Interobserver agreement and validity of bedside 'positive signs' for functional weakness, sensory and gait disorders in conversion disorder: a pilot study.

Details

Serval ID
serval:BIB_3D7D0A37196B
Type
Article: article from journal or magazin.
Collection
Publications
Title
Interobserver agreement and validity of bedside 'positive signs' for functional weakness, sensory and gait disorders in conversion disorder: a pilot study.
Journal
Journal of neurology, neurosurgery, and psychiatry
Author(s)
Daum C., Gheorghita F., Spatola M., Stojanova V., Medlin F., Vingerhoets F., Berney A., Gholam-Rezaee M., Maccaferri G.E., Hubschmid M., Aybek S.
ISSN
1468-330X (Electronic)
ISSN-L
0022-3050
Publication state
Published
Issued date
04/2015
Peer-reviewed
Oui
Volume
86
Number
4
Pages
425-430
Language
english
Notes
Publication types: Journal Article ; Validation Study
Publication Status: ppublish
Abstract
Conversion disorder (CD) is no longer a diagnosis of exclusion. The new DSM-V criteria highlight the importance of 'positive signs' on neurological examination. Only few signs have been validated, and little is known about their reliability.
The aim was to examine the clinical value of bedside positive signs in the diagnosis of CD presenting with weakness, gait or sensory symptoms by assessing their specificity, sensitivity and their inter-rater reliability.
Standardised video recorded neurological examinations were performed in 20 consecutive patients with CD and 20 'organic' controls. Ten previously validated sensory and motor signs were grouped in a scale. Thirteen additional motor/sensory 'positive signs', 14 gait patterns and 1 general sign were assessed in a pilot validation study. In addition, two blinded independent neurologists rated the video recordings to assess the inter-rater reliability (Cohen's κ) of each sign.
A score of ≥ 4/14 on the sensory motor scale showed a 100% specificity (CI 85 to 100) and a 95% sensitivity (CI 85 to 100). Among the additional tested signs, 10 were significantly more frequent in CD than controls. The interobserver agreement was acceptable for 23/38 signs (2 excellent, 10 good, 11 moderate).
Our study confirms that six bedside 'positive signs' are highly specific for CD with good-excellent inter-rater reliability; we propose to consider them as 'highly reliable signs'. In addition 13 signs could be considered as 'reliable signs' and six further signs as 'suggestive signs' while all others should be used with caution until further validation is available.
Keywords
Adult, Aged, Conversion Disorder/diagnosis, Diagnostic and Statistical Manual of Mental Disorders, Female, Gait Disorders, Neurologic/diagnosis, Humans, Male, Middle Aged, Muscle Weakness/diagnosis, Observer Variation, Pilot Projects, Point-of-Care Systems, Reproducibility of Results, Sensation Disorders/diagnosis, Hysteria
Pubmed
Web of science
Create date
05/09/2014 13:28
Last modification date
20/02/2020 17:19
Usage data