Use of Item Response Analysis to Investigate Measurement Properties and Clinical Validity of Data for the Dynamic Gait Index

Chiu, Yi-Po; Fritz, Stacy L.; Light, Kathye E.; Velozo, Craig A.

doi:10.1093/ptj/86.6.778

Cited by 59 publications

(12 citation statements)

References 38 publications

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“…Huisstede et al (2009) also noted a lack of relevance of several items to the neck and suggested caution in applying the DASH to neck pain patients without upper limb symptoms. Future studies may consider the value of an abbreviated version of the DASH for neck pain patients and a starting point could be to formally examine the construct validity of the DASH with a Rasch analysis, an increasingly popular method to examine validity of assessment tools (Chiu et al, 2006;Hsueh et al, 2006). Some preliminary suggestions in an informal sense, based on the results of this study, could be to retain activity items that were scored ≥2 by 50% or greater of the participants (Table 3).…”

Section: Discussionmentioning

confidence: 99%

Patients with non-specific neck disorders commonly report upper limb disability

Osborn

Jull

2013

Manual Therapy

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Patients with neck disorders can report difficulties with functional use of their upper limb because of their neck pain. Yet, there is little information on the frequency and specifically, the nature of these upper limb activities. This study surveyed patients with neck pain disorders (n = 103) presenting for management at private physiotherapy clinics in a large metropolitan area to investigate the frequency and nature of reduced upper limb function. Participants were asked to complete four questionnaires, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, the Neck Disability Index (NDI), Pictorial Fear of Activity Scale-Cervical (PFActs-C) and Patient Specific Functional Scale (PSFS). Approximately 80% of patients spontaneously reported that upper limb activities aggravated their neck pain (PSFS). Most frequently, these activities involved loading of the upper limb such as lifting. Eight activity items on the DASH were scored positive by ≥50% of participants. Participants had mild to moderately severe neck pain (NDI: range 2%-68%). The DASH and NDI were moderately-highly correlated (ρ = 0.669; p <0.001), indicating the higher the neck pain severity the greater the upper limb functional restrictions. There was a low correlation between the NDI and PFActS-C (ρ = 0.319; p = 0.001). These findings provide evidence that upper limb function is often impaired in association with neck pain disorders and suggest clinicians should routinely question patients regarding upper limb function. The DASH could be used as a suitable outcome measure in its current or possibly a modified form.

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Section: Discussionmentioning

confidence: 99%

Patients with non-specific neck disorders commonly report upper limb disability

Osborn

Jull

2013

Manual Therapy

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“…Dynamic gait index (DGI): This is a performance-based assessment of gait, balance, and falls risk in older adults. 25,26 The DGI examines a patient’s ability to modify his/her gait in response to changing task demands. The test examines walking on level surface, walking with head turns, walking around and over obstacles, and climbing stairs.…”

Section: Methodsmentioning

confidence: 99%

Ataxic Gait in Essential Tremor: A Disease-Associated Feature?

Rao

Louis²

2019

Tremor and Other Hyperkinetic Movements

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BackgroundWhile accumulating evidence suggests that balance and gait impairments are commonly seen in patients with essential tremor (ET), questions remain regarding their prevalence, their relationship with normal aging, whether they are similar to the impairments seen in spinocerebellar ataxias, their functional consequences, and whether some ET patients carry greater susceptibility.MethodsWe conducted a literature search (until December 2018) on this topic.ResultsWe identified 23 articles on gait or balance impairments in ET. The prevalence of balance impairment (missteps on tandem walk test) was seven times higher in ET patients than controls. Gait impairments in ET included reduced speed, increased asymmetry, and impaired dynamic balance. While balance and gait problems worsened with age, ET patients were more impaired than controls, independent of age. The pattern of impairments seen in ET was qualitatively similar to that seen in spinocerebellar ataxias. Balance and gait impairments resulted in greater number of near falls in ET patients. Factors associated with balance and gait impairments in ET included age, presence of tremor in midline structures, and cognitive dysfunction.DiscussionAccumulating evidence suggests that balance and gait impairments are common in ET patients and occur to a greater extent in controls. Thus, they represent a disease-associated feature. These impairments, which are qualitatively similar to those seen in spinocerebellar ataxias, are not merely subclinical but result in difficulty performing functional tasks and increase falls risk. A subset of patients is more susceptible to balance and gait impairments. The full spectrum of impairments remains to be characterized.

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“…History of falls, injurious falls and near falls Fear of falling [17,24,53,57,58] Physical Performance Measures (consider one or more of the following) Timed up and go (gait velocity measure): Time to rise from a chair, walk 3 m, turn around, walk back to the chair, turn around and sit back down [45,87] Cut-off scores for fall risk have been found to be >13-14 s in older adults [43,45,69] Time to perform and score <5 min Gait Abnormality Rating Scale-Modified (gait variability measure) 50-foot walk is videotaped to allow scoring using a 7-item observational and qualitative scale to detect abnormal gait patterns associated with fall risk, including gait variability [76] A score of less than or equal to 3 suggests minimal to no risk for falls, and scores of greater or equal to 9 are linked with risk for recurrent falls among community dwelling older adults [46] Time to perform and score <10 min [77] Four-Item Dynamic Gait Index (vestibular sensitive measure): Subject is graded on a 4-point scale on walking, walking with speed changes, walking with horizontal head turns and walking with vertical head movements [44,88] A score of less than 10 out of 12 indicates increased fall risk [44] This tool appears sensitive to the vestibular component of balance [89] Time to complete and score is <10 min [44] needed to validate assessment strategies in patients with haemophilia, an in-depth physical therapy evaluation of balance dysfunction in other populations includes assessment of cervical mobility, lower extremity range of motion and strength, trunk control, gait and higher level balance activities as well as the performance of a bedside vestibular exam [90,91]. It has been clearly demonstrated that rehabilitation can improve balance and gait, and decrease falls [2, 80,92], Research supports the use of exercise [91,92], and programmes that include more than one type of exercise (e.g.…”

Section: Fall History Questionsmentioning

confidence: 99%

Screening for fall risk in patients with haemophilia

Flaherty

Josephson

2012

Haemophilia

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Many risk factors for falls identified in the general population are found in patients with haemophilia. Furthermore, fall risk increases with age and patients with haemophilia are increasingly entering the over 65 age group. After a fall occurs, there are often behavioural changes that have significant health consequences and further increase fall risk. Fall risk can be quickly assessed in the clinical setting with specific questions in the medical history and by a variety of performance-based screening tools. Identification of fall risk enables early intervention, thereby preventing injury and fear of physical activity, both of which have been associated with falling and may carry an increased risk in patients with haemophilia. Review of the existing literature on assessment of fall risk reveals the importance of screening in the clinical setting, which is commonly done via a fall history and performance-based assessment tools. Selecting appropriate fall risk screening tools is an important step in identifying and providing optimal interventions for those at risk. Assessments of fall history, fear of falling, gait velocity, gait variability and vestibular dysfunction are suggested as screening tools for patients with haemophilia. Additional research is needed to determine the optimal screening, evaluation and treatment techniques for these patients. The longitudinal physical therapy care provided by Haemophilia Treatment Centres presents a unique opportunity for instituting measures that will reduce the incidence of falling in patients with haemophilia.

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Use of Item Response Analysis to Investigate Measurement Properties and Clinical Validity of Data for the Dynamic Gait Index

Cited by 59 publications

References 38 publications

Patients with non-specific neck disorders commonly report upper limb disability

Patients with non-specific neck disorders commonly report upper limb disability

Ataxic Gait in Essential Tremor: A Disease-Associated Feature?

Screening for fall risk in patients with haemophilia

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