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 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 Validity and reproducibility of the Functional Gait Assessment in persons after stroke

2018 ◽  
Vol 33 (1) ◽  
pp. 94-103 ◽  
Author(s):  
Maijke Van Bloemendaal ◽  
Walter Bout ◽  
Sicco A Bus ◽  
Frans Nollet ◽  
Alexander CH Geurts ◽  
...  
Keyword(s):  
Standard Error ◽  
Ceiling Effect ◽  
Measurement Properties ◽  
Minimal Detectable Change ◽  
Post Stroke ◽  
Gait Assessment ◽  
Walking Balance ◽  
Functional Gait ◽  
Standard Error Of Measurement ◽  
Error Of Measurement

Objective: To evaluate construct validity and reproducibility of the Functional Gait Assessment (FGA) for measuring walking balance capacity in persons after stroke. Design: Cross-sectional study. Setting: Inpatient and outpatient rehabilitation center. Subjects: Fifty-two persons post-stroke (median (25% and 75% percentiles)) time post-stroke 6 (5–10) weeks) with independent walking ability (mean gait speed 1.1 ± .4 m/s). Methods: Subjects completed a standardized FGA twice within one to eight days by the same investigator. Validity was evaluated by testing hypotheses on the association with two timed walking tests, Berg Balance Scale, and the mobility domain of the Stroke Impact Scale using correlation coefficients ( r), and with Functional Ambulation Categories using the Kruskal–Wallis test. Reproducibility of FGA scores was assessed with intraclass correlation coefficient and standard error of measurement. Results: Subjects scored a median of 22 out of 30 points at the first FGA. Moderate to high significant correlations ( r .61–.83) and significant differences in FGA median scores between the Functional Ambulation Categories were found. Eight hypotheses (80%) could be confirmed. Inter-rater, intra-rater, and test–retest reliability of the total scores were excellent. The standard error of measurement and minimal detectable change were 2 and 6 points, respectively. No relevant ceiling effect was observed. Conclusion: The FGA demonstrated good measurement properties in persons after stroke and yielded no ceiling effect in contrast to other capacity measures. In clinical practice, a measurement error of 6 points should be taken into account in interpreting changes in walking balance.

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 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

Difficulties in the Use of Everyday Technology among Older Adults with Subjective Memory Complaint and Cognitive Decline

Gerontology ◽  
2021 ◽  
pp. 1-9
Author(s):  
Yuriko Ikeda ◽  
Michio Maruta ◽  
Suguru Shimokihara ◽  
Atsushi Nakamura ◽  
Gwanghee Han ◽  
...  
Keyword(s):  
Older Adults ◽  
Cognitive Decline ◽  
Community Dwelling ◽  
Subjective Memory Complaints ◽  
Subjective Memory ◽  
Memory Complaint ◽  
Social Lives ◽  
Early Signs ◽  
Main Effect ◽  
The Individual

<b><i>Introduction:</i></b> The ability to use everyday technology (ET) is becoming increasingly necessary for maintaining domestic and social lives. For older adults, difficulties with using ETs can begin at the mild cognitive impairment (MCI) state and may indicate increasing cognitive decline. The aim of this study was to conduct a detailed investigation into the ability to use ETs among Japanese older community-dwelling adults at 3 stages of cognitive function and the ability to carry out daily activities. <b><i>Method:</i></b> We analyzed family members’ responses to questions about older adults with cognitive decline in their families. A total of 168 older adults with subjective memory complaints (SMC) or cognitive decline and inconvenience in daily life were analyzed. A questionnaire was used to assess the characteristics, ability to use ETs, and ability to manage refrigerator contents, all of which can be early signs of dementia. Participants were divided 3 groups by the type of dementia: SMC (<i>n</i> = 77), MCI (<i>n</i> = 36), and Alzheimer’s disease (AD) (<i>n</i> = 55) for comparison. <b><i>Result:</i></b> The observation list of early signs of dementia (OLD) total score indicated a significant positive correlation with the number of ET errors (<i>r</i> = 0.37, <i>p</i> &#x3c; 0.001) and number of difficulties with refrigerator management (<i>r</i> = 0.18, <i>p</i> = 0.031). Regarding number of ET errors, there was a significant main effect for the 3 groups, and the SMC group made significantly fewer errors than the AD group (<i>p</i> = 0.02). In 7 of the 11 ET categories, errors with using ETs were associated with all 3 groups, with the SMC group making fewer errors, and the AD group making more. Regarding difficulties with refrigerator management, 2 out of 9 problems were associated with the 3 groups, with the SMC group having fewer difficulties and the AD group having more. <b><i>Discussion/Conclusion:</i></b> The results indicated that the ability to use ETs and to manage refrigerator contents begins to decline at the SMC stage. Further evaluation of the ability to use ETs is needed for older adults with SMC so that adequate support in the context of the individual can be provided.

scholarly journals Effects of Endurance-Focused Physical Activity Interventions on Brain Health

2016 ◽  
Vol 19 (1) ◽  
pp. 53-64 ◽  
Author(s):  
Shannon Halloway ◽  
JoEllen Wilbur ◽  
Michael E. Schoeny ◽  
Konstantinos Arfanakis
Keyword(s):  
Physical Activity ◽  
Older Adults ◽  
Physical Activity Intervention ◽  
Controlled Trial ◽  
Community Dwelling ◽  
Effect Sizes ◽  
Community Based ◽  
The Individual ◽  
Neurocognitive Measures ◽  
The Brain

Physical activity intervention studies that focus on improving cognitive function in older adults have increasingly used magnetic resonance imaging (MRI) measures in addition to neurocognitive measures to assess effects on the brain. The purpose of this systematic review was to identify the effects of endurance-focused physical activity randomized controlled trial (RCT) interventions on the brain as measured by MRI in community-dwelling middle-aged or older adults without cognitive impairment. Five electronic databases were searched. The final sample included six studies. None of the studies reported racial or ethnic characteristics of the participants. All studies included neurocognitive measures in addition to MRI. Five of the six interventions included laboratory-based treadmill or supervised bike exercise sessions, while one included community-based physical activity. Physical activity measures were limited to assessment of cardiorespiratory fitness and, in one study, pedometer. Due to the lack of adequate data reported, effect sizes were calculated for only one study for MRI measures and two studies for neurocognitive measures. Effect sizes ranged from d = .2 to .3 for MRI measures and .2 to .32 for neurocognitive measures. Findings of the individual studies suggest that MRI measures may be more sensitive to the effects of physical activity than neurocognitive measures. Future studies are needed that include diverse, community-based participants, direct measures of physical activity, and complete reporting of MRI and neurocognitive findings.

Associations between CAMCOG-R subscale performance and formal education attainment in South African older adults

2014 ◽  
Vol 27 (2) ◽  
pp. 251-260 ◽  
Author(s):  
Katharine A. James ◽  
Laurian K. Grace ◽  
Kevin G.F. Thomas ◽  
Marc I. Combrinck
Keyword(s):  
Older Adults ◽  
Educational Attainment ◽  
Formal Education ◽  
Screening Tool ◽  
Resource Constraints ◽  
Subscale Score ◽  
Community Dwelling ◽  
Middle Income ◽  
Recent Memory ◽  
The Individual

ABSTRACTBackground:The Cambridge Cognitive Examination-Revised (CAMCOG-R) is a sensitive screening tool for the early diagnosis of dementia in older adults. Overall performance on the CAMCOG-R is influenced by educational attainment. Few studies have, however, examined the association between educational attainment and performance on the individual CAMCOG subscales. We aimed to address this question in a sample from a low-and middle-income country (LAMIC), where resource constraints may have compromised access to, and quality of, education for many older adults.Methods:Participants, all over 60 years of age, were 51 cognitively healthy community-dwelling volunteers and 47 individuals diagnosed with mild-moderate stage Alzheimer's disease (AD). Most participants had some high school education. They were administered the CAMCOG-R under standardized conditions.Results:Within both the control and AD patient groups, there were significant associations between years of completed education and CAMCOG-R total score, MMSE score, and CAMCOG-R Language subscale score. In both groups, level of education was not associated with scores on these subscales: in controls, recent memory, R2 = .21, p = .055, learning memory, R2 = .16, p = .398, attention/calculation, R2 = .19, p = .467, and perception, R2 = .18, p = .984; in AD patients, recent memory, R2 = .14, p = .340, learning memory, R2 = .03, p = .680, perception, R2 = .09, p = .723, and attention/calculation, R2 = .19, p = .097.Conclusions:Some CAMCOG-R subscale scores were more strongly associated with educational attainment than others. Importantly, however, performance on the recent memory and learning memory subscales was not affected by education. These subscales are sensitive indicators of amnestic mild cognitive impairment (MCI) and early AD. These subscales may therefore remain valid for use as an AD screening tool in resource-poor healthcare settings.

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.

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