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. 2019 Feb;29(1):105-112.
doi: 10.1007/s10286-018-0511-5. Epub 2018 Feb 28.

Initial validation of symptom scores derived from the orthostatic discriminant and severity scale

Jacquie Baker  1   2 , Justin R Paturel  1 , David M Sletten  3 , Phillip A Low  3 , Kurt Kimpinski  4   5   6
Affiliations

Initial validation of symptom scores derived from the orthostatic discriminant and severity scale

Jacquie Baker et al. Clin Auton Res. 2019 Feb.

Abstract

Objective: To develop a scale to quantify and discriminate orthostatic from non-orthostatic symptoms. In the current study, we present validation and reliability of orthostatic and non-orthostatic symptom scores taken from the orthostatic discriminate and severity scale (ODSS).

Methods: Validity and reliability were assessed in participants with and without orthostatic intolerance. Convergent validity was assessed by correlating symptoms scores with previously validated tools [autonomic symptom profile (ASP) and the orthostatic hypotension questionnaire (OHQ)]. Clinical validity was assessed by correlating scores against standardized autonomic testing. Test-retest reliability was calculated using an intra-class correlation coefficient.

Results: Convergent validity: orthostatic (OS) and non-orthostatic (NS) symptom scores from 77 controls and 67 patients with orthostatic intolerance were highly correlated with both the orthostatic intolerance index of the ASP (OS: r = 0.903; NS: r = 0.651; p < 0.001) and the composite score of the OHQ: (OS: r = 0.800; NS: r = 0.574; p < 0.001). Clinical validity: symptom scores were significantly correlated with the total composite autonomic severity score (OS: r = 0.458; NS: r = 0.315; p < 0.001), and the systolic blood pressure change during head-up tilt (OS: r = - 0.445; NS: r = - 0.354; p < 0.001). In addition, patients with orthostatic intolerance had significantly higher symptom scores compared to controls (OS: 66.5 ± 18.1 vs. 17.4 ± 12.9; NS: 19.9 ± 11.3 vs. 10.2 ± 6.8; p < 0.001, respectively). Test-retest reliability: Both orthostatic and non-orthostatic symptom scores were highly reliable (OS: r = 0.956 and NS: r = 0.574, respectively; p < 0.001) with an internal consistency of 0.978 and 0.729, respectively.

Interpretation: Our initial results demonstrate that the ODSS is capable of producing valid and reliable orthostatic and non-orthostatic symptom scores. Further studies are ongoing to test sensitivity, specificity and symptom severity.

Keywords: Autonomic dysfunction; Autonomic reflex screen; Orthostatic intolerance; Questionnaires.

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References

    1. Low P, Sandroni P, Joyner MJ, Shen W (2008) Postural tachycardia syndrome. In: Low PA, Benarroch EE (eds) Clinical autonomic disorders, 3rd edn. Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia, pp 515–533
    1. Lanier JB, Mote MB, Clay EC (2011) Evaluation and management of orthostatic hypotension. Am Fam Physicians 84:527–536
    1. Low P, Benarroch E (2008) Clinical autonomic disorders. Third. Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia
    1. Kimpinski K, Iodice V, Sandroni P, Low PA (2010) Postural tachycardia syndrome and pregnancy effect of pregnancy on postural tachycardia syndrome. Mayo Clin Proc 85:639–644 - DOI - PubMed - PMC
    1. Freeman R, Wieling W, Axelrod FB et al (2011) Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clin Auton Res 21:69–72 - DOI - PubMed

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