Review Question 1What are the clinical signs and symptoms for predicting and monitoring respiratory impairment in people with motor neurone disease?

DetailsAdditional commentsStatus
1. Review question ID1
2. Review questionWhat are the clinical signs and symptoms for predicting and monitoring respiratory impairment in people with motor neurone disease?
3. ObjectivesTo identify clinical prediction model for predicting and monitoring respiratory impairment in people with motor neurone disease.As per protocol, with exclusion of service delivery issues
4. LanguageEnglish only.As per protocol
5. Study designCross-sectional studies, case-control studies, RCTs, Cohort studiesAs per protocol
6. StatusPublished papers (full papers only)As per protocol
7. Population & Healthcare settingInclusion:
  • Adults (aged 18 and over) with a diagnosis of MND
Subgroups:
  • People with MND who have moderate or severe bulbar impairment
  • People with MND who have severe cognitive impairment or dementia
Exclusion:
  • Children (17 or younger) with a diagnosis of MND
  • Adults with other neurodegenerative disorders
  • Adults with respiratory impairment not related to MND
Healthcare setting:
  • Primary care and community settings, secondary care and tertiary care.
As per protocol, with exclusion of service delivery issues
8. InterventionInclusion:
Clinical signs and symptoms, or any clinical screening/clinical prediction model used to predict or monitor respiratory impairment in people with motor neurone disease.
As per protocol, with exclusion of service delivery issues
9. ComparisonsReference tests/event rates of confirmed respiratory impairment in people with motor neurone disease.
10. Outcomes Clinical/Test utility including: Since the review question is more general about clinical signs and symptoms for prediction and monitoring, not just solely focused on ‘diagnostic accuracy’ for respiratory impairment (ie. sensitivity, specificity, PPV, NPV, LHR, DOR and area under the ROC), studies that reported test validity (eg: face validity, content validity, construct validity, criterion validity) and test reliability (eg: internal reliability/consistency, test- retest reliability, inter-rater reliability) are also included.As per protocol, with exclusion of service delivery issues
11. Other criteria for inclusion/ exclusion of studiesInclusion:
Only studies/screening tools/prediction models carried out and validated within the population of people (adults) with motor neurone disease.

Exclusion:
Case series and case reports.
Reasons for strict inclusion and exclusion criteria are concern over spectrum bias* and clinical applicability.

*Spectrum biasheterogeneity of test performance ie. sensitivity and/or specificity of a test varying with different populations tested.

Example: the sample population chosen is not representative of the population at risk
As per protocol, with exclusion of service delivery issues
12. Search strategiesPlease see appendix 9.5.As per protocol
13. Review strategiesThe NICE Methodology Checklist for diagnostic studies (QUADAS) and prognostic studies will be used as a guide to appraise the quality of individual studies will be summarised in evidence tables.

GRADE evidence profiles will be adapted to present the outcomes for generating evidence statements.

Where possible, a meta-analytic approach will be used to give an overall summary effect.
Meta-analysis was not carried out as there is a lack of robust data (only one study included).

From: Appendix 9.2, Key clinical issues, review questions and review protocol

Cover of Motor Neurone Disease
Motor Neurone Disease: The Use of Non-Invasive Ventilation in the Management of Motor Neurone Disease [Internet].
NICE Clinical Guidelines, No. 105.
Centre for Clinical Practice at NICE (UK).
Copyright © 2010, National Institute for Health and Clinical Excellence.

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