The Functional Gait Assessment in Older Adults: Validation Through Rasch Modeling (original) (raw)
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Minimal clinically important difference of the functional gait assessment in older adults
Physical therapy, 2014
The Functional Gait Assessment (FGA) is commonly used to measure walking balance. The minimal clinically important difference (MCID) has yet to be determined for the FGA. The purposes of this study were to determine: (1) the MCID in the FGA for older community-dwelling adults relative to patients' and physical therapists' estimates of change and (2) the extent of agreement between patients' and physical therapists' estimates of change. This study was a prospective case series. Patients and physical therapists rated the amount of change in balance while walking after an episode of physical therapy for balance retraining on a 15-point global rating of change (GROC) scale. Weighted kappa statistics were calculated to express agreement between patients' and physical therapists' GROC ratings. Functional Gait Assessment change scores were plotted on receiver operating characteristic curves. A cutoff of +3 on the GROC was the criterion used for important change. The...
Physical therapy, 2006
The Dynamic Gait Index (DGI) is a standardized clinical assessment that aids in evaluating a subject's ability to modify gait in response to changing demands. The purpose of this study was to use Rasch measurement theory to examine whether the DGI rating scale meets suggested psychometric guidelines, whether the hierarchical order of DGI tasks is consistent with a clinically logical testing procedure, and whether the DGI represents a unidimensional construct. Subjects were 84 community-dwelling male veterans (age range=64-88 years; mean+/-SD=75+/-6.47 years). Data were retrieved retrospectively from the participants' clinical records. The Rasch measurement model with the WINSTEPS program was used in this study because it offers distinct advantages over traditional psychometric approaches. Overall, the DGI showed sound item psychometric properties. Each of the original 4 rating scale categories appeared to distinctly identify subjects at different ability levels. The analysis...
Physical Therapy, 2010
Background. The Functional Gait Assessment (FGA) is a reliable and valid measure of gait-related activities. Objective. The purpose of this study was to determine the concurrent, discriminative, and predictive validity of the FGA in community-dwelling older adults. Design. This was a prospective cohort study. Methods. Thirty-five older adults aged 60 to 90 years completed the Activitiesspecific Balance Confidence Scale (ABC), Berg Balance Scale (BBS), Dynamic Gait Index (DGI), Timed "Up & Go" Test (TUG), and Functional Gait Assessment (FGA) during one session. Falls were tracked by having participants complete a monthly fall calendar for 6 months. Spearman correlation coefficients were used to determine concurrent validity among the ABC, BBS, TUG, DGI, and FGA. To determine the optimum scores to classify fall risk, sensitivity (Sn), specificity (Sp), and positive and negative likelihood ratios (LRϩ and LRϪ) were calculated for the FGA in classifying fall risk based on the published criterion scores of the DGI and TUG and for the FGA, TUG, and DGI in identifying prospective falls. Receiver operator curves with area under the curve were used to determine the effectiveness of the FGA in classifying fall risk and of the DGI, TUG, and FGA in identifying prospective falls. Results. The FGA correlated with the ABC (rϭ.053, PϽ.001), BBS (rϭ.84, PϽ.001), and TUG (rϭϪ.84, PϽ.001). An FGA score of Յ22/30 provides both discriminative and predictive validity. The FGA (scores Յ22/30) provided 100% Sn, 72% Sp, LRϩ of 3.6, and LRϪ of 0 to predict prospective falls. Limitations. The study was limited by the length of time of follow-up and the small sample size that did not allow for evaluation of criterion scores by decade. Conclusions. The FGA with a cutoff score of 22/30 is effective in classifying fall risk in older adults and predicting unexplained falls in community-dwelling older adults.
Functional Gait Assessment Tests in Elderly: A Systematic Review
Caspian Journal of Neurological Sciences, 2023
Background: Due to the mobility problems of the elderly, it is better to use low-cost and applicable methods in any place, which do not require expertise to measure gait. One of these ubiquitous methods is functional gait assessment (FGA). Objectives: The purpose of this study was to collect and evaluate FGA in the elderly. Materials & Methods: This study conducted a comprehensive study of FGA in the elderly by searching the databases of PubMed, MEDLINE, Web of Science, ScienceDirect, Cochrane Central Register of Controlled Clinical Trials, Google Scholar, Scopus, MAGIRAN, IRANDOC, Iran Medex, MedLib, and SID from 1996 to November 2020. After compiling the search results, we first studied the titles and then the abstracts. If an article matched the inclusion and exclusion criteria, its results were used in the review study; otherwise, it was excluded. Results: Based on the research criteria and objectives, from 23 different tests, the results of 19 articles that studied FGA in the elderly were selected and reported. Conclusion: Studies seem to attempt FGA in the elderly using different methods and for different purposes. For example, studies to assess gait velocity, normal gait, and gait, along with functional and cognitive tasks, have measured FGA in the elderly. Besides, the two main features of a valid test including sensitivity and specificity have been less studied. Therefore, more studies should focus on these test features in measuring FGA in the elderly.
Reference Group Data for the Functional Gait Assessment
Physical Therapy, 2007
The Functional Gait Assessment (FGA) is a clinical tool for evaluating performance in walking. The purpose of this study was to determine age-referenced norms for performance on the FGA in community-living older adults.
Gait & Posture, 2009
The Dynamic Gait Index (DGI) was developed as a clinical tool to assess gait, balance and fall risk. Because the DGI evaluates not only usual steady-state walking, but also walking during more challenging tasks, it may be an especially sensitive test. The present investigation evaluated the DGI and its association with falls, fear of falling, depression, anxiety and other measures of balance and mobility in 278 healthy elderly. Measures included the DGI, the Berg Balance test (BBT), the Timed Up and Go (TUAG), the Mini-Mental State Exam (MMSE), the Unified Parkinson's Disease Rating Scale (UPDRS) motor part, the Activities-Specific Balance Confidence (ABC) scale and the number of annual falls. The DGI was moderately correlated with the BBT (r=0.53;p<0.001), the TUAG (r= −0.42;p<0.001) and the ABC (r=0.49;p<0.001). Fallers performed worse on the DGI compared to non-fallers (p=0.029). Scores on the DGI were near perfect in men (23.3±1.2), but among women, there was a small, but significant (p<0.001) decrease (22.5±1.6). The reduction in the DGI score in women was due to stair climbing performance, with many women (65%) choosing to walk while holding a handrail, compared to only 39% of men. Scores on the BBT, the TUAG, the UPDRS and the MMSE were similar in men and women. Conversely, ABC scores and fall history were different. These findings suggest that the DGI, although susceptible to ceiling effects, appears to be an appropriate tool for assessing function in healthy older adults.
Assessment of Gait, Balance, and Mobility in Older Adults: Considerations for Clinicians
Current Translational Geriatrics and Experimental Gerontology Reports, 2013
Accurate assessment of gait, balance, and mobility in older adults is an important aspect of clinical practice for clinicians working with this population. This report presents evidence regarding assessment in each of these domains. Outcome measures were selected for inclusion if recent evidence (publication within previous 18 months) regarding their properties was available in the literature.
Expanding the scoring system for the Dynamic Gait Index
Physical therapy, 2013
The Dynamic Gait Index (DGI) measures the capacity to adapt gait to complex tasks. The current scoring system combining gait pattern (GP) and level of assistance (LOA) lacks clarity, and the test has a limited range of measurement. This study developed a new scoring system based on 3 facets of performance (LOA, GP, and time) and examined the psychometric properties of the modified DGI (mDGI). A cross-sectional, descriptive study was conducted. Nine hundred ninety-five participants (855 patients with neurologic pathology and mobility impairments [MI group] and 140 patients without neurological impairment [control group]) were tested. Interrater reliability was calculated using kappa coefficients. Internal consistency was computed using the Cronbach alpha coefficient. Factor analysis and Rasch analysis investigated unidimensionality and range of difficulty. Internal validity was determined by comparing groups using multiple t tests. Minimal detectable change (MDC) was calculated for t...