scholarly journals Minimal Clinically Important Difference of the Functional Gait Assessment in Older Adults

2014 ◽  
Vol 94 (11) ◽  
pp. 1594-1603 ◽  
Author(s):  
Marianne Beninato ◽  
Arlene Fernandes ◽  
Laura S. Plummer
Keyword(s):  
Older Adults ◽  
Minimal Clinically Important Difference ◽  
Physical Therapists ◽  
Weighted Kappa ◽  
Small Sample ◽  
Community Dwelling ◽  
Poor Agreement ◽  
Gait Assessment ◽  
Clinically Important Difference ◽  
Functional Gait

BackgroundThe 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.ObjectiveThe 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.DesignThis study was a prospective case series.MethodsPatients 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 optimal FGA change cutoff score for MCID was determined, and sensitivity (SN), specificity (SP), and likelihood ratios (LRs) were calculated.ResultsOne hundred thirty-five community-dwelling older adults (average age=78.8 years) and 14 physical therapists participated. There was poor agreement between the patients' and therapists' ratings of change (weighted kappa=.163). The estimated MCID value for the FGA using physical therapists' ratings of change as an anchor was 4 points (SN=0.66, SP=0.84, LR+=4.07, LR−=0.40). No accurate value for the FGA MCID could be determined based on the patients' ratings of change.LimitationsThe small sample size was a limitation.ConclusionPoor agreement between therapists' and patients' ratings indicate the need for further communication relative to patient goals. The 4-point MCID value for the FGA can be used for goal setting, tracking patient progress, and program evaluation.

scholarly journals Functional Gait Assessment: Concurrent, Discriminative, and Predictive Validity in Community-Dwelling Older Adults

2010 ◽  
Vol 90 (5) ◽  
pp. 761-773 ◽  
Author(s):  
Diane M. Wrisley ◽  
Neeraj A. Kumar
Keyword(s):  
Older Adults ◽  
Predictive Validity ◽  
Fall Risk ◽  
Small Sample Size ◽  
Small Sample ◽  
Community Dwelling ◽  
Cutoff Score ◽  
Gait Assessment ◽  
Functional Gait ◽  
Community Dwelling Older Adults

BackgroundThe Functional Gait Assessment (FGA) is a reliable and valid measure of gait-related activities.ObjectiveThe purpose of this study was to determine the concurrent, discriminative, and predictive validity of the FGA in community-dwelling older adults.DesignThis was a prospective cohort study.MethodsThirty-five older adults aged 60 to 90 years completed the Activities-specific 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 (LR+ and LR−) 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.ResultsThe FGA correlated with the ABC (r=.053, P<.001), BBS (r=.84, P<.001), and TUG (r=−.84, P<.001). An FGA score of ≤22/30 provides both discriminative and predictive validity. The FGA (scores ≤22/30) provided 100% Sn, 72% Sp, LR+ of 3.6, and LR− of 0 to predict prospective falls.LimitationsThe 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.ConclusionsThe 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.

scholarly journals The Functional Gait Assessment in Older Adults: Validation Through Rasch Modeling

2016 ◽  
Vol 96 (4) ◽  
pp. 456-468 ◽  
Author(s):  
Marianne Beninato ◽  
Larry H. Ludlow
Keyword(s):  
Older Adults ◽  
Retrospective Chart Review ◽  
Ceiling Effect ◽  
Community Dwelling ◽  
Rasch Modeling ◽  
Gait Assessment ◽  
Balance Ability ◽  
The Individual ◽  
Walking Balance ◽  
Functional Gait

BackgroundThe Functional Gait Assessment (FGA), a measure of walking balance ability, was developed to eliminate the ceiling effect observed in the Dynamic Gait Index (DGI). Three presumably more difficult tasks were added and 1 easier task was removed from the original 8 DGI tasks. The effects of these modifications on item hierarchy have not previously been analyzed.ObjectiveThe purpose of this study was to determine: (1) the ordering of the 10 FGA tasks and the extent to which they map along a clinically logical difficulty continuum, (2) whether the spread of tasks is sufficient to measure patients of varying functional ability levels without a ceiling effect, (3) where the 3 added tasks locate along the task difficulty continuum, and (4) the psychometric properties of the individual FGA tasks.DesignA retrospective chart review was conducted.MethodsFunctional Gait Assessment scores from 179 older adults referred for physical therapy for balance retraining were analyzed by Rasch modeling.ResultsThe FGA task hierarchy met clinical expectations, with the exception of the “walking on level” task, which locates in the middle of the difficulty continuum. There was no ceiling effect. Two of the 3 added tasks were the most difficult FGA tasks. Performance on the most difficult task (“gait with narrow base of support”) demonstrated greater variability than predicted by the Rasch model.LimitationsThe sample was limited to older adults who were community dwelling and independently ambulating. Findings cannot be generalized to other patient groups.ConclusionsThe revised scoring criteria of the FGA may have affected item hierarchy. The results suggest that the FGA is a measure of walking balance ability in older adults that is clinically appropriate and has construct validity. Administration of the FGA may be modified further to improve administration efficiency.

scholarly journals CROSS-CULTURAL ADAPTATION AND RELIABILITY OF THE FUNCTIONAL GAIT ASSESSMENT FOR OLDER BRAZILIANS

2021 ◽  
Author(s):  
Renata Noce Kirkwood ◽  
Natália Cristina Lisboa Batista ◽  
Larissa Bragança Falcão Marques ◽  
Juliana de Melo Ocarino ◽  
Lucas Lobo Alcântara Neves ◽  
...  
Keyword(s):  
Older Adults ◽  
Cultural Adaptation ◽  
Community Dwelling ◽  
Gait Assessment ◽  
Functional Gait ◽  
Dynamic Gait Index ◽  
Dynamic Gait ◽  
Community Dwelling Older Adults ◽  
Standard Error Of Measurement ◽  
Error Of Measurement

INTRODUCTION: Many instruments have been used to identify older adults at risk of falling, including performance-oriented mobility assessment, timed up and go test, Berg balance scale, and dynamic gait index. However, there have been reports of these clinical tests having a ceiling effect on community-dwelling older adults. To address this issue, the functional gait assessment was developed based on the dynamic gait index. Therefore, the functional gait assessment is an instrument that assesses postural stability during tasks that cause changes in gait patterns. OBJECTIVES: To translate and cross-culturally adapt the functional gait assessment to the Brazilian Portuguese language and to assess its psychometric properties in older Brazilians living in the community. METHODS: The process of translation and cross-cultural adaptation followed the recommendations of international guidelines. The pre-final version was administered to a sample of 30 older adults, both male and female, living independently in the community. To examine the psychometric properties (reliability, standard error of measurement, and internal consistency), 70 older adults aged 60 to 87 years were evaluated. RESULTS: The original and the translated versions were considered conceptually equivalent. All functional gait assessment items whose numbers were measured in inches and feet were converted to centimeters and rounded off to comply with the unit of measurement used in Brazil. The functional gait assessment-Brazil showed excellent inter- and intraexaminer reliability (intraclass correlation coefficient > 0.90), low standard error of measurement (range = 1.03 to 1.52), and good internal consistency (Cronbach alpha = 0.858). CONCLUSIONS: The functional gait assessment-Brazil is a semantically, linguistically, and psychometrically appropriate instrument for assessing balance during walking in community-dwelling older adults.

scholarly journals Construct and criterion validity of the functional gait assessment—Brazil in community-dwelling older adults

2020 ◽  
Author(s):  
Larissa Bragança Falcão Marques ◽  
Bruno de Souza Moreira ◽  
Juliana de Melo Ocarino ◽  
Rosana Ferreira Sampaio ◽  
Alessandra de Carvalho Bastone ◽  
...  
Keyword(s):  
Older Adults ◽  
Criterion Validity ◽  
Community Dwelling ◽  
Gait Assessment ◽  
Functional Gait ◽  
Community Dwelling Older Adults

scholarly journals Reference Group Data for the Functional Gait Assessment

2007 ◽  
Vol 87 (11) ◽  
pp. 1468-1477 ◽  
Author(s):  
Martha L Walker ◽  
Alvis G Austin ◽  
Gina M Banke ◽  
Suzanne R Foxx ◽  
Lynn Gaetano ◽  
...  
Keyword(s):  
Older Adults ◽  
Reference Group ◽  
Intraclass Correlation ◽  
Clinical Tool ◽  
Gait Assessment ◽  
Group Data ◽  
Expected Performance ◽  
Clinical Changes ◽  
Functional Gait ◽  
Patient Performance

Background and Purpose 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. Subjects Subjects were 200 adults, ages 40 to 89 years, living independently. Methods Each subject completed the FGA one time and was scored simultaneously by 2 testers. Results The intraclass correlation coefficient for interrater reliability was .93. Mean scores for the FGA ranged from 29/30 for adults in their 40s to 21/30 for adults in their 80s. Discussion and Conclusion Patient performance on the FGA can be compared with age-referenced norms for expected performance. Further research is needed to determine the FGA’s usefulness in tracking clinical changes or predicting falls. The FGA is a reliable test for people without disease, and it is able to detect decreases in gait performance among typical older adults.

scholarly journals The relationship between chronic stress, emotion regulation and depressive symptoms in healthy older adults

2021 ◽  
Author(s):  
Vivian Huang
Keyword(s):  
Older Adults ◽  
Depressive Symptoms ◽  
Sample Size ◽  
Chronic Stress ◽  
Sex Education ◽  
Allostatic Load ◽  
Small Sample Size ◽  
Small Sample ◽  
Community Dwelling ◽  
The Relationship

The current study examined the association between chronic stress (measured in allostatic load or AL), ER, and depressive symptoms in a group of community-dwelling older adults. It was hypothesized that chronic stress levels would mediate the relationship between ER and depressive symptoms. A total of 70 older adults aged 60 and older participated in the study. There were no significant associations found in the main analyses between the AL index and depressive symptoms, as well as no significant relationship was found between ER strategies and AL index, after controlling for age, sex, education, and perceived SES. However, perceived stress significantly mediated the relationship between maladaptive ER strategies and depressive symptoms, and the relationship between adaptive ER strategies and depressive symptoms. Given the small sample size and the lack of variability of the AL index, the study would benefit from a larger sample size to clarify the present results.

scholarly journals Impaired Stabilisation of Orthostatic Cerebral Oxygenation is Associated with Slower Gait Speed: Evidence from The Irish Longitudinal Study on Ageing

2021 ◽  
Author(s):  
John D O'Connor ◽  
Matthew D L O’Connell ◽  
Silvin P Knight ◽  
Louise Newman ◽  
Orna A Donoghue ◽  
...  
Keyword(s):  
Older Adults ◽  
Longitudinal Study ◽  
Gait Speed ◽  
Near Infrared ◽  
Cerebral Oxygenation ◽  
Saturation Index ◽  
Small Sample ◽  
Community Dwelling ◽  
Clinical Tool ◽  
Wide Range

Abstract Background Cerebral autoregulation (CAR) systems maintain blood flow to the brain across a wide range of blood pressures. Deficits in CAR have been linked to gait speed but previous studies had small sample sizes and used specialised equipment which impede clinical translation. The purpose of this work was to assess the association between gait speed and orthostatic cerebral oxygenation in a large, community-dwelling sample of older adults. Methods Data for this study came from the Irish Longitudinal Study on Ageing. A near infrared spectroscopy (NIRS) device attached to the forehead of each participant (n=2708) was used to track tissue saturation index (TSI; the ratio of oxygenated to total haemoglobin) during standing. Gait speed (GS) was assessed using a portable walkway. Results Recovery was impaired in slower GS participants with a TSI value at 20 seconds (after standing) of -0.55% (95% CI: -0.67, -0.42) below baseline in the slowest GS quartile versus -0.14% (95% CI: -0.25, -0.04) in the fastest quartile. Slower GS predicted a lower TSI throughout the 3-minute monitoring period. Results were not substantially altered by adjusting for orthostatic hypotension. Adjustment for clinical and demographic covariates attenuated the association between but differences remained between GS quartiles from 20 seconds to 3 minutes after standing. Conclusion This study reported evidence for impaired recovery of orthostatic cerebral oxygenation depending on gait speed in community-dwelling older adults. Future work assessing NIRS as a clinical tool for monitoring the relationship between gait speed and cerebral regulation is warranted.

scholarly journals Guidelines for Gait Assessments in the Canadian Consortium on Neurodegeneration in Aging (CCNA)

2018 ◽  
Vol 21 (2) ◽  
pp. 157-165 ◽  
Author(s):  
Stephanie Cullen ◽  
Manuel Montero-Odasso ◽  
Louis Bherer ◽  
Quincy Almeida ◽  
Sarah Fraser ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Impairments ◽  
Community Dwelling ◽  
Older Individuals ◽  
Simple Manner ◽  
Gait Performance ◽  
Assessment Protocol ◽  
Gait Assessment ◽  
Incident Dementia ◽  
Fast Pace

BackgroundMotor and cognitive impairments are common among older adults and often co-exist, increasing their risk of dementia, falls, and fractures. Gait performance is an accepted indicator of global health and it has been proposed as a valid motor marker to detect older adults at risk of developing mobility and cognitive declines including future falls and incident dementia. Our goal was to provide a gait assessment protocol to be used for clinical and research purposes.MethodsBased on a consensus that identified common evaluations to assess motor–cognitive interactions in community-dwelling older individuals, a protocol on how to evaluate gait in older adults for the Canadian Consortium on Neurodegeneration in Aging (CCNA) was developed.ResultsThe CCNA gait assessment includes preferred and fast pace gait, and dual-task gait that comprises walking while performing three cognitively demanding tasks: counting backwards by ones, countingbackwards by sevens, and naming animals. This gait protocol can be implemented using an electronic-walkway, as well as by using a regular stopwatch. The latter approach provides a simple manner to evaluate quantitative gait performance in clinics.ConclusionsEstablishing a standardized gait assessment protocol will help to assess motor–cognitive interactions in aging and neurodegeneration, to compare results across studies, and to feasibly implement and translate gait testing in clinics for detecting impending cognitive and mobility decline.

scholarly journals Management of Falls in Community-Dwelling Older Adults: Clinical Guidance Statement From the Academy of Geriatric Physical Therapy of the American Physical Therapy Association

2015 ◽  
Vol 95 (6) ◽  
pp. 815-834 ◽  
Author(s):  
Keith G. Avin ◽  
Timothy A. Hanke ◽  
Neva Kirk-Sanchez ◽  
Christine M. McDonough ◽  
Tiffany E. Shubert ◽  
...  
Keyword(s):  
Older Adults ◽  
Physical Therapy ◽  
Fall Risk ◽  
Gap Analysis ◽  
Physical Therapists ◽  
Community Dwelling ◽  
Health Concern ◽  
Clinical Guidance ◽  
Practice Committee ◽  
Community Dwelling Older Adults

Background Falls in older adults are a major public health concern due to high prevalence, impact on health outcomes and quality of life, and treatment costs. Physical therapists can play a major role in reducing fall risk for older adults; however, existing clinical practice guidelines (CPGs) related to fall prevention and management are not targeted to physical therapists. Objective The purpose of this clinical guidance statement (CGS) is to provide recommendations to physical therapists to help improve outcomes in the identification and management of fall risk in community-dwelling older adults. Design and Methods The Subcommittee on Evidence-Based Documents of the Practice Committee of the Academy of Geriatric Physical Therapy developed this CGS. Existing CPGs were identified by systematic search and critically appraised using the Appraisal of Guidelines, Research, and Evaluation in Europe II (AGREE II) tool. Through this process, 3 CPGs were recommended for inclusion in the CGS and were synthesized and summarized. Results Screening recommendations include asking all older adults in contact with a health care provider whether they have fallen in the previous year or have concerns about balance or walking. Follow-up should include screening for balance and mobility impairments. Older adults who screen positive should have a targeted multifactorial assessment and targeted intervention. The components of this assessment and intervention are reviewed in this CGS, and barriers and issues related to implementation are discussed. Limitations A gap analysis supports the need for the development of a physical therapy–specific CPG to provide more precise recommendations for screening and assessment measures, exercise parameters, and delivery models. Conclusion This CGS provides recommendations to assist physical therapists in the identification and management of fall risk in older community-dwelling adults.

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