The use of Z scores to report PFT results, both clinically and for research is occurring more and more frequently. Both the Z score and the Lower Limit of Normal (LLN) come from the same roots and in that sense can be said to be saying much the same thing. The difference between the two however, is in the emphasis each places on how results are analyzed. The LLN primarily emphasizes only whether a result is normal or abnormal. The Z score is instead a description of how far a result is from the mean value and therefore emphasizes the probability that a result is normal or abnormal.
Reference equations are developed from population studies and the measurements that come from these studies almost always fall into what’s called a normal distribution (also known as a bell-shaped curve).
A normal distribution has two important properties: the mean value and the standard deviation. The mean value is essentially the average of the results while the standard deviation describes whether the distribution of results around the mean is narrow or broad.
The simple definition of the Z score for a particular result is that it is the number of standard deviations that a result is away from the mean. It is calculated as:
