Randomised parallel trial on the effectiveness and cost-effectiveness in screening gait disorder of silent cerebrovascular disease assisted by artificial intelligent system versus clinical doctors (ACCURATE-1): study protocol

Beini Fei, Jin Zhao, Xin Li, Yanmin Tang, Guoyou Qin, Wei Zhang, Jing Ding, Min Hu, Xin Wang, Beini Fei, Jin Zhao, Xin Li, Yanmin Tang, Guoyou Qin, Wei Zhang, Jing Ding, Min Hu, Xin Wang

Abstract

IntroductionSilent cerebrovascular disease (SCD), which is a common disease in the elderly, leads to cognitive decline, gait disorders, depression and urination dysfunction, and increases the risk of cerebrovascular events. Our study aims to compare the accuracy of the diagnosis of SCD-related gait disorders between the intelligent system and the clinician. Our team have developed an intelligent evaluation system for gait. This study will evaluate whether the intelligent system can help doctors make clinical decisions and predictions, which aids the early prevention and treatment of SCD.

Methods and analysis: This study is a multi-centred, prospective, randomised and controlled trial.SCD subjects aged 60-85 years in Shanghai and Guizhou will be recruited continuously. All subjects will randomly be divided into a doctor with intelligence assistance group or a doctor group, at a 1:1 ratio. The doctor and intelligent assistant group will accept the intelligent system evaluation. The intelligent system obtains gait parameters by an Red-Green-Blue-depth camera and computer vision algorithm. The doctor group will accept the clinicians' routine treatment procedures. Meanwhile, all subjects will accept the panel's gait assessment and recognition rating scale as the gold standard. The primary outcome is the sensitivity of the intelligent system and clinicians to screen for gait disorders. The secondary outcomes include the healthcare costs and the incremental cost effectiveness ratio of intelligent systems and clinicians to screen for gait disorders.

Ethics and dissemination: Approval was granted by the Ethics Committee of Zhongshan Hospital affiliated with Fudan University on 26 November 2019. The approval number is B2019-027(2) R. All subjects will sign an informed consent form before enrolment. Serious adverse events will be reported to the main researchers and ethics committees. The subjects' data will be kept strictly confidential. The results will be disseminated in peer-reviewed journals.

Trial registration number: NCT04457908.

Keywords: adult neurology; health economics; stroke.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Flow diagram of ACCURATE-1. SCD, silent cerebrovascular disease.

References

    1. Smith EE, Saposnik G, Biessels GJ, et al. . Prevention of stroke in patients with silent cerebrovascular disease: a scientific statement for healthcare professionals from the American heart Association/American stroke association. Stroke 2017;48:e44–71. 10.1161/STR.0000000000000116
    1. Vermeer SE, Longstreth WT, Koudstaal PJ. Silent brain infarcts: a systematic review. Lancet Neurol 2007;6:611–9. 10.1016/S1474-4422(07)70170-9
    1. Leary MC, Saver JL. Annual incidence of first silent stroke in the United States: a preliminary estimate. Cerebrovasc Dis 2003;16:280–5. 10.1159/000071128
    1. Kim BJ, Lee S-H. Prognostic impact of cerebral small vessel disease on stroke outcome. J Stroke 2015;17:101–10. 10.5853/jos.2015.17.2.101
    1. Poels MMF, Steyerberg EW, Wieberdink RG, et al. . Assessment of cerebral small vessel disease predicts individual stroke risk. J Neurol Neurosurg Psychiatry 2012;83:1174–9. 10.1136/jnnp-2012-302381
    1. Vermeer SE, Hollander M, van Dijk EJ, et al. . Silent brain infarcts and white matter lesions increase stroke risk in the general population: the Rotterdam scan study. Stroke 2003;34:1126–9. 10.1161/01.STR.0000068408.82115.D2
    1. Debette S, Beiser A, DeCarli C, et al. . Association of MRI markers of vascular brain injury with incident stroke, mild cognitive impairment, dementia, and mortality: the Framingham offspring study. Stroke 2010;41:600–6. 10.1161/STROKEAHA.109.570044
    1. Reed SD, Blough DK, Meyer K, et al. . Inpatient costs, length of stay, and mortality for cerebrovascular events in community hospitals. Neurology 2001;57:305–14. 10.1212/WNL.57.2.305
    1. Barry E, Galvin R, Keogh C, et al. . Is the timed up and go test a useful predictor of risk of falls in community dwelling older adults: a systematic review and meta-analysis. BMC Geriatr 2014;14:14. 10.1186/1471-2318-14-14
    1. Y-m T, Y-h W, X-y F. Diagnostic value of a vision-based intelligent gait analyzer in screening for gait abnormalities. Gait & Posture 2022;91:205–11.
    1. Tsoi KKF, Chan JYC, Hirai HW, et al. . Cognitive tests to detect dementia: a systematic review and meta-analysis. JAMA Intern Med 2015;175:1450–8. 10.1001/jamainternmed.2015.2152
    1. Creavin ST, Wisniewski S, Noel-Storr AH, et al. . Mini-Mental state examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations. Cochrane Database Syst Rev 2016;1:Cd011145. 10.1002/14651858.CD011145.pub2
    1. O'Driscoll C, Shaikh M. Cross-Cultural applicability of the Montreal cognitive assessment (MoCA): a systematic review. J Alzheimers Dis 2017;58:789–801. 10.3233/JAD-161042
    1. Scarpina F, Tagini S. The Stroop color and word test. Front Psychol 2017;8:557. 10.3389/fpsyg.2017.00557
    1. Tripathi R, Kumar K, Bharath S, et al. . Indian older adults and the digit span a preliminary report. Dement Neuropsychol 2019;13:111–5. 10.1590/1980-57642018dn13-010013
    1. Whiteside DM, Kealey T, Semla M, et al. . Verbal fluency: language or executive function measure? Appl Neuropsychol 2016;23:29–34. 10.1080/23279095.2015.1004574
    1. Peters DM, Fritz SL, Krotish DE. Assessing the reliability and validity of a shorter walk test compared with the 10-Meter walk test for measurements of gait speed in healthy, older adults. J Geriatr Phys Ther 2013;36:24–30. 10.1519/JPT.0b013e318248e20d
    1. Canbek J, Fulk G, Nof L, et al. . Test-Retest reliability and construct validity of the tinetti performance-oriented mobility assessment in people with stroke. J Neurol Phys Ther 2013;37:14–19. 10.1097/NPT.0b013e318283ffcc
    1. Sterke CS, Huisman SL, van Beeck EF, et al. . Is the Tinetti performance oriented mobility assessment (PomA) a feasible and valid predictor of short-term fall risk in nursing home residents with dementia? Int Psychogeriatr 2010;22:254–63. 10.1017/S1041610209991347
    1. Luo N, Liu G, Li M, et al. . Estimating an EQ-5D-5L value set for China. Value Health 2017;20:662–9. 10.1016/j.jval.2016.11.016
    1. Joseph C, Brodin N, Leavy B, et al. . Cost-effectiveness of the HiBalance training program for elderly with Parkinson’s disease: analysis of data from a randomized controlled trial. Clin Rehabil 2019;33:222–32. 10.1177/0269215518800832
    1. Doi T, Nakakubo S, Tsutsumimoto K, et al. . Spatio-Temporal gait variables predicted incident disability. J Neuroeng Rehabil 2020;17:11. 10.1186/s12984-020-0643-4
    1. Rosso AL, Verghese J, Metti AL, et al. . Slowing gait and risk for cognitive impairment. Neurology 2017;89:336–42. 10.1212/WNL.0000000000004153
    1. Dumurgier J, Artaud F, Touraine C, Elbaz A, Singh-Manoux A, et al. . Gait speed and decline in gait speed as predictors of incident dementia. J Gerontol A Biol Sci Med Sci 2017;72:75. 10.1093/geroni/igx004.310
    1. Ahad MAR, Ngo TT, Antar AD, et al. . Wearable Sensor-Based gait analysis for age and gender estimation. Sensors 2020;20:2424. 10.3390/s20082424
    1. Qiu S, Wang H, Li J, et al. . Towards Wearable-Inertial-Sensor-Based gait posture evaluation for subjects with unbalanced gaits. Sensors 2020;20:1193. 10.3390/s20041193

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