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The Orthostatic Discriminant and Severity Scale (ODSS): an assessment of orthostatic intolerance

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Abstract

Purpose

To assess the ability of the Orthostatic Discriminant and Severity Scale (ODSS) to distinguish symptoms of orthostatic intolerance from non-orthostatic symptoms.

Methods

Clinical evaluations and questionnaire responses were collected in 73 healthy controls and 132 patients referred to the Autonomic Disorders Clinic from September 1, 2016, through April 30, 2018, for queries regarding autonomic dysfunction. A receiver operating characteristic (ROC) curve analysis was used to interpret sensitivity and specificity and to determine cutoff scores for symptom assessment. Inter-item reliability was assessed using Cronbach’s alpha. To calculate positive and negative predictive powers, patient data were collected in a single-blinded fashion where the researcher collecting questionnaire data was blinded to the clinical evaluation and diagnosis. Predictive powers were calculated using a chi-squared cross-tabulation.

Results

The orthostatic and non-orthostatic symptoms scores produced ROC curves with an area under the curve of 0.89 and 0.79, respectively. The orthostatic scores yielded a positive and negative predictive power value of 73% and 81%, respectively. Combined, the ODSS identified patients with and without orthostatic symptoms with an overall accuracy of 76%. The reliability of the ODSS was significant, with a Cronbach’s alpha of 0.88, and all dichotomous items were deemed worthy of retention following an inter-item reliability assessment.

Conclusions

The ODSS demonstrated a strong ability to distinguish patients with and without orthostatic intolerance and demonstrated sensitivity and specificity equivalent to that of other standardized measures. Overall, the ODSS produces symptom scores that are both reliable and useful for both research and clinical practice.

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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. Lippincott Williams & Wilkins, Philadelphia, pp 515–533

    Google Scholar 

  2. Lanier JB, Mote MB, Clay EC (2011) Evaluation and management of orthostatic hypotension. Am Fam Physicians 84:527–536

    Google Scholar 

  3. Low P, Benarroch E (2008) Clinical autonomic disorders, 3rd edn. Lippincott Williams & Wilkins, Philadelphia

    Google Scholar 

  4. 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

    Article  PubMed Central  Google Scholar 

  5. 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

    Article  Google Scholar 

  6. Baker J, Kimpinski K (2017) Management of supine hypertension complicating neurogenic orthostatic hypotension. CNS Drugs 8:653–663

    Article  Google Scholar 

  7. Baker J, Paturel JR, Sletten DM et al (2018) Initial validation of symptom scores derived from the orthostatic discriminant and severity scale. Clin Auton Res. https://doi.org/10.1007/s10286-018-0511-5

    Article  PubMed  Google Scholar 

  8. Low P, Opfer-Gehrking TL (1999) The autonomic laboratory. Am J Electroneurodiagnostic Technol 39:65–76

    Article  CAS  Google Scholar 

  9. Low P (1993) Composite autonomic scoring scale for laboratory quantification of generalized autonomic failure. Mayo Clin Proc 68:748–752

    Article  CAS  Google Scholar 

  10. Suarez G, Opfer-Gehrking TL, Offord K et al (1999) The autonomic symptom profile: a new instrument to assess autonomic symptoms. Neurology 52:523–528

    Article  CAS  Google Scholar 

  11. Kaufmann H, Malamut R, Norcliffe-Kaufmann L et al (2012) The orthostatic hypotension questionnaire (OHQ): validation of a novel symptom assessment scale. Clin Auton Res 22:79–90

    Article  Google Scholar 

  12. Wenning GK, Tison F, Seppi K et al (2004) Development and validation of the Unified Multiple System Atrophy Rating Scale (UMSARS). Mov Disord 19:1391–1402

    Article  Google Scholar 

  13. Zilliox L, Peltier AC, Wren PA et al (2011) Assessing autonomic dysfunction in early diabetic neuropathy. Neurology 76:1099–1105

    Article  CAS  PubMed Central  Google Scholar 

  14. Visser M, Marinus J, Stiggelbout AM, van Hilten JJ (2004) Assessment of autonomic dysfunction in Parkinson’s disease: the SCOPA-AUT. Mov Disord 19:1306–1312

    Article  Google Scholar 

  15. Berger M, Kimpinski K (2014) A practical guide to the treatment of neurogenic orthostatic hypotension. Can J Neurol Sci 41:156–163

    Article  Google Scholar 

  16. Low PA, Singer W (2008) Management of neurogenic orthostatic hypotension: an update. Lancet Neurol 7:451–458

    Article  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Clinical Neurological Sciences, Rm B7-140B, University Hospital, London Health Sciences Centre, 339 Windermere Road, London, ON, N6A 5A5, Canada

    Jacquie Baker, Justin R. Paturel & Kurt Kimpinski

  2. Schulich School of Medicine and Dentistry, Western University, London, ON, Canada

    Kurt Kimpinski

  3. School of Kinesiology, Western University, London, ON, Canada

    Jacquie Baker & Kurt Kimpinski

  4. Department of Neurology, Mayo Clinic, Rochester, MN, USA

    David M. Sletten & Phillip A. Low

Authors
  1. Jacquie Baker
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  2. Justin R. Paturel
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  3. David M. Sletten
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  4. Phillip A. Low
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  5. Kurt Kimpinski
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Contributions

JB and KK each contributed to experimental design, data analysis and manuscript preparation. JRP contributed to data collection and analysis and reviewed the manuscript for intellectual content. DMS and PAL each contributed to data analysis and reviewed the manuscript for intellectual content.

Corresponding author

Correspondence to Jacquie Baker.

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On behalf of all authors, there are no conflicts of interest.

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Baker, J., Paturel, J.R., Sletten, D.M. et al. The Orthostatic Discriminant and Severity Scale (ODSS): an assessment of orthostatic intolerance. Clin Auton Res 30, 69–77 (2020). https://doi.org/10.1007/s10286-018-00586-5

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  • DOI: https://doi.org/10.1007/s10286-018-00586-5

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