Validity and Reliability of Four Clinical Gait Measures in Patients with Multiple Sclerosis

Bennett, Susan E.; Bromley, Lacey; Fisher, Nadine M.; Tomita, Machiko; Niewczyk, Paulette

doi:10.7224/1537-2073.2015-006

Cited by 68 publications

(43 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results indicated that the BBS had a consistently higher correlation with the TUG and T25FW (two measures of lower extremity strength and mobility) when compared to the DGI. The DGI correlation coefficients for the TUG and T25FW were similar to those reported previously in people with MS (DGI correlation coefficients of −0.762 and −0.778, respectively) [15] and (−0.809 and −0.800) [38]. In PDDS > 2, the DGI appeared to have greater convergence with the 6MWT when compared to TUG and T25FW, a finding similar to that reported previously [38].…”

Section: Discussionsupporting

confidence: 89%

“…The DGI correlation coefficients for the TUG and T25FW were similar to those reported previously in people with MS (DGI correlation coefficients of −0.762 and −0.778, respectively) [15] and (−0.809 and −0.800) [38]. In PDDS > 2, the DGI appeared to have greater convergence with the 6MWT when compared to TUG and T25FW, a finding similar to that reported previously [38]. The BBS–TUG convergence seemed to be greater than the DGI–TUG convergence; the difference was statistically significant when multiple testing was not considered as an issue.…”

Section: Discussionsupporting

confidence: 87%

See 1 more Smart Citation

Comparing the Convergent and Concurrent Validity of the Dynamic Gait Index with the Berg Balance Scale in People with Multiple Sclerosis

et al. 2019

View full text Add to dashboard Cite

Background: Recent clinical guidelines for adults with neurological disabilities suggest the need to assess measures of static and dynamic balance using the Berg Balance Scale (BBS) and Dynamic Gait Index (DGI) as core outcome measures. Given that the BBS measures both static and dynamic balance, it was unclear as to whether either of these instruments was superior in terms of its convergent and concurrent validity, and whether there was value in complementing the BBS with the DGI. Objective: The objective was to evaluate the concurrent and convergent validity of the BBS and DGI by comparing the performance of these two functional balance tests in people with multiple sclerosis (MS). Methods: Baseline cross-sectional data on 75 people with MS were collected for use in this study from 14 physical therapy clinics participating in a large pragmatic cluster-randomized trial. Convergent validity estimates between the DGI and BBS were examined by comparing the partial Spearman correlations of each test to objective lower extremity functional measures (Timed Up and Go (TUG), Six-Minute Walk Test (6MWT), Timed 25-Foot Walk (T25FW) test) and the self-reported outcomes of physical functioning and general health using the 36-Item Short Form Health Survey (SF-36). Concurrent validity was assessed by applying logistic regression with gait disability as the binary outcome (Patient Determined Disease Steps (PDDS) as the criterion measure). The predictive ability of two models, a reduced/parsimonious model including the BBS only and a second model including both the BBS and DGI, were compared using the adjusted coefficient of determinations. Results: Both the DGI and BBS were strongly correlated with lower extremity measures overall as well as across the two PDSS strata with correlations. In PDDS ≤ 2, the difference in the convergence of BBS with TUG and DGI with TUG was −0.123 (95% CI: −0.280, −0.012). While this finding was statistically significant at a type 1 error rate of 0.05, it was not significant (Hommel’s adjusted p-value = 0.465) after accounting for multiple testing corrections to control for the family-wise error rate. The BBS–SF-36 physical functioning correlation was at least moderate and significant overall and across both PDDS strata. However, the DGI–physical functioning score did not have a statistically significant correlation within PDDS ≤ 2. None of the differences in convergent and concurrent validity between the BBS and DGI were significant. The additional variation in 6MWT explained by the DGI when added to a model with the BBS was 7.78% (95% CI: 0.6%, 15%). Conclusions: These exploratory analyses on data collected in pragmatic real-world settings suggest that neither of these measures of balance is profoundly superior to the other in terms of its concurrent and convergent validity. The DGI may not have any utility for people with PDDS ≤ 2, especially if the focus is on mobility, but may be useful if the goal is to provide insight on lower extremity endurance. Further research leveraging longitudinal data from pragmatic trials and quasi-experimental designs may provide more information about the clinical usefulness of the DGI in terms of its predictive validity when compared to the BBS.

show abstract

Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 87%

Comparing the Convergent and Concurrent Validity of the Dynamic Gait Index with the Berg Balance Scale in People with Multiple Sclerosis

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Functional ambulation using the Dynamic Gait Index [68,[73][74][75] Static and dynamic visual acuity assessed using an Early Treatment Diabetic Retinopathy Study (EDTR S) chart with and without passive head motion (40 0 yaw rotation at 1.5 Hz) [76,77] Visual dependency assessed using the Rod and Disc test [78,79] Cognitive impairment and processing speed assessed using the Symbol Digit Modalities Test (SDMT) [80] Impact of MS on walking assessed using the 12 item self-report walking scale (MSWS-12) Version 2.0 [81] Perceived confidence in performing activities of daily living assessed using the self-report Activities-Specific Balance Confidence Scale [82] Self-reported symptoms of poor balance and increased anxiety and arousal assessed using the Vertigo Symptom Scale-Short Form [59,83] Symptoms of visually induced dizziness symptoms assessed using the self-report Situational Characteristic Questionnaire [52] Fatigue as assessed using the self-report Fatigue Scale for Motor and Cognitive functions (FSMC) [84] Symptoms of depression and anxiety assessed using the self-report Hospital Anxiety and Depression Scale (HADS) [85] Health-related quality of life using the 29-item Multiple Sclerosis Impact Scale (MSIS-29) Version 2.0 [86], a disease specific patient-reported outcome measure [87] QALYs assessed by the Multiple Sclerosis Impact Scaleeight dimensions (MSIS-8D) and the Multiple Sclerosis Impact Scale -Eight Dimensions Patient version (MSIS-8D-P) [88,89]. Both measures are based on responses to the MSIS-29, and will be used in sensitivity analyses Retrospective diary of falls over the past month for baseline measure and prospective daily falls diary over 12 weeks for assessment 2 (T14) and follow up (T26) Treatment adherence as determined by the use of patient reported diaries and reported as the percentage of completed prescribed exercises and attendance at face to face sessions User experience of the intervention will be explored through brief semi-structured face to face individual exit interviews based on an interview schedule.…”

Section: Secondary Outcome Measuresmentioning

confidence: 99%

Vestibular rehabilitation in multiple sclerosis: study protocol for a randomised controlled trial and cost-effectiveness analysis comparing customised with booklet based vestibular rehabilitation for vestibulopathy and a 12 month observational cohort study of the symptom reduction and recurrence rate following treatment for benign paroxysmal positional vertigo

et al. 2020

View full text Add to dashboard Cite

Background Symptoms arising from vestibular system dysfunction are observed in 49–59% of people with Multiple Sclerosis (MS). Symptoms may include vertigo, dizziness and/or imbalance. These impact on functional ability, contribute to falls and significant health and social care costs. In people with MS, vestibular dysfunction can be due to peripheral pathology that may include Benign Paroxysmal Positional Vertigo (BPPV), as well as central or combined pathology. Vestibular symptoms may be treated with vestibular rehabilitation (VR), and with repositioning manoeuvres in the case of BPPV. However, there is a paucity of evidence about the rate and degree of symptom recovery with VR for people with MS and vestibulopathy. In addition, given the multiplicity of symptoms and underpinning vestibular pathologies often seen in people with MS, a customised VR approach may be more clinically appropriate and cost effective than generic booklet-based approaches. Likewise, BPPV should be identified and treated appropriately. Methods/ design People with MS and symptoms of vertigo, dizziness and/or imbalance will be screened for central and/or peripheral vestibulopathy and/or BPPV. Following consent, people with BPPV will be treated with re-positioning manoeuvres over 1–3 sessions and followed up at 6 and 12 months to assess for any re-occurrence of BPPV. People with central and/or peripheral vestibulopathy will be entered into a randomised controlled trial (RCT). Trial participants will be randomly allocated (1:1) to either a 12-week generic booklet-based home programme with telephone support or a 12-week VR programme consisting of customised treatment including 12 face-to-face sessions and a home exercise programme. Customised or booklet-based interventions will start 2 weeks after randomisation and all trial participants will be followed up 14 and 26 weeks from randomisation. The primary clinical outcome is the Dizziness Handicap Inventory at 26 weeks and the primary economic endpoint is quality-adjusted life-years. A range of secondary outcomes associated with vestibular function will be used. Discussion If customised VR is demonstrated to be clinically and cost-effective compared to generic booklet-based VR this will inform practice guidelines and the development of training packages for therapists in the diagnosis and treatment of vestibulopathy in people with MS. Trial registration ISRCTN Number: 27374299 Date of Registration 24/09/2018 Protocol Version 15 25/09/2019

show abstract

“…In addition, the patient completed a Lower Extremity Functional Scale (LEFS) [8] with score of 13/80. Upon the patient's fourth visit, the patient performed a Timed Up and Go (TUG) Test [9], 30-Second Chair Stand Test [10], and completed an Oswestry Low Back Pain Disability Questionnaire [11]. The prognosis for this patient was fair.…”

Section: Examinationmentioning

confidence: 99%

Physical Therapy for Transverse Myelitis: A Case Report

Huang¹

2018

J Nov Physiother Rehabil

View full text Add to dashboard Cite

Background and Purpose: Transverse myelitis (TM) is a rare neurological diagnosis found in 1-4 per million people. Rehabilitation is recommended secondary to steroid treatment. There is limited clinical research on physical therapy (PT) for TM. The purpose of this case report is to present PT examination and management strategies for a patient with TM.Case Description: A 25-year-old female patient diagnosed with TM was referred to PT. She presented foot drop causing ataxic gait, decreased sensation in bilateral lower extremities, signifi cant fatigue, and low back pain. The patient required signifi cant rest time between all tests and measures due to severely increased fatigue. PT plan of care was focused on therapeutic exercises per patient tolerance, passive range of motion (ROM) administered by the therapist, and gait training when activity tolerance was increased. Outcomes:The patient was able to tolerate bouts of exercise as prescribed through home exercise program. She responded very well to passive ROM treatment during breaks between exercises to maintain ROM and decrease rigidity. Active ROM exercise was used to build activity tolerance while being mindful of limited ability due to fatigue. Upon increased activity tolerance, the patient was able to tolerate gait training with multiple breaks and maintain corrected gait when addressed during treatment.Discussion: PT intervention was helpful for this patient with TM. Breaking down functional activities based on patient tolerance is important when treating people with TM. More experimental research is needed to support the benefi ts of PT for TM.

show abstract

Validity and Reliability of Four Clinical Gait Measures in Patients with Multiple Sclerosis

Cited by 68 publications

References 31 publications

Comparing the Convergent and Concurrent Validity of the Dynamic Gait Index with the Berg Balance Scale in People with Multiple Sclerosis

Comparing the Convergent and Concurrent Validity of the Dynamic Gait Index with the Berg Balance Scale in People with Multiple Sclerosis

Physical Therapy for Transverse Myelitis: A Case Report

Contact Info

Product

Resources

About