu wyników
- Wnioski i perspektywy
Prognozy zaburzeń równowagi (Problemy z równowagą Prognosis)
Zaburzenia równowagi stanowią istotny problem kliniczny, który może prowadzić do znacznych ograniczeń funkcjonalnych i zwiększonego ryzyka upadków. Przewidywanie wyników leczenia oraz długoterminowych rezultatów u pacjentów z zaburzeniami równowagi jest kluczowe dla planowania interwencji terapeutycznych oraz poprawy jakości życia pacjentów. W poniższym artykule przedstawiono aktualne dane na temat możliwości prognozowania przebiegu zaburzeń równowagi w różnych populacjach pacjentów oraz narzędzia wykorzystywane do tego celu.12
Wartość prognostyczna testów równowagi
Jednym z najczęściej stosowanych narzędzi oceny równowagi jest test stania na jednej nodze (one-legged balance test), który mimo powszechnego zastosowania wykazuje ograniczoną wartość prognostyczną. Badania długoterminowe wykazały, że test ten ma ograniczoną zdolność przewidywania przyszłych upadków (zakres AUC dla modeli uwzględniających płeć i wyniki testu równowagi: 0,577-0,600). Co istotne, dokładność prognostyczna poprawiała się po dodaniu do modelu historii upadków (zakres: 0,604-0,634). Wyniki te są sprzeczne z powszechnym włączaniem tego testu do klinicznych narzędzi przesiewowych, podkreślając potrzebę opracowania bardziej wiarygodnych metod oceny ryzyka upadków.34
Badania wskazują, że połączenie oceny równowagi na jednej nodze z samodzielnie zgłaszaną historią upadków poprawia dopasowanie prognostyczne z poziomu słabego do średniego. Średnia skuteczność prognostyczna kombinacji płci, oceny równowagi na jednej nodze i samodzielnie zgłaszanej historii upadków dodatkowo podkreśla złożoność ryzyka upadków.5
Skala równowagi Berga jako narzędzie prognostyczne
Skala równowagi Berga (Berg Balance Scale, BBS) jest najbardziej znanym narzędziem oceny równowagi i ryzyka upadków u dorosłych. Jej użyteczność kliniczna obejmuje możliwość przewidywania wyników rehabilitacji na podstawie całkowitego wyniku skali. Badania dotyczące prognozowania wyników rehabilitacji sugerują, że wyniki mierzone przy przyjęciu za pomocą BBS są odwrotnie proporcjonalne do długości hospitalizacji i mogą przewidywać czas trwania hospitalizacji oraz ostateczne decyzje dotyczące wypisu.67
Badania wykazały również możliwość kategoryzacji poziomów funkcjonalnych na podstawie punktacji BBS:
- 0-20 punktów – zdolność chodzenia z pomocy ortopedycznych
- 21-40 punktów – zdolność chodzenia z asystą
- 41-56 punktów – zdolność samodzielnego chodzenia
Minimalna klinicznie istotna różnica (MCID) dla poprawy równowagi wynosiła 13,5 punktów u pacjentów po udarze, co wskazuje, że MCID dla BBS skutecznie wykrywa zmiany w zdolnościach równowagi u osób po udarze. Skala BBS jest zatem użytecznym narzędziem w przewidywaniu ryzyka upadków, ocenie deficytów równowagi, dostarczaniu oceny liczbowej, którą można śledzić w celu poprawy w czasie, a nawet ocenie długości pobytu w rehabilitacji.910
Mini-BESTest w prognozowaniu zaburzeń równowagi
Eksperci rekomendują, aby jako minimum stosować albo Skalę Równowagi Berga, albo Mini Balance Evaluation Systems Test (Mini-BESTest) podczas pomiaru równowagi w populacjach dorosłych, zarówno w badaniach, jak i w praktyce klinicznej.11
Mini-BESTest okazał się wiarygodnym i trafnym narzędziem do oceny równowagi u osób po przebytej ciężkiej chorobie, co czyni go odpowiednim zarówno dla praktyki klinicznej, jak i badań naukowych. W badaniu obejmującym pacjentów po ciężkich chorobach (250 pacjentów, 34% kobiet, średni wiek 62±14 lat, mediana pobytu na OIT 55 dni), średni wynik Mini-BESTest podwoił się do 16,3±8,2 punktów przy drugiej wizycie, co odzwierciedla duży efekt terapeutyczny (efekt wielkości 0,819).12
Mimo znacznej poprawy w okresie rehabilitacji, u wielu uczestników równowaga była nadal zaburzona w momencie wypisu, a mediana wyniku Mini-BESTest wynosiła tylko 18,5 z 28 możliwych punktów. Zgodnie z analizą regresji liniowej wielokrotnej, czynniki związane z funkcją równowagi obejmowały:
- Siłę mięśniową
- Funkcje poznawcze
- Obecność polineuropatii/miopatii związanej z chorobą krytyczną (CIP/CIM)
- Choroby mózgowe
- Depresję
Prognozy zaburzeń równowagi w szczególnych grupach pacjentów
Pacjenci po przebytej chorobie krytycznej
Osoby, które przeżyły ciężkie choroby często doświadczają zaburzeń, takich jak nabyta na oddziale intensywnej terapii słabość (ICUAW), charakteryzująca się osłabieniem mięśni i deficytami sensorycznymi. Dobra równowaga jest kluczowa dla niezależności w codziennych czynnościach, a jej zaburzenia wpływają na uczestnictwo w społeczności, co wykazano u osób po udarze i stwardnieniu rozsianym.1516
Badania wykazały, że pomimo znacznej poprawy w trakcie rehabilitacji, zaburzenia równowagi były powszechne u osób, które przeżyły ciężkie choroby, co sugeruje potrzebę kontynuowania terapii. Siła mięśniowa, funkcje poznawcze, choroby mózgowe, polineuropatia/miopatia związana z chorobą krytyczną oraz depresja były istotnie związane z równowagą.17
Pacjenci z urazowym uszkodzeniem mózgu
Przewidywanie wyników leczenia u pacjentów z urazowym uszkodzeniem mózgu (TBI) jest wyzwaniem na całym świecie. Badania z wykorzystaniem algorytmów uczenia maszynowego (ML) wskazują, że wśród różnych zmiennych, komponenta motoryczna skali Glasgow, stan źrenic oraz stan cystern były najbardziej wiarygodnymi cechami do przewidywania śmiertelności wewnątrzszpitalnej, natomiast wiek pacjentów zastępuje stan cystern przy prognozowaniu długoterminowego przeżycia pacjentów z TBI.18
Oceny szerokiego tła, cech klinicznych i paraklinicznych przy użyciu różnych modeli wskazały, że stan źrenic, stan cystern (obecne, nieobecne lub skompresowane) oraz wiek pacjentów są najlepszymi predyktorami śmiertelności wewnątrzszpitalnej, podczas gdy stan źrenic, komponent motoryczny skali Glasgow (GCSM) i wiek są najważniejszymi cechami klinicznymi w przewidywaniu śmiertelności długoterminowej.19
Zgodnie z badaniami, modele Random Forest (RF), Logistic Regression (LR) i Generalized Linear Model (GLM) są najdokładniejszymi modelami do przewidywania śmiertelności wewnątrzszpitalnej pacjentów (w oparciu o 2-klasową skalę GOS). Z kolei GLM (z dokładnością 82%) okazał się najdokładniejszym predyktorem śmiertelności 6-miesięcznej.2021
Uczenie maszynowe w prognozowaniu zaburzeń równowagi
Wiele zbiorów danych klinicznych jest z natury niezrównoważonych, zdominowanych przez przeważające grupy większościowe. Gotowe modele uczenia maszynowego, które optymalizują prognozę dla większościowych typów pacjentów (np. klasa zdrowa), mogą powodować znaczne błędy w klasie predykcji mniejszościowej (np. klasa chorób) i podgrupach demograficznych (np. pacjenci czarnoskórzy lub młodzi).22
Badania wykazały, że niewykryte przypadki zgonów są 3,14 razy częstsze niż niewykryte przypadki przeżycia w modelu predykcji śmiertelności. Słaba wydajność predykcji w próbkach mniejszościowych nie jest odzwierciedlona w powszechnie stosowanych miarach. W przypadku niezrównoważonych zbiorów danych, konwencjonalne miary, takie jak ogólna dokładność i AUC-ROC, są w dużej mierze pod wpływem wydajności próbek większościowych, do których modele uczenia maszynowego dążą.23
Metoda korekcji błędu DP (Double Prioritized Bias Correction) priorytetyzuje określoną podgrupę demograficzną (np. pacjentów czarnoskórych), która cierpi z powodu nierównowagi danych, replikując przypadki klasy predykcji mniejszościowej (C1) z tej grupy (np. czarnoskórych pacjentów z wewnątrzszpitalnymi zgonami). DP stopniowo zwiększa liczbę zduplikowanych jednostek i wybiera optymalną liczbę jednostek na podstawie wynikowej wydajności modeli.24
Wyniki pokazują, że modele uczenia maszynowego trenowane z metodą korekcji błędu DP wykazują najmniejsze dysproporcje rasowe i wiekowe. Dla zrównoważonej dokładności i odwołania C1 zarówno w zadaniach IHM (śmiertelność wewnątrzszpitalna), jak i BCS (nowotwór piersi), większość względnych wartości dysproporcji DP mieści się w zakresie sprawiedliwym (1,25 i niższym), znacznie zmniejszając dysproporcję w oryginalnym modelu. W szczególności DP ma 14,8% do 23,9% poprawy w porównaniu z oryginalnym modelem pod względem dysproporcji odwołania C1.25
Modele predykcyjne w innych obszarach medycyny
Doświadczenia z modelami predykcyjnymi w innych obszarach medycyny mogą dostarczyć cennych wskazówek dla rozwoju podobnych modeli w obszarze zaburzeń równowagi.
Przewidywanie niewydolności nerek
Równania ryzyka niewydolności nerek (Kidney Failure Risk Equation) wykorzystują dane pacjenta dotyczące moczu, płci, wieku i GFR, aby dostarczyć 2- i 5-letniego prawdopodobieństwa niewydolności nerek wymagającej leczenia u potencjalnych pacjentów z CKD w stadium 3 do 5. Równania z czterema i ośmioma zmiennymi dokładnie przewidują to prawdopodobieństwo.26
Dla pacjentów z miejscowym rakiem nerki stojących przed częściową lub radykalną nefrektomią, Równanie Ryzyka Raka Nerki (KCRE) może być wykorzystane do przewidywania ryzyka niewydolności nerek 5 lat po operacji raka nerki. Znajomość ryzyka może pomóc w podejmowaniu decyzji dotyczących leczenia.27
Przewidywanie utraty masy ciała po operacjach bariatrycznych
W przypadku otyłych pacjentów chińskich z BMI ≥32,5 kg/m², nomogram oparty na Inbody integrujący spoczynkowy wydatek energetyczny/masę ciała (REE/BW), indeks beztłuszczowej masy ciała (FFMI) oraz obwód talii (WC) oferuje skuteczne narzędzie przedoperacyjne do przewidywania wyników utraty masy ciała rok po laparoskopowej rękawowej gastrektomii (LSG), ułatwiając planowanie operacji i postępowanie pooperacyjne.28
Zalecenia dotyczące podstawowego zestawu wyników
Panel ekspertów zaleca, aby jako minimum stosować albo Skalę Równowagi Berga, albo Mini Balance Evaluation Systems Test podczas pomiaru równowagi w pozycji stojącej w badaniach i praktyce w populacjach dorosłych. Te zalecenia dotyczące podstawowego zestawu wyników (Core Outcome Set, COS) dla oceny równowagi w pozycji stojącej odzwierciedlają próbę znalezienia wspólnej płaszczyzny, która może zaspokoić potrzeby szerokiego grona użytkowników.29
Zalecany COS dla równowagi w pozycji stojącej będzie bezpośrednio i znacząco wpływał na badania kliniczne i praktykę na całym świecie, przyczyniając się do poprawy jakości opieki nad pacjentami z zaburzeniami równowagi.30
Wnioski i perspektywy
Prognozowanie wyników u pacjentów z zaburzeniami równowagi pozostaje wyzwaniem klinicznym. Obecnie stosowane narzędzia, takie jak test stania na jednej nodze, mają ograniczoną wartość prognostyczną, podczas gdy bardziej złożone instrumenty, jak Skala Równowagi Berga czy Mini-BESTest, oferują lepsze możliwości przewidywania.3132
Rozwój modeli uczenia maszynowego może potencjalnie poprawić dokładność prognozowania, szczególnie gdy uwzględnia się specyficzne potrzeby podgrup demograficznych i klinicznych. Kluczowe znaczenie ma nie tylko dokładność prognozowania, ale także możliwość wczesnego wykrywania i interwencji w przypadku niekorzystnych zdarzeń, takich jak upadki.33
Przyszłe badania powinny skupić się na opracowaniu bardziej zaawansowanych i zintegrowanych modeli prognostycznych, które uwzględniają szeroki zakres czynników klinicznych, demograficznych i funkcjonalnych, aby lepiej przewidywać długoterminowe wyniki u pacjentów z zaburzeniami równowagi i umożliwić personalizację interwencji terapeutycznych.3435
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Materiały źródłowe
- #1 Outcome Measurement in Balance Problems: Berg Balance Scalehttps://pmc.ncbi.nlm.nih.gov/articles/PMC11058368/
Balance has been recognized as a crucial factor, as it involves maintaining posture during static stance and transitioning between movements, and it plays a significant role in performing daily activities. Consequently, numerous studies have been conducted to evaluate balance ability over the years. […] The clinical utility of the BBS includes the ability to estimate rehabilitation outcomes using the total score of the scale. Research on estimating rehabilitation outcomes suggests that scores measured at admission using the BBS are inversely related to the length of hospitalization and can predict the duration of hospitalization and eventual discharge decisions. Additionally, studies have categorized functional levels based on scores; for instance, scores ranging from 0 to 20 indicate the ability to walk with a walking aid, scores from 21 to 40 suggest the ability to walk with assistance, and scores from 41 to 56 indicate independent walking capability.
- #2 Recommendations for a Core Outcome Set for Measuring Standing Balance in Adult Populations: A Consensus-Based Approach | PLOS Onehttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0120568
Standing balance is imperative for mobility and avoiding falls. […] The objective of this project was to propose recommendations for a COS of standing balance measures for research and practice settings in adult populations. […] The expert panel convened in the current project recommends that at a minimum, either the Berg Balance Scale or the Mini Balance Evaluation Systems Test should be used when measuring standing balance for research and practice in adult populations. […] These COS recommendations for evaluating standing balance reflect an attempt to find common ground that can meet the needs of a broad range of users. Our recommended COS for standing balance will directly and substantially inform clinical research and practice internationally.
- #3 Prognostic accuracy of the one-legged balance test in predicting falls: 15-years of midlife follow-up in a British birth cohort studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC9869374/
The one-legged balance test is a common screening tool for fall risk. Yet, there is little empirical evidence assessing its prognostic ability. […] The predictive ability of balance tests in predicting either fall outcome was poor (AUC range for sex and balance models: 0.5770.600). Prognostic accuracy consistently improved by adding fall history to the model (range: 0.6040.634). […] Despite previous observational evidence showing associations between better one-legged balance performance and reduced fall risk, the one-legged balance test had limited prognostic accuracy in predicting recurrent falls. This contradicts ongoing translation of this test into clinical screening tools for falls and highlights the need to consider new and existing screening tools that can reliably predict fall risk.
- #4 Prognostic accuracy of the one-legged balance test in predicting falls: 15-years of midlife follow-up in a British birth cohort studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC9869374/
The findings presented in this study are consistent with other longitudinal studies examining prediction of any fall (AUC0.56), although no study examined recurrent fall outcomes. […] Replacing or combining one-legged balance performance with a self-reported measure of fall history improved prognostic fit from poor to average. […] The average prognostic performance of combining sex, one-legged balance assessment and self-reported fall history further highlights the complexity of fall risk. […] This study highlighted that one-legged balance performance was a poor prognostic indicator of subsequent fall risks over a four to fifteen year period. Further research is needed to examine how empirical associations can be translated into effective screening tools to address problems encountered by the ageing population.
- #5 Prognostic accuracy of the one-legged balance test in predicting falls: 15-years of midlife follow-up in a British birth cohort studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC9869374/
The findings presented in this study are consistent with other longitudinal studies examining prediction of any fall (AUC0.56), although no study examined recurrent fall outcomes. […] Replacing or combining one-legged balance performance with a self-reported measure of fall history improved prognostic fit from poor to average. […] The average prognostic performance of combining sex, one-legged balance assessment and self-reported fall history further highlights the complexity of fall risk. […] This study highlighted that one-legged balance performance was a poor prognostic indicator of subsequent fall risks over a four to fifteen year period. Further research is needed to examine how empirical associations can be translated into effective screening tools to address problems encountered by the ageing population.
- #6 Outcome Measurement in Balance Problems: Berg Balance Scalehttps://www.e-arm.org/journal/view.php?number=4366
Balance has been recognized as a crucial factor, as it involves maintaining posture during static stance and transitioning between movements, and it plays a significant role in performing daily activities. Consequently, numerous studies have been conducted to evaluate balance ability over the years. […] The clinical utility of the BBS includes the ability to estimate rehabilitation outcomes using the total score of the scale. Research on estimating rehabilitation outcomes suggests that scores measured at admission using the BBS are inversely related to the length of hospitalization and can predict the duration of hospitalization and eventual discharge decisions. […] In conclusion, the BBS is a useful outcome measure in predicting the risk of falls, assessing balance deficits, providing a numerical score that can be tracked for improvement over time, and even assessing the length of stay at inpatient rehabilitation.
- #7 Outcome Measurement in Balance Problems: Berg Balance Scalehttps://www.e-arm.org/journal/view.php?number=4366&viewtype=pubreader
The Berg Balance Scale (BBS) is the best-known balance measure that assesses balance and fall risk in adults. […] The clinical utility of the BBS includes the ability to estimate rehabilitation outcomes using the total score of the scale. Research on estimating rehabilitation outcomes suggests that scores measured at admission using the BBS are inversely related to the length of hospitalization and can predict the duration of hospitalization and eventual discharge decisions. […] In conclusion, the BBS is a useful outcome measure in predicting the risk of falls, assessing balance deficits, providing a numerical score that can be tracked for improvement over time, and even assessing the length of stay at inpatient rehabilitation.
- #8 Outcome Measurement in Balance Problems: Berg Balance Scalehttps://pmc.ncbi.nlm.nih.gov/articles/PMC11058368/
Balance has been recognized as a crucial factor, as it involves maintaining posture during static stance and transitioning between movements, and it plays a significant role in performing daily activities. Consequently, numerous studies have been conducted to evaluate balance ability over the years. […] The clinical utility of the BBS includes the ability to estimate rehabilitation outcomes using the total score of the scale. Research on estimating rehabilitation outcomes suggests that scores measured at admission using the BBS are inversely related to the length of hospitalization and can predict the duration of hospitalization and eventual discharge decisions. Additionally, studies have categorized functional levels based on scores; for instance, scores ranging from 0 to 20 indicate the ability to walk with a walking aid, scores from 21 to 40 suggest the ability to walk with assistance, and scores from 41 to 56 indicate independent walking capability.
- #9 Outcome Measurement in Balance Problems: Berg Balance Scalehttps://pmc.ncbi.nlm.nih.gov/articles/PMC11058368/
The minimal clinically important difference (MCID) for balance improvement was 13.5 points in stroke patients, indicating that the BBS MCID does clinically detect changes in balance abilities in persons with stroke. […] In conclusion, the BBS is a useful outcome measure in predicting the risk of falls, assessing balance deficits, providing a numerical score that can be tracked for improvement over time, and even assessing the length of stay at inpatient rehabilitation.
- #10 Outcome Measurement in Balance Problems: Berg Balance Scalehttps://www.e-arm.org/journal/view.php?number=4366&viewtype=pubreader
The Berg Balance Scale (BBS) is the best-known balance measure that assesses balance and fall risk in adults. […] The clinical utility of the BBS includes the ability to estimate rehabilitation outcomes using the total score of the scale. Research on estimating rehabilitation outcomes suggests that scores measured at admission using the BBS are inversely related to the length of hospitalization and can predict the duration of hospitalization and eventual discharge decisions. […] In conclusion, the BBS is a useful outcome measure in predicting the risk of falls, assessing balance deficits, providing a numerical score that can be tracked for improvement over time, and even assessing the length of stay at inpatient rehabilitation.
- #11 Recommendations for a Core Outcome Set for Measuring Standing Balance in Adult Populations: A Consensus-Based Approach | PLOS Onehttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0120568
Standing balance is imperative for mobility and avoiding falls. […] The objective of this project was to propose recommendations for a COS of standing balance measures for research and practice settings in adult populations. […] The expert panel convened in the current project recommends that at a minimum, either the Berg Balance Scale or the Mini Balance Evaluation Systems Test should be used when measuring standing balance for research and practice in adult populations. […] These COS recommendations for evaluating standing balance reflect an attempt to find common ground that can meet the needs of a broad range of users. Our recommended COS for standing balance will directly and substantially inform clinical research and practice internationally.
- #12 Balance function in critical illness survivors and evaluation of psychometric properties of the Mini-BESTest | Scientific Reportshttps://www.nature.com/articles/s41598-024-61745-5
The average Mini-BESTest score doubled to 16.38.2 points at V2, which is reflected by a large effect size of 0.819. […] However, balance was still impaired at discharge in many participants and the median Mini-BESTest was only 18.5 of 28 points. […] According to the multiple linear regression, muscle strength, cognitive function, the presence of CIP/CIM, cerebral disease, and depression were associated with balance function. […] The Mini-BESTest was shown to be a reliable and valid tool for assessing balance in individuals after critical illness and therefore seems well-suited for clinical practice and research.
- #13 Balance function in critical illness survivors and evaluation of psychometric properties of the Mini-BESTest | Scientific Reportshttps://www.nature.com/articles/s41598-024-61745-5
The average Mini-BESTest score doubled to 16.38.2 points at V2, which is reflected by a large effect size of 0.819. […] However, balance was still impaired at discharge in many participants and the median Mini-BESTest was only 18.5 of 28 points. […] According to the multiple linear regression, muscle strength, cognitive function, the presence of CIP/CIM, cerebral disease, and depression were associated with balance function. […] The Mini-BESTest was shown to be a reliable and valid tool for assessing balance in individuals after critical illness and therefore seems well-suited for clinical practice and research.
- #14 Balance function in critical illness survivors and evaluation of psychometric properties of the Mini-BESTest | Scientific Reportshttps://www.nature.com/articles/s41598-024-61745-5
Critical illness survivors commonly face impairments, such as intensive care unit-acquired weakness (ICUAW) which is characterized by muscle weakness and sensory deficits. […] Therefore, we aimed to assess balance function using the Mini-BESTest, evaluate its psychometric properties, and identify associated variables. […] Despite significant improvements during the rehabilitation period, balance disorders were prevalent in critical illness survivors. Ongoing therapy is recommended. […] The prospective cohort study comprised 250 patients (34% female, 6214 years, median ICU stay 55 days). […] Muscle strength, cognitive function, cerebral disease, critical illness polyneuropathy/myopathy, and depression were significantly associated with balance. […] Good balance performance is crucial for independence in activities of daily living.
- #15 Balance function in critical illness survivors and evaluation of psychometric properties of the Mini-BESTest | Scientific Reportshttps://www.nature.com/articles/s41598-024-61745-5
Critical illness survivors commonly face impairments, such as intensive care unit-acquired weakness (ICUAW) which is characterized by muscle weakness and sensory deficits. […] Therefore, we aimed to assess balance function using the Mini-BESTest, evaluate its psychometric properties, and identify associated variables. […] Despite significant improvements during the rehabilitation period, balance disorders were prevalent in critical illness survivors. Ongoing therapy is recommended. […] The prospective cohort study comprised 250 patients (34% female, 6214 years, median ICU stay 55 days). […] Muscle strength, cognitive function, cerebral disease, critical illness polyneuropathy/myopathy, and depression were significantly associated with balance. […] Good balance performance is crucial for independence in activities of daily living.
- #16 Balance function in critical illness survivors and evaluation of psychometric properties of the Mini-BESTest | Scientific Reportshttps://www.nature.com/articles/s41598-024-61745-5
It was shown that community participation was affected in individuals post stroke and multiple sclerosis who displayed balance impairments. […] Hence, it is essential to tackle balance impairments. […] Although balance impairments seem to be a major aspect in the recovery of patients after critical illness, no investigations about manifestations, the development over time, or associated factors were done in this population. […] The aims of this study were: (1) to describe balance function in critical illness survivors during neurorehabilitation, (2) to investigate independent variables associated with balance, and (3) to evaluate the psychometric properties of the Mini-BESTest in critical illness survivors. […] Balance function was compared between the two study visits by the Wilcoxon signed rank test on paired samples as data were either non-parametric or did not follow normal distribution.
- #17 Balance function in critical illness survivors and evaluation of psychometric properties of the Mini-BESTest | Scientific Reportshttps://www.nature.com/articles/s41598-024-61745-5
Critical illness survivors commonly face impairments, such as intensive care unit-acquired weakness (ICUAW) which is characterized by muscle weakness and sensory deficits. […] Therefore, we aimed to assess balance function using the Mini-BESTest, evaluate its psychometric properties, and identify associated variables. […] Despite significant improvements during the rehabilitation period, balance disorders were prevalent in critical illness survivors. Ongoing therapy is recommended. […] The prospective cohort study comprised 250 patients (34% female, 6214 years, median ICU stay 55 days). […] Muscle strength, cognitive function, cerebral disease, critical illness polyneuropathy/myopathy, and depression were significantly associated with balance. […] Good balance performance is crucial for independence in activities of daily living.
- #18 Prognosis prediction in traumatic brain injury patients using machine learning algorithms | Scientific Reportshttps://www.nature.com/articles/s41598-023-28188-w
Predicting treatment outcomes in traumatic brain injury (TBI) patients is challenging worldwide. […] Our findings reveal that among different variables included in this study, the motor component of the Glasgow coma scale, the condition of pupils, and the condition of cisterns were the most reliable features for predicting in-hospital mortality, while the patients age takes the place of cisterns condition when considering the long-term survival of TBI patients. […] Our results showed that using appropriate markers and with further development, ML has the potential to predict TBI patients survival in the short- and long-term. […] The first aim of this paper was to find the most reliable prognostic markers related to TBI. […] Several features have been introduced as the most reliable variables in recent years.
- #19 Prognosis prediction in traumatic brain injury patients using machine learning algorithms | Scientific Reportshttps://www.nature.com/articles/s41598-023-28188-w
Our assessments on wide background, clinical, and paraclinical features with various models indicated that the condition of pupils, the condition of cisterns (being present, absent, or compressed), and the patients age are the best predictors of in-hospital mortality, while the condition of the pupils, GCSM, and age are the most important clinical features in predicting the long-term mortality. […] The second aim of the present study was to provide efficient ML and statistical models to predict the short- and long-term outcomes of TBI patients. […] According to our findings, the RF, LR, and GLM models are the most accurate models to predict the in-hospital mortality of patients (based on the 2-class GOS). […] On the other hand, GLM (with an accuracy of 82%) was found to be the most accurate predictor of 6-months mortality.
- #20 Prognosis prediction in traumatic brain injury patients using machine learning algorithms | Scientific Reportshttps://www.nature.com/articles/s41598-023-28188-w
Our assessments on wide background, clinical, and paraclinical features with various models indicated that the condition of pupils, the condition of cisterns (being present, absent, or compressed), and the patients age are the best predictors of in-hospital mortality, while the condition of the pupils, GCSM, and age are the most important clinical features in predicting the long-term mortality. […] The second aim of the present study was to provide efficient ML and statistical models to predict the short- and long-term outcomes of TBI patients. […] According to our findings, the RF, LR, and GLM models are the most accurate models to predict the in-hospital mortality of patients (based on the 2-class GOS). […] On the other hand, GLM (with an accuracy of 82%) was found to be the most accurate predictor of 6-months mortality.
- #21 Prognosis prediction in traumatic brain injury patients using machine learning algorithms | Scientific Reportshttps://www.nature.com/articles/s41598-023-28188-w
However, as described in the results, the accuracy of the 5-class GOS is lower than the 2-class GOS. […] The race toward achieving reliable ML model for robust clinical decision-making continues. […] The novelties of our proposed model are as follows: We have obtained high performance using simple ML algorithms. […] We have gathered a TBI dataset in Iran. […] The collected dataset has been analysed to determine features with significant impact on fGOS and GOS0. […] In this work, we have used ML methods such as RF and GLM for survival prediction of TBI patients in short- and long-term periods. […] According to our findings, the condition of pupils, GCSM, condition of cisterns, and the patients age are the best predictors of their survival.
- #22 Subpopulation-specific Machine Learning Prognosis for Underrepresented Patients with Double Prioritized Bias Correction | medRxivhttps://www.medrxiv.org/content/10.1101/2021.03.26.21254401v3.full-text
Many clinical datasets are intrinsically imbalanced, dominated by overwhelming majority groups. Off-the-shelf machine learning models that optimize the prognosis of majority patient types (e.g., healthy class) may cause substantial errors on the minority prediction class (e.g., disease class) and demographic subgroups (e.g., Black or young patients). For example, our work found that missed death cases are 3.14 times higher than missed survival cases in a mortality prediction model. […] Poor prediction performance in minority samples is not reflected in widely used metrics. For imbalanced datasets, conventional metrics such as overall accuracy and AUC-ROC are largely influenced by the performance of majority samples, which machine learning models aim to fit. […] Our results show that machine learning models trained with our DP bias correction method exhibit the smallest racial and age disparities. For balanced accuracy and C1 recall of both IHM and BCS tasks, most of DP’s relative disparity values are in the fair range (1.25 and lower), substantially reducing the disparity in the original model. Specifically, DP has a 14.8% to 23.9% improvement than the original model in terms of C1 recall disparity.
- #23 Subpopulation-specific Machine Learning Prognosis for Underrepresented Patients with Double Prioritized Bias Correction | medRxivhttps://www.medrxiv.org/content/10.1101/2021.03.26.21254401v3.full-text
Many clinical datasets are intrinsically imbalanced, dominated by overwhelming majority groups. Off-the-shelf machine learning models that optimize the prognosis of majority patient types (e.g., healthy class) may cause substantial errors on the minority prediction class (e.g., disease class) and demographic subgroups (e.g., Black or young patients). For example, our work found that missed death cases are 3.14 times higher than missed survival cases in a mortality prediction model. […] Poor prediction performance in minority samples is not reflected in widely used metrics. For imbalanced datasets, conventional metrics such as overall accuracy and AUC-ROC are largely influenced by the performance of majority samples, which machine learning models aim to fit. […] Our results show that machine learning models trained with our DP bias correction method exhibit the smallest racial and age disparities. For balanced accuracy and C1 recall of both IHM and BCS tasks, most of DP’s relative disparity values are in the fair range (1.25 and lower), substantially reducing the disparity in the original model. Specifically, DP has a 14.8% to 23.9% improvement than the original model in terms of C1 recall disparity.
- #24 Subpopulation-specific Machine Learning Prognosis for Underrepresented Patients with Double Prioritized Bias Correction | medRxivhttps://www.medrxiv.org/content/10.1101/2021.03.26.21254401v3.full-text
DP prioritizes a specific demographic subgroup (e.g., Black patients) that suffers from data imbalance by replicating minority prediction class (C1) cases from this group (e.g., Black in-hospital deaths). DP incrementally increases the number of duplicated units and chooses the optimal unit number based on resulting models performance.
- #25 Subpopulation-specific Machine Learning Prognosis for Underrepresented Patients with Double Prioritized Bias Correction | medRxivhttps://www.medrxiv.org/content/10.1101/2021.03.26.21254401v3.full-text
Many clinical datasets are intrinsically imbalanced, dominated by overwhelming majority groups. Off-the-shelf machine learning models that optimize the prognosis of majority patient types (e.g., healthy class) may cause substantial errors on the minority prediction class (e.g., disease class) and demographic subgroups (e.g., Black or young patients). For example, our work found that missed death cases are 3.14 times higher than missed survival cases in a mortality prediction model. […] Poor prediction performance in minority samples is not reflected in widely used metrics. For imbalanced datasets, conventional metrics such as overall accuracy and AUC-ROC are largely influenced by the performance of majority samples, which machine learning models aim to fit. […] Our results show that machine learning models trained with our DP bias correction method exhibit the smallest racial and age disparities. For balanced accuracy and C1 recall of both IHM and BCS tasks, most of DP’s relative disparity values are in the fair range (1.25 and lower), substantially reducing the disparity in the original model. Specifically, DP has a 14.8% to 23.9% improvement than the original model in terms of C1 recall disparity.
- #26 The Kidney Failure Risk Equationhttps://kidneyfailurerisk.com/
Using the patient’s Urine, Sex, Age and GFR, the kidney failure risk equation provides the 2 and 5 year probability of treated kidney failure for a potential patient with CKD stage 3 to 5. […] The four and eight variable equations accurately predict the 2 and 5 year probability of treated kidney failure (dialysis or transplantation) for a potential patient with CKD Stage 3 to 5. […] Determining the probability of kidney failure may be useful for patient and provider communication, triage and management of nephrology referrals and timing of dialysis access placement and living related kidney transplant. […] For patients with localized kidney cancer facing either a partial or radical nephrectomy, the Kidney Cancer Risk Equation (KCRE) can be used to predict the risk of kidney failure 5-years after kidney cancer surgery. Knowing your risk can help inform treatment decisions, such as surgery (partial versus radical nephrectomy), or watchful waiting. […] Patient risk of progression to kidney failure requiring dialysis or transplant after kidney cancer surgery:
- #27 The Kidney Failure Risk Equationhttps://kidneyfailurerisk.com/
Using the patient’s Urine, Sex, Age and GFR, the kidney failure risk equation provides the 2 and 5 year probability of treated kidney failure for a potential patient with CKD stage 3 to 5. […] The four and eight variable equations accurately predict the 2 and 5 year probability of treated kidney failure (dialysis or transplantation) for a potential patient with CKD Stage 3 to 5. […] Determining the probability of kidney failure may be useful for patient and provider communication, triage and management of nephrology referrals and timing of dialysis access placement and living related kidney transplant. […] For patients with localized kidney cancer facing either a partial or radical nephrectomy, the Kidney Cancer Risk Equation (KCRE) can be used to predict the risk of kidney failure 5-years after kidney cancer surgery. Knowing your risk can help inform treatment decisions, such as surgery (partial versus radical nephrectomy), or watchful waiting. […] Patient risk of progression to kidney failure requiring dialysis or transplant after kidney cancer surgery:
- #28 Establishing a Prediction Model for Weight Loss Outcomes After LSG in | DMSOhttps://www.dovepress.com/establishing-a-prediction-model-for-weight-loss-outcomes-after-lsg-in–peer-reviewed-fulltext-article-DMSO
In obese Chinese patients with a BMI 32.5 kg/m2, the Inbody-based nomogram integrating REE/BW, FFMI, and WC offers an effective preoperative tool for predicting weight loss outcomes one year after LSG, facilitating surgical planning and postoperative management. […] The five most influential variables were subsequently included in a multivariate logistic regression model, which indicated that REE/BW, FFMI, and WC were independent predictors of weight loss outcomes. […] This study developed a preoperative predictive model for weight loss outcomes following LSG by integrating three key indicators: REE/BW, FFMI, and WC. […] In conclusion, the combination of REE/BW, FFMI, and WC provides a relatively accurate preoperative prediction of weight loss outcomes one year post-LSG.
- #29 Recommendations for a Core Outcome Set for Measuring Standing Balance in Adult Populations: A Consensus-Based Approach | PLOS Onehttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0120568
Standing balance is imperative for mobility and avoiding falls. […] The objective of this project was to propose recommendations for a COS of standing balance measures for research and practice settings in adult populations. […] The expert panel convened in the current project recommends that at a minimum, either the Berg Balance Scale or the Mini Balance Evaluation Systems Test should be used when measuring standing balance for research and practice in adult populations. […] These COS recommendations for evaluating standing balance reflect an attempt to find common ground that can meet the needs of a broad range of users. Our recommended COS for standing balance will directly and substantially inform clinical research and practice internationally.
- #30 Recommendations for a Core Outcome Set for Measuring Standing Balance in Adult Populations: A Consensus-Based Approach | PLOS Onehttps://journals.plos.org/plosone/article?id=10.1371/journal.pone.0120568
Standing balance is imperative for mobility and avoiding falls. […] The objective of this project was to propose recommendations for a COS of standing balance measures for research and practice settings in adult populations. […] The expert panel convened in the current project recommends that at a minimum, either the Berg Balance Scale or the Mini Balance Evaluation Systems Test should be used when measuring standing balance for research and practice in adult populations. […] These COS recommendations for evaluating standing balance reflect an attempt to find common ground that can meet the needs of a broad range of users. Our recommended COS for standing balance will directly and substantially inform clinical research and practice internationally.
- #31 Prognostic accuracy of the one-legged balance test in predicting falls: 15-years of midlife follow-up in a British birth cohort studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC9869374/
The findings presented in this study are consistent with other longitudinal studies examining prediction of any fall (AUC0.56), although no study examined recurrent fall outcomes. […] Replacing or combining one-legged balance performance with a self-reported measure of fall history improved prognostic fit from poor to average. […] The average prognostic performance of combining sex, one-legged balance assessment and self-reported fall history further highlights the complexity of fall risk. […] This study highlighted that one-legged balance performance was a poor prognostic indicator of subsequent fall risks over a four to fifteen year period. Further research is needed to examine how empirical associations can be translated into effective screening tools to address problems encountered by the ageing population.
- #32 Outcome Measurement in Balance Problems: Berg Balance Scalehttps://pmc.ncbi.nlm.nih.gov/articles/PMC11058368/
The minimal clinically important difference (MCID) for balance improvement was 13.5 points in stroke patients, indicating that the BBS MCID does clinically detect changes in balance abilities in persons with stroke. […] In conclusion, the BBS is a useful outcome measure in predicting the risk of falls, assessing balance deficits, providing a numerical score that can be tracked for improvement over time, and even assessing the length of stay at inpatient rehabilitation.
- #33 Risk-Averse Active Sensing for Timely Outcome Prediction under Cost Pressure | OpenReviewhttps://openreview.net/forum?id=aw1vLo7TE7
Timely outcome prediction is essential in healthcare to enable early detection and intervention of adverse events. […] To balance the timely and accurate outcome predictions with acquisition costs, an effective active sensing strategy is crucial. […] Our method outperforms baseline active sensing approaches in experiments with both synthetic and real-world datasets, and we illustrate the significance of our policy decomposition and the necessity of a risk-averse sensing policy through case studies.
- #34 Prognosis prediction in traumatic brain injury patients using machine learning algorithms | Scientific Reportshttps://www.nature.com/articles/s41598-023-28188-w
However, as described in the results, the accuracy of the 5-class GOS is lower than the 2-class GOS. […] The race toward achieving reliable ML model for robust clinical decision-making continues. […] The novelties of our proposed model are as follows: We have obtained high performance using simple ML algorithms. […] We have gathered a TBI dataset in Iran. […] The collected dataset has been analysed to determine features with significant impact on fGOS and GOS0. […] In this work, we have used ML methods such as RF and GLM for survival prediction of TBI patients in short- and long-term periods. […] According to our findings, the condition of pupils, GCSM, condition of cisterns, and the patients age are the best predictors of their survival.
- #35 Prognostic accuracy of the one-legged balance test in predicting falls: 15-years of midlife follow-up in a British birth cohort studyhttps://pmc.ncbi.nlm.nih.gov/articles/PMC9869374/
The findings presented in this study are consistent with other longitudinal studies examining prediction of any fall (AUC0.56), although no study examined recurrent fall outcomes. […] Replacing or combining one-legged balance performance with a self-reported measure of fall history improved prognostic fit from poor to average. […] The average prognostic performance of combining sex, one-legged balance assessment and self-reported fall history further highlights the complexity of fall risk. […] This study highlighted that one-legged balance performance was a poor prognostic indicator of subsequent fall risks over a four to fifteen year period. Further research is needed to examine how empirical associations can be translated into effective screening tools to address problems encountered by the ageing population.