Logistic Regression and Elastic Net Regularization for the Diagnosis of Fibromyalgia

Completed

• Conditions: Fibromyalgia
• Interventions: Diagnostic Test: Ultrasound Imaging

• Registration Number: NCT04088747
• Lead Sponsor: Toronto Rehabilitation Institute

Brief Summary

This study will utilize ultrasound image texture variables to construct an elastic net regularized, logistic regression model to differentiate between healthy and Fibromyalgia patients. The collected ultrasound data will be from participants who are healthy, and from participants who have Fibromyalgia. The predicted performance accuracy of the diagnostic model will be validated and this will confirm or deny the hypothesis that differentiation between the two cohorts is possible.

Detailed Description

Fibromyalgia (FM) diagnosis remains a challenge for clinicians due to a lack of objective diagnostic tools. One proposed solution is the use of quantitative ultrasound (US) techniques, such as image texture analysis, which has demonstrated discriminatory capabilities with other chronic pain conditions. The investigators propose the use of US image texture variables to construct an elastic net regularized, logistic regression model, for differentiating between the trapezius muscle in the healthy and FM patients. 162 Ultrasound videos of the right and left trapezius muscle were acquired from healthy participants and participants with FM. The videos will then be put through a mutli-step processing pipe including converting them into skeletal muscle regions of interest (ROI). The ROI's will be then filtered by an algorithm utilizing the complex wavelet structural similarity index (CW-SSIM), which removes ROI's that are too similar to one another. Eighty-eight texture variables will be extracted from the ROI's, which will be used in nested cross-validation to construct a logistic regression model with and without elastic net regularization. The generalized performance accuracy of both models will be estimated and confirmed with a final validation on a holdout test set. Depending on the predicted, generalized performance accuracy it will be validated or not by the final, holdout test set (confirming the model construction is accurate). These models should then confirm or deny the hypothesis that a regularized logistic regression model built on ultrasound texture features can accurately differentiate between healthy trapezius muscle and that of patients with FM.

Study Timeline

• Study Start: 2018-09-01
• Status Verified: 2019-09
• Primary Completion: 2019-09-06
• Study Completion: 2019-09-06
• Study First Submitted: 2019-09-11
• Study First Submitted QC: 2019-09-12
• Last Update Submitted: 2019-09-12
• Study First Posted: 2019-09-13
• Last Update Posted: 2019-09-17

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 81

Inclusion Criteria

• gender independent; chronic widespread pain, fitting the 2016 FM criteria, absence of myofascial pain syndrome trigger points and between the ages of 20 and 65 years (44.3 ± 13.9 years).
• Healthy asymptomatic volunteers who were age matched (n = 17) with no physical complaints or abnormality on physical examination also participated.

Exclusion Criteria

• Participants were excluded if they demonstrated clinical evidence of another cause for widespread pain, such as polymyositis, dermatomyositis, endocrine disorders, etc. None of the participants had performed any physical exercise during the two to three days prior to entry into the study.

Study & Design

• Study Type: OBSERVATIONAL
• Study Design: Not specified

Arm && Interventions

Group	Intervention	Description
Fibromyalgia	Ultrasound Imaging	Patients who display symptoms and have a history of Fibromyalgia, between 20-65 years of age.
Healthy Controls	Ultrasound Imaging	Age-matched, healthy controls, between 20-65 years of age who present no signs of chronic pain.

Primary Outcome Measures

Name	Time	Method
Central Sensitization Inventory	10 minutes	This is a self reported outcome measure designed to identify patients that experience central sensitization. It involves 25 questions which include symptomatic experiences. The subject must answer on a scale of 0(never) to 5(always) corresponding to how often they experience these. The maximum score is 100 and a score of more than 40 indicates the presence of Central Sensitization. This criteria was evaluated on each patient to determine which cohort they belong to.
Ultrasound Image Texture Variables	1 hour	91 statistical image texture variables are extracted from the B mode ultrasound images from both cohorts in order to construct a diagnostic model. The texture variables will be extracted using MATLAB.
Fibromyalgia Diagnostic Criteria	10 minutes	This evaluates symptoms related to Fibromyalgia and determines a score to assess the severity. This score is comprised of the Widespread Pain Index(WPI), which quantifies the regions of pain, and the Symptom Severity Scale(SSS), which measures qualitative aspects of pain such as fatigue and cognitive symptoms. The WPI scale ranges from 0-19 (0- no areas of body pain, 19- all body regions have pain), whereas the SSS ranges from 0-12 (0-no qualitative aspects of pain, 12-many qualitative aspects of pain). This criteria was evaluated on each patient to determine which cohort they belong to. According to the Fibromyalgia Diagnostic Criteria, one is diagnosed with Fibromyalgia if they have a WPI score of 7 or higher, and a SSS score of 5 or higher. Fibromyalgia is also diagnosed with a score of 3-6 on the WPI score, and a score of 9 or higher on the SSS score.

Trial Locations

Locations (1)

Toronto Rehabilitation Institute; 🇨🇦 Toronto, Ontario, Canada