Tandem Gait Test-Retest Reliability Among Healthy Child and Adolescent Athletes

Abstract

Context The tandem gait test is a method for assessing dynamic postural control and part of the Sport Concussion Assessment Tool, versions 3 and 5. However, its reliability among child and adolescent athletes has yet to be established. Objective To examine the test-retest reliability of the single-task and dual-task tandem gait test among healthy child and adolescent athletes. Design Descriptive laboratory study. Setting Sports injury-prevention center. Patients or Other Participants Uninjured and healthy athletes between the ages of 9 and 18 years. Intervention(s) Tandem gait measures repeated 3 times across the period of approximately 1 month. Main Outcome Measure(s) Participants completed the tandem gait test under single-task and dual-task (ie, while simultaneously executing a cognitive task) conditions. Our primary outcome measure was completion time during the single-task and dual-task conditions. We also assessed cognitive accuracy and response rate while participants completed the dual-task tandem gait test. Results Thirty-two child and adolescent athletes completed the study (mean age = 14.3 ± 2.4 years; females = 16). Single-task tandem gait times were similar across the 3 testing sessions (14.4 ± 4.8, 13.5 ± 4.2, and 13.8 ± 4.8 seconds; P = .45). Dual-task tandem gait times steadily improved across the test timeline (18.6 ± 6.9, 16.6 ± 4.5, and 15.8 ± 4.7 seconds; P = .02). Bivariate correlations indicated moderately high to high agreement from test 1 to test 2 (single-task r = .627; dual-task r = 0.655) and from test 2 to test 3 (single-task r = 0.852; dual-task r = 0.775). Both the single-task (intraclass correlation coefficient; ICC [3,1] = 0.86; 95% confidence interval [CI] = 0.73, 0.93) and dual-task (ICC [3,1] = 0.84; 95% CI = 0.69, 0.92) conditions demonstrated high reliability across testing sessions. Conclusions Tandem gait outcome measures demonstrated high test-retest reliability in both the single- and dual-task conditions. The overall reliability was within the acceptable range for clinical practice, but improvements across tests suggested a moderate practice effect. Tandem gait represents a reliable, dynamic, postural-control test that requires minimal space, cost, and time.

Clinical Feasibility and Utility of a Dual-Task Tandem Gait Protocol for Pediatric Concussion Management

“…This builds on previous research illustrating high test-retest reliability between sessions approximately two weeks apart. 7 As such, our data suggest that a tandem gait protocol for use in concussion assessment among adolescent patients may only require two single-task trials, and one dual-task trial, with concurrent words-backward task completion.…”

“…This protocol is consistent with procedures used in previous studies. 5,6,7 Psychometric properties for tandem gait have been established previously, with reported sensitivity (0.63), specificity (0.61), and area under the curve (0.70) values. 5 In addition, the tandem gait test in single-task (intra-class correlation coefficient = 0.86) and dual-task (intra-class correlation coefficient = 0.84) conditions has demonstrated suitable levels of test-retest reliability for repeat clinical assessment over multiple sessions on different days.…”

“…Therefore, establishing a uniform tandem gait protocol, currently missing from the SCAT-5, 1,11 can improve test feasibility and reduce test variability. Although high test-retest reliability of tandem gait has been established for pediatric patients, 7 the intra-session reliability of the assessment is currently unknown.…”

“…5 In addition, the tandem gait test in single-task (intra-class correlation coefficient = 0.86) and dual-task (intra-class correlation coefficient = 0.84) conditions has demonstrated suitable levels of test-retest reliability for repeat clinical assessment over multiple sessions on different days. 7…”

“…This test can be performed under single-task, with undivided attention, and dual-task conditions, where the individual is asked to simultaneously complete a cognitive task. 5,6,7 Single-task tandem gait time, the total number of seconds from commencement to completion, has demonstrated the capacity to distinguish concussed individuals from healthy controls when testing occurs within one week of injury. 6,8,9 Furthermore, dual-task tandem gait time can differentiate concussed patients from healthy controls even after symptom resolution, demonstrating its ability to provide useful information within concussion management beyond that of typically used measures, such as symptom severity.…”