Results: (1) The sensorimotor scale and (2) The ADDITIONAL signs
| CD (N=20) | Control (N=20) | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Scale Points | Overall frequency of the sign (%) | pos | neg | pos | neg | p Value* | κ (Cohen)† | Specificity (CI) | Sensitivity (CI) | ||
| SENSORIMOTOR SCALE | |||||||||||
| Give-way weakness | 2 | 45 | 18 | 2 | 0 | 20 | p<0.01 | Good | 0.61 | 100 (40 to 100) | 85 (75 to 100) |
| Drift without pronation | 2 | 22.5 | 9 | 10 | 0 | 20 | p<0.01 | Good | 0.78 | 95 (60 to 100) | 61 (17 to 83) |
| Collapsing weakness | 1 | 15 | 6 | 12 | 0 | 18 | p<0.01 | Moderate | 0.45 | 100 (41 to 100) | 44 (22 to 67) |
| Co-contraction | 1 | 20 | 8 | 12 | 0 | 19 | p<0.05 | Good | 0.77 | 100 (78 to 100) | 30 (10 to 50) |
| Spinal injury test (SIC) | 1 | 10 | 2 | 13 | 2 | 18 | NS | Moderate | 0.52 | 90 (74 to 100) | 13 (0 to 33) |
| Hoover's sign | 2 | 32.5 | 13 | 4 | 0 | 18 | p<0.01 | NE | NE | 100 (50 to 100) | 76 (55 to 94) |
| Splitting the midline | 2 | 22.5 | 9 | 8 | 0 | 14 | p<0.01 | Good | 0.63 | 100 (73 to 100) | 42 (21 to 63) |
| Splitting of vibration sense | 1 | 27.5 | 9 | 9 | 2 | 14 | p<0.05 | Good | 0.66 | 88 (56 to 100) | 50 (17 to 74) |
| Non-anatomical territory | 1 | 45 | 17 | 3 | 1 | 19 | p<0.01 | Fair | 0.23 | 90 (45 to 100) | 80 (32 to 95) |
| Systematic failure | 1 | 7.5 | 3 | 17 | 0 | 20 | NS | Poor | 0.16 | 100 (5 to 100) | 15 (0 to 30) |
| TOTAL SCORE | 14 | A score of ≥4 95% sensitivity (CI 85 to 100) and 100% specificity (CI 85 to 100) | |||||||||
| ADDITIONAL SIGNS | |||||||||||
| Sternocleidomastoid-test | 17.5 | 7 | 12 | 0 | 20 | p<0.05 | Excellent | 0.83 | 100 (77 to 100) | 31 (11 to 53) | |
| Irregular drift | 7.5 | 3 | 16 | 0 | 20 | NS | Good | 0.72 | 95 (80 to 100) | 11 (0 to 28) | |
| Non-concavity of the palm of hand | 55 | 15 | 3 | 7 | 13 | p<0.01 | Good | 0.65 | 65 (25 to 86) | 89 (53 to 100) | |
| Inconsistence of direction | 20 | 7 | 12 | 1 | 19 | p<0.05 | Moderate | 0.42 | 95 (69 to 100) | 39 (9 to 63) | |
| Non digiti quinti sign | 2.5 | 0 | 19 | 1 | 19 | NS | Moderate | 0.48 | 95 (100 to 100) | 0 (0 to 5) | |
| Drift against gravity | 5 | 0 | 19 | 2 | 18 | NS | Fair | 0.36 | 90 (67 to 98) | 0 (0 to 21) | |
| Weakness NOT distal>proximal | 72.5 | 19 | 0 | 10 | 10 | p<0.05 | Fair | 0.21 | 50 (18 to 72) | 89 (60 to 100) | |
| Arm drop test | 7.5 | 2 | 0 | 1 | 6 | NS | NE | NE | 83 (50 to 100) | 100 (33 to 100) | |
| Babinski trunk-thigh test | 65 | 14 | 5 | 12 | 3 | NS | Poor | 0.18 | 22 (7 to 48) | 94 (71 to 100) | |
| Mingazzini: drift without extension | 37.5 | 9 | 10 | 6 | 14 | NS | Fair | 0.27 | 70 (43 to 89) | 47 (21 to 71) | |
| Mingazzini: irregular drift | 27.5 | 11 | 8 | 0 | 20 | p<0.01 | Moderate | 0.60 | 95 (64 to 100) | 47 (13 to 68) | |
| Barré: drift without contraction | 12.5 | 3 | 15 | 2 | 9 | NS | Poor | 0.03 | 82 (52 to 100) | 22 (4 to 46) | |
| Yes/No test | 5 | 2 | 3 | 0 | 0 | NS | NE | NE | NE | 40 (7 to 83) | |
| GAIT | |||||||||||
| Leg dragging | 5 | 2 | 17 | 0 | 19 | NS | Moderate | 0.44 | 100 (90 to 100) | 11 (0 to 26) | |
| Falls always towards support | 10 | 4 | 10 | 0 | 16 | NS | Excellent | 0.83 | 93 (73 to 100) | 19 (0 to 83) | |
| Excessive slowness | 15 | 5 | 14 | 1 | 18 | NS | Moderate | 0.47 | 94 (71 to 100) | 32 (7 to 53) | |
| Staggering long distances | 0 | 0 | 20 | 0 | 10 | NS | NE | NE | 100 (79 to 100) | 0 (0 to 20) | |
| Psychogenic Romberg | 17.5 | 7 | 12 | 0 | 19 | p>0.05 | Moderate | 0.54 | 100 (73 to 100) | 39 (17 to 61) | |
| Non-economic posture | 7.5 | 3 | 16 | 0 | 19 | NS | Moderate | 0.53 | 100 (83 to 100) | 21 (5 to 42) | |
| Sudden knee buckling | 15 | 5 | 14 | 1 | 18 | NS | Moderate | 0.52 | 95 (75 to 100) | 21 (3 to 40) | |
| Hesitation | 22.5 | 9 | 10 | 0 | 19 | p<0.05 | Good | 0.66 | 100 (75 to 100) | 37 (16 to 58) | |
| Walking on ice | 0 | 0 | 19 | 0 | 19 | NS | NE | NE | 100 (79 to 100) | 0 (0 to 21) | |
| Robot walk | 5 | 2 | 17 | 0 | 19 | NS | Fair | 0.28 | 100 (84 to 100) | 16 (0 to 32) | |
| Tremulousness | 5 | 2 | 16 | 0 | 19 | NS | Good | 0.64 | 100 (84 to 100) | 16 (0 to 32) | |
| Flailing arms | 12.5 | 5 | 15 | 0 | 18 | p<0.01 | Poor | 0.08 | 100 (73 to 100) | 42 (21 to 63) | |
| Bizarre excursion trunk | 17.5 | 7 | 13 | 0 | 18 | p<0.05 | Moderate | 0.48 | 100 (77 to 100) | 21 (11 to 53) | |
| Sudden side steps | 12.5 | 4 | 16 | 1 | 18 | NS | Fair | 0.37 | 94 (74 to 100) | 16 (0 to 36) | |
| GENERAL SIGN | |||||||||||
| Expressive behaviour | 32.5 | 11 | 9 | 2 | 18 | p<0.01 | Good | 0.62 | 95 (62 to 100) | 55 (15 to 75) | |
NS=not significant at p<0.05 level.
*Two-tailed Fisher's exact test.
†Cohen's κ inter-rater reliability agreement poor (<0.20), fair (0.21–0.40), moderate (0.41–0.60), good (0.61–0.80) or excellent (0.81–1).
CD, conversion disorder.