scholarly journals Construction and Validation of the 4-Item Dynamic Gait Index

2006 ◽  
Vol 86 (12) ◽  
pp. 1651-1660 ◽  
Author(s):  
Gregory F Marchetti ◽  
Susan L Whitney
Keyword(s):  
Psychometric Properties ◽  
Short Form ◽  
Vestibular Disorders ◽  
Factor Analyses ◽  
Clinical Measurement ◽  
Control Subjects ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Difficulty Walking ◽  
Gait Index

Background and PurposePeople with balance disorders often have difficulty walking. The purpose of this study was to develop and test the psychometric properties of a short form of the Dynamic Gait Index (DGI) for the clinical measurement of walking function in people with balance and vestibular disorders. Subjects. A total of 123 subjects with such disorders (test subjects) and 103 control subjects were included in this study. Methods. Rasch and factor analyses were used to create a short form of the DGI. Internal consistency and discriminative validity for test subjects versus control subjects and for falling versus nonfalling test subjects were evaluated. Results. Four items were selected for the shorter version of the test: gait on level surfaces, changes in gait speed, and horizontal and vertical head turns. Discussion and Conclusion. The clinical psychometric properties of the 4-item DGI were equivalent or superior to those of the 8-item test. The 4-item DGI can be used by clinicians to measure gait in people with balance and vestibular disorders without compromising important clinical measurement characteristics.

scholarly journals Temporal and Spatial Characteristics of Gait During Performance of the Dynamic Gait Index in People With and People Without Balance or Vestibular Disorders

2008 ◽  
Vol 88 (5) ◽  
pp. 640-651 ◽  
Author(s):  
Gregory F Marchetti ◽  
Susan L Whitney ◽  
Philip J Blatt ◽  
Laura O Morris ◽  
Joan M Vance
Keyword(s):  
Intraclass Correlation ◽  
Vestibular Dysfunction ◽  
Vestibular Disorders ◽  
Cross Sectional ◽  
Control Subjects ◽  
Gait Characteristics ◽  
Gait Parameters ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

Background and Purpose Understanding underlying gait characteristics during performance of the Dynamic Gait Index (DGI) could potentially guide interventions. The purpose of this study was to describe the characteristics and reliability of gait performance during the level walking items of the DGI in people with balance or vestibular dysfunction. The study was a cross-sectional investigation with 2-group comparisons. Subjects and Methods Forty-seven subjects (mean age=59.2 years, SD=8.5, range=24–90) participated in the study; 26 were control subjects, and 21 were subjects with balance or vestibular dysfunction. Three trials of each level gait item were administered to subjects as they ambulated on an instrumented walkway. Test-retest reliability was determined by use of an intraclass correlation coefficient (3,1) 2-way random-effects model for gait parameters associated with continuous walking and the item requiring turning and stopping quickly. Mean gait parameter differences between control subjects and subjects with balance or vestibular disorders were compared by use of a multivariate analysis of variance for each gait task. Results The reliability of most gait parameters during DGI performance were fair to excellent between trials. Subjects with balance or vestibular disorders demonstrated differences in gait characteristics compared with control subjects. The heterogeneity of the group of subjects with balance or vestibular disorders does not permit inferences to be drawn regarding the relationship between gait and any specific balance or vestibular diagnosis. The results are most pertinent to people with chronic balance or vestibular disorders. Discussion and Conclusion Gait parameters underlying dynamic walking appeared to be relatively reliable across multiple trials and distinguished subjects with balance or vestibular disorders. Evaluating a person's performance on items of the DGI may be useful in identifying gait deviations and in evaluating gait improvements as a result of interventions.

The sensitivity and specificity of the Timed "Up & Go" and the dynamic gait index for self-reported falls in persons with vestibular disorders

2004 ◽  
Vol 14 (5) ◽  
pp. 397-409 ◽  
Author(s):  
Susan L. Whitney ◽  
Gregory F. Marchetti ◽  
Annika Schade ◽  
Diane M. Wrisley
Keyword(s):  
Physical Therapy ◽  
Sensitivity And Specificity ◽  
Fall Risk ◽  
Vestibular Dysfunction ◽  
Initial Assessment ◽  
Vestibular Disorders ◽  
Patient Chart ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

The purpose of this study was to determine the sensitivity and specificity of the Timed "Up & Go" (TUG) and Dynamic Gait Index in identifying self-reported fallers among persons with vestibular dysfunction. One hundred three patient charts were included from a tertiary vestibular physical therapy practice. The patients ranged in age from 14–90 years and had vestibular diagnoses, falls reported in the patient chart, and completed the TUG and/or the Dynamic Gait Index (DGI). Thirty-one persons reported falling one or more times in the previous 6 months during their initial assessment. Persons who took longer than 13.5 seconds to perform the TUG test were 3.7 times more likely to have reported a fall in the previous 6 months. Those persons with scores less than or equal to 18 on the DGI were 2.7 times (p = 0.03) more likely to have reported a fall in the previous 6 months. The sensitivity of the DGI at 18 or less was 70% and the specificity was 51%. People who scored greater than 11.1 seconds on the TUG were 5times (p = 0.001) more likely to have reported a fall in the previous 6 months. Sensitivity (80%) and specificity (56%) were calculated for TUG scores of greater than 11.1 seconds. The TUG and the DGI appear to be helpful in identifying fall risk in persons with vestibular dysfunction. Slower scores on the TUG (> 11.1 seconds) and lower scores on the DGI (18) correlated with reports of falls in persons with vestibular dysfunction.

Assessing the Validity of the Dynamic Gait Index in a Balance Disorders Clinic: An Application of Rasch Analysis

2013 ◽  
Vol 93 (6) ◽  
pp. 809-818 ◽  
Author(s):  
Deanna C. Dye ◽  
Aaron M. Eakman ◽  
Kayla M. Bolton
Keyword(s):  
Rating Scale ◽  
Item Difficulty ◽  
Ceiling Effect ◽  
Scale Model ◽  
Vestibular Disorders ◽  
Present Sample ◽  
Medical Diagnoses ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

BackgroundThe Dynamic Gait Index (DGI) has emerged as a valid indicator of functional gait abilities for people with balance and vestibular disorders. Recent Rasch-based analyses have indicated possible concerns for multidimensionality and a ceiling effect within the DGI.ObjectiveThe aim of this study was to evaluate the DGI in a sample of patients from a dizziness and balance clinic to determine whether patient features such as dizziness or fall history influence the measurement characteristics of the DGI.DesignThis study used a retrospective design.MethodsA sample of 117 patients' charts was reviewed, and patients were grouped according to a primary impairment of dizziness only or imbalance and were categorized based on a history of falls. A one-parameter Rasch-Andrich rating scale model was used with thorough analyses, including rating scale analysis, item-difficulty hierarchy, scale unidimensionality, and differential item functioning (DIF).ResultsThe DGI demonstrated an effective rating scale design and was found to be a unidimensional measurement of dynamic gait. The DGI displayed a modest ceiling effect, primarily with patients with higher functional levels displaying symptoms of dizziness. Three items (“vertical head nods,” “gait on level surface,” and “stepping over obstacles”) demonstrated DIF based on categories of patient characteristics, although the effects on measurement were negligible.LimitationsFunctional categories were based on impairments and not underlying medical diagnoses derived from a retrospective chart review, whereas the limited sample size may have underestimated statistically significant DIF.ConclusionsResults from this study offer additional evidence supporting the validity of the DGI as a measure of gait ability. The present findings also are in agreement with prior research that has shown a ceiling effect for the DGI in people with balance or vestibular disorders. Effects of DIF were found to be negligible, yet the presence of DIF within the present sample helped to explain some differences in DGI item-difficulty hierarchies from prior studies. Continued research is needed to determine how population differences may affect performance on the DGI and to develop and test assessments capable of measuring a broader range of gait abilities.

scholarly journals Evidence for the Validity of the Modified Dynamic Gait Index Across Diagnostic Groups

2014 ◽  
Vol 94 (7) ◽  
pp. 996-1004 ◽  
Author(s):  
Patricia Noritake Matsuda ◽  
Catherine S. Taylor ◽  
Anne Shumway-Cook
Keyword(s):  
Psychometric Properties ◽  
Differential Item Functioning ◽  
Gait Pattern ◽  
Minimal Detectable Change ◽  
Cross Sectional ◽  
Gait Abnormality ◽  
Item Functioning ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

BackgroundThe modified Dynamic Gait Index (mDGI) measures the capacity to adapt gait to complex tasks utilizing 8 tasks and 3 facets of performance. The measurement stability of the mDGI in specific diagnostic groups is unknown.ObjectiveThis study examined the psychometric properties of the mDGI in 5 diagnostic groups.DesignThis was a cross-sectional, descriptive study.MethodsA total of 794 participants were included in the study: 140 controls, 239 with stroke, 140 with vestibular dysfunction, 100 with traumatic brain injury, 91 with gait abnormality, and 84 with Parkinson disease. Differential item functioning analysis was used to examine the comparability of scores across diagnoses. Internal consistency was computed using Cronbach alpha. Factor analysis was used to examine the factor loadings for the 3 performance facet scores. Minimal detectable change at the 95% confidence level (MDC95%) was calculated for each of the groups.ResultsLess than 5% of comparisons demonstrated moderate to large differential item functioning, suggesting that item scores had the same order of difficulty for individuals in all 5 diagnostic groups. For all 5 patient groups, 3 factors had eigenvalues >1.0 and explained 80% of the variability in scores, supporting the importance of characterizing mobility performance with respect to time, level of assistance, and gait pattern.LimitationsThere were uneven sample sizes in the 6 groups.ConclusionsThe strength of the psychometric properties of the mDGI across the 5 diagnostic groups further supports the validity and usefulness of scores for clinical and research purposes. In addition, the meaning of a score from the mDGI, regardless of whether at the task, performance facet, or total score level, was comparable across the 5 diagnostic groups, suggesting that the mDGI measured mobility function independent of medical diagnosis.

scholarly journals Expanding the Scoring System for the Dynamic Gait Index

2013 ◽  
Vol 93 (11) ◽  
pp. 1493-1506 ◽  
Author(s):  
Anne Shumway-Cook ◽  
Catherine S. Taylor ◽  
Patricia Noritake Matsuda ◽  
Michael T. Studer ◽  
Brady K. Whetten
Keyword(s):  
Psychometric Properties ◽  
Scoring System ◽  
Internal Validity ◽  
Control Group ◽  
Minimal Detectable Change ◽  
Detectable Change ◽  
Cross Sectional ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Gait Index

BackgroundThe 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.ObjectiveThis 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).DesignA cross-sectional, descriptive study was conducted.MethodsNine 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 total score and 3 facet scores using the reliability estimate for the alpha coefficients.ResultsInterrater agreement was strong, with kappa coefficients ranging from 90% to 98% for time scores, 59% to 88% for GP scores, and 84% to 100% for LOA scores. Test-retest correlations (r) for time, GP, and LOA were .91, .91, and .87, respectively. Three factors (time, LOA, GP) had eigenvalues greater than 1.3 and explained 79% of the variance in scores. All group differences were significant, with moderate to large effect sizes. The 95% minimal detectable change (MDC95) was 4 for the mDGI total score, 2 for the time and GP total scores, and 1 for the LOA total score.LimitationsThe limitations included uneven sample sizes in the 2 groups. The MI group were patients receiving physical therapy; therefore, they may not be representative of this population.ConclusionsThe mDGI, with its expanded scoring system, improves the range, discrimination, and facets of measurement related to walking function. The strength of the psychometric properties of the mDGI warrants its adoption for both clinical and research purposes.

The dynamic gait index relates to self-reported fall history in individuals with vestibular dysfunction

2000 ◽  
Vol 10 (2) ◽  
pp. 99-105 ◽  
Author(s):  
S.L. Whitney ◽  
M.T. Hudak ◽  
G.F. Marchetti
Keyword(s):  
Vestibular Dysfunction ◽  
Vestibular Disorders ◽  
Vestibular Disorder ◽  
Odds Ratios ◽  
Chi Square ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
The Relationship ◽  
Gait Index

The purpose of this study was to determine the relationship between gait instability and falls history in people with vestibular disorders. A total of 247 people (164 women, 83 men) participated in the study (mean age = 62.5). Falls history within the last 6 months and scores on the Dynamic Gait Index (DGI) were compared using the Mantel-Hantzel Chi-square statistic. Thirty-seven percent of all subjects reported falling within the last 6 months. Odds ratios in favor of falls with DGI scores of 19 or lower was 2.58 (95% were 2.58 times more likely to have reported a fall in the previous 6 months than subjects with scores above 19. Younger subjects (those under 65 years of age) with vestibular disorders reported more falls than persons 65 years of age or over. Younger people may be more willing to risk a fall while actively having a vestibular disorder. The DGI appears to be a good indicator of fall status in persons with vestibular disorders, regardless of age.

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