Τρίτη 21 Ιουνίου 2016

Dynamic Gait Index

Acronym:
DGI
Purpose:
Assesses individual's ability to modify balance while walking in the presence of external demands
Description:
  • Performed with a marked distance of 20 feet
  • Can be performed with or without an assistive device
  • Scores are based on a 4-point scale:
    • 3 = No gait dysfunction
    • 2 = Minimal impairment
    • 1 = Moderate impairment
    • 0 = Severe impairment
  • Highest possible score is 24 points. Tasks include:
    • Steady state walking
    • Walking with changing speeds
    • Walking with head turns both horizontally and vertically
    • Walking while stepping over and around obstacles
    • Pivoting while walking
    • Stair climbing
Area of Assessment: Balance Vestibular, Balance Non-Vestibular, Functional Mobility, Gait
Body Part: Not Applicable
ICF Domain: Activity
Domain: Motor
Assessment Type: Observer
Length of Test: 06 to 30 Minutes
Time to Administer:
< 10 minutes (may vary with the patient's abilities)
Number of Items: 8
Equipment Required:
  • Shoe box
  • Two obstacles (must be same size)
  • Stairs
  • 20 foot (6.1 meter) pathway
Training Required:
None
Type of training required: No Training
Cost: Free
Actual Cost:
Free
Age Range: Adult: 18-64 years, Elderly adult: 65+
Administration Mode: Paper/Pencil
Diagnosis: Geriatrics, Multiple Sclerosis, Parkinson's Disease, Stroke, Vestibular Disorders
Populations Tested:
  • Brain injury
  • Geriatric
  • Multiple Sclerosis
  • Parkinson's disease
  • Stroke
  • Vestibular disorders
Standard Error of Measurement (SEM):

Community Dwelling Elderly:

 

(Romero et al 2011; n = 42; mean age = 75.6 (range 59-88) years, Community Dwelling Elderly)

 

  • SEM = 1.04 points

Multiple Sclerosis:

 

(Cattaneo et al, 2007; n = 25, mean age = 41.7 (12.5) years; mean time since onset = 8.7 (8.8) years; Italian sample, MS)

 

  • SEM inter-rater reliability = 1.51 points
  • SEM intra-rater relibaility = 2.00 points

Stroke:

 

(Jonsdottir & Cattaneo, 2007, n = 25; mean age = 61.6 (13.1) years; mean time since stroke = 4.2 (7.5) years, range 0.5-35.3 years; Italian sample, Chronic Stroke)

 

  • SEM for inter-rater reliability = 0.97 points 
  • SEM for interrater reliability = 0.94 points

Peripheral Vestibular Disorders:

 

(Calculated from Hall & Herdman, 2006; n = 16; age 51.8 (13.4) years, diagnosis of unilateral or bilateral vestibular hypofunction)

 

  • SEM calculated = 2.8 points
Minimal Detectable Change (MDC):

Chronic Stroke:

(calculated from Jonsdottir and Cattaneo, 2007)

  • MDC (calculated from SEM) = 2.6 points

 

Community Dwelling Elderly:

 

(Romero et al, 2011, Community Dwelling Elderly)

 

  • MDC = 2.9 points

Multiple Sclerosis:

 

(Cattaneo et al, 2007, MS)

 

  • MDC (Calculated from SEM) = 4.19-5.54

Parkinson's Disease:

 

(Huang et al, 2011, n = 72; mean age = 67.5 (11.6); range of disease duration = 2 months-15 years; Hoehn-Yahr range I-III(Stage I = 17, II = 33, III = 22), Taiwanese sample)

 

  • MDC = 2.9 points
  • MDC% = 13.3%

Stroke:

 

(Lin et al, 2010; n = 45; mean age = 60.7 (12.2) years; median time since stroke = 9 months (range 3 to 36 months); Taiwanese sample, Stroke)

 

  • MDC = 4 points
  • Percent change = 16.6%

Vestibular Disorders:

 

(Calculated from Hall & Herdman, 2006, Peripheral Vestibular Disorders)

 

  • MDC calculated = 3.2 points
Minimally Clinically Important Difference (MCID):

Community-dwelling Older adults:

(Pardasaney et al, 2012; n = 111 aged 65 or older; mean age 75.9 + 7 years, 68.5% female)

  • 1.90 points for total sample
  • 1.80 for subjects with DGI scores < 21/24
  • 0.60 for subjects with DGI scores > 21/24
Cut-Off Scores:

Community Dwelling Elderly:

 

(Shumway-Cook et al,1997; n = 44; age > 65, Community Dwelling Elderly)

 

  • < 19 indicative of increased fall risks (Sensitivity 59%, Specificity 64%) 

Community-Dwelling Older Adults:

(Wrisley and Kumar, 2010; n = 35, mean age 72.9 + 7.8 years followed for prospective falls)

  • < 19 indicates increased risk of falls (Sensitivity 67%, specificity 86%)

 

Vestibular Disorders:

(Whitney et al, 2000; n = 247, age 14-95 years, mean 62.4 years, central and peripheral vestibular dysfunction)

 

  • Subjects with scores of < 19/24 are 2.58 times more like to have reported a fall in the previous 6 months than subjects with scores above 19

Multiple Sclerosis:

 

(Cattaneo et al, 2006; n = 51; relapsing-remitting or secondary progressive MS; mean age 45.3 (18.1) years; mean time since onset 15.6 (7.6) years, MS)

 

  • < 12 indicative of fall-risk (Sensitivity 45%, Specificity 80%)

Parkinson's Disease:

(Dibble et al, 2008; total n = 70, mean age = 73.9(6.45), mean J&Y=2.5 (range 1-4), 36 fallers & 34 nonfallers; fallers (n = 36, mean age = 75.25(5.15)), mean duration of PD = 8.32 (8.67), mean modified H&Y=2.5, 28 male/8 female); and non-fallers (n = 34, mean age = 72.50(7.4)), mean duration of PD = 6.49(4.93), mean modified H&Y = 2.0

  • Adequate discriminative ability between fallers and non-fallers based on cutoff score < 19 (sensitivity = 0.64, specificity = 0.85, +LR = 4.26, -LR = 0.42)

(Landers et al 2008, JNPT) (Total n = 49, mean age = 70.9(8.9) yrs, 20 female/29 male; 25 of participants were fallers (mean duration of diagnosis = 75.6(66.9) months, mean UPDRS = 41.8(9.6), mean H&Y = 3.0(0.55)) and 24 participants were non-fallers (mean age = 70.1(6.9) yrs, mean duration since Dx = 45.4(36.9) months, mean UPDRS = 26.8(10.0), mean H&Y = 2.1(0.61)}

  • Adequate discriminative ability between fallers and nonfallers using cut score = 18.5 (AUC = 0.758, Sensitivity = 0.68, Specificity = 0.708, +LR = 2.33, -LR = 0.45; post-test probability = 0.708, Odds ratio 5.20(1.54-17.56) 95%CI)
Normative Data:
Healthy Adults:

(Vereeck et al, 2008; n = 318; mean age = 49.2(18.7), Healthy Adults)

Decade

Mean

SD

5th Percentile

Range

3

24.0

0.2

24

23-24

4

24.0

0.2

24

23-24

5

23.9

0.4

23

22-24

6

23.9

0.4

23

22-24

7

23.2

0.9

21

21-24

8

22.0

2.0

18

13-24

 

Stroke:

(Lin et al, 2010, Acute and Chronic Stroke)

Median Scores for DGI:

1 week

2 months

5 months

Median score

13

14

14

Range: 1st to 3rd quartile

10-18

10-20

11-20

 

(Hwang et al, 2010; n = 11; mean age = 48.09 (5.85) years; mean time post stroke = 24.36 (10.84) months, Chronic Hemiparetic Stroke)

 

Mean DGI Score:
 
Mean
SD
Pretest
10.64
2.01
Posttest
11.64
3.36

 

Parkinson's Disease:

(Cakit et al, 2007; n = 31; mean age 71.8 (6.4) years, Parkinson's Disease)

Mean DGI Score:
 
Mean
SD
Baseline
16.3
5.2
Outcome
16.54
3.35
Test-retest Reliability:

Multiple Sclerosis:

 

(Cattaneo et al, 2007, Multiple Sclerosis)

 

  • Excellent test-retest reliability (ICC = 0.85)

Parkinson's Disease:

 

(Huang et al, 2010, Parkinson's Disease)

 

  • Excellent test-retest reliability (ICC = 0.84)

(Kadivar et al, 2011) (n = 16, age range 59-81 yrs, 5 female/11 males, H&Y stage (range 2-4))

  • Excellent test retest reliability (ICC > 0.99)

Stroke:

 

(Lin et al, 2010; tested in separate sample of 48 patients with chronic stroke; mean age = 54.9 (10.2) years, Acute and Chronic Stroke)

 

  • Excellent test-retest reliability (ICC > 0.94; 0.91-0.97)

(Jonsdottir & Cattaneo, 2007; n = 25 mean age = 61.6 (13.1) years, Chronic Stroke)

 

  • Excellent total score test re-test reliability (ICC = 0.96)
    • Individual items varied from 0.56 (gait and pivot turns) to 1.00 (stair climbing)

Vestibular Population:

 

(Hall et al, 2006; n = 16 patients with vestibular disorders; mean age = 51.8 (13.4) years)

 

  • Excellent test-retest reliability (ICC = 0.86 (total score) (individual items ranged from 0.04-0.90))
Interrater/Intrarater Reliability:

Community Dwelling Older Adults with Baseline Impairment:

 

(Jønsson et al, 2011; n = 24 (Hospital), mean age = 79.4 (6.8) years; n = 26 (outpatient rehabilitation), mean age = 76.8 (6.4) years; assessed at a 1.5 hour interval, rated by 3 PT's at each site; Danish language sample, Community Dwelling Older Adults)

 

Hospital:

  • Excellent intrarater reliability (ICC = 0.90)
  • Excellent interrater reliability (ICC = 0.92)

Outpatient Rehabilitation:

  • Excellent intrarater reliability (ICC = 0.89)
  • Excellent interrater reliability (ICC = 0.82)

Multiple Sclerosis:

 

(McConvey and Bennett, 2005, MS)

 

  • Excellent interrater reliability (ICC = 0.983)
  • Range from r = 0.910-0.976 for individual test terms
  • Excellent intrarater reliability (ICC = 0.760-0.98)

Stroke:

 

(Jonsdottir & Cattaneo, 2007, Chronic Stroke)

 

  • Excellent interrater reliability (ICC = 0.96)

Vestibular:

(Wrisley et al, 2003; n = 30, age range 27-88 years referred for vestibular rehabilitation)

  • Adequate inter-rater reliability (k = 0.64)
Internal Consistency:
Not Established
Criterion Validity (Predictive/Concurrent):

Brain Injury:

(Medley, A. et al, 2006; n = 26; mean age = 41.9 (12.4) years, Brain Injury)

  • Found that a person who scores 19 out of 24 points on the DGI has a 28% probability of falling. A person who scores 24 out of 24 points would have a 6% chance of falling and a person who scores 0 out of 24 points would have a 100% change of falling

(McConvey and Bennet, 2005)

  • Excellent concurrent validity with 6.1m timed walked test (r = -0.81)
Community Dwelling Older Adults:
 
(Shumway-Cook et al, 1997; n = 44; aged 65 to 94 years, Community Dwelling Older Adults)
  • Excellent, Balance Self-Perceptions Test and DGI (r = 0.76)
  • Excellent, Berg Balance Scale and DGI (r = 0.67)
  • Adequate, Assistive Devices History and DGI (r = -0.44)
  • Adequate, History of imbalance and DGI (r = -0.46)
Multiple Sclerosis:
(Cattaneo et al, 2006; Cattaneo et al, 2007, MS)
  • Excellent concurrent validity with the Berg Balance Scale, TUG, DI, and ABC respectively (Spearman coefficient = 0.78, -0.80, -0.54)
  • Poor concurrent validity with the DHI (Spearman coefficient = -0.39)

Parkinson's Disease:

(Cakit et al. 2007; n = 31, mean age = 71.8(6.4), mean duration of PD = 5.58(2.9), mean UPDRS motor subscale = 18.4(9.32))

  • Adequate concurrent validity with UPDRS-motor subscale scores (r = -0.567, p < 0.001)
  • Excellent correlation with history of falls in PD (r = 0.643, p < 0.01)
Stroke:
 
(Jonsdottir and Cattaneo, 2007, Chronic Stroke)
  • Excellent concurrent validity with Berg Balance Scale (r = 0.83)
  • Excellent concurrent validity with the ABC (r = 0.68)

(Lin et al, 2010, Acute and Chronic Stroke)

  • Excellent concurrent validity amongst DGI, 4 itme DGI, and FGA (r > 0.91)
Vestibular Population:
 
(Hall & Herdman, 2006; n = 16 patients with confirmed peripheral vestibular disorders; mean age = 51.8 (13.4) years, Vestibular Population)
  • Berg Balance Scale and DGI scores agreed 63% of the time on fall risk criteria
  • DGI appears to be more sensitive than the Berg Balance Scale in identifying fall risk in patients with vestibular disorders

(Whitney et al. 2000 (n = 30 patients (aged 27 to 88) diagnosed with vestibular disorders, Vestibular Population)

  • Excellent concurrent validity (r = 0.71) between the DGI and the Berg Balance Scale
Construct Validity (Convergent/Discriminant):

Acute and Chronic Stroke:

(Lin et al, 2010)

  • Excellent with the 10 meter walk (r = -0.68, -0.87, -0.83) test and Postural Assessment Scale (r = 0.85, 0.76, 0.83) for Stroke at 1st week of PT, 2 months after PT, and 5 months after PT

Multiple Sclerosis:

(Cattaneo et al, 2006)

  • Statistically significant difference of three points noted between fallers and non-fallers (P = 0.025)

Parkinson's Disease:

(Landers et al, 2008)

  • Significant difference in total DGI scores between fallers (16.1, SD = 3.4) and non-fallers (19.6, SD = 2.6) in PD cohort, p < 0.01

(Dibble et al, 2006; n = 45 with idiopathic PD, mean age = 69.94(11.8), mean duration of PD = 7.43(5.62) years, mean H&Y level = 2.6(0.66); fallers n = 25 and non-fallers n = 20;  faller subgroup characteristics (mean age = 73.25(8.58), mean duration of PD = 9.07(6.13), mean H&Y = 2.95(0.62)); non-faller subgroup characteristics (mean age = 65.91(9.89), mean duration of PD = 5.43(4.25), mean H&Y = 2.17(0.42))

  • Significant difference in DGI scores between fallers {17.92 (4.36) 95% CI = 16.23-19.62} and non-fallers {21.82 (3.42) 95%CI 21.02-22.63
  • Adequate discriminative ability between fallers and non-fallers based on cutoff score = 22 {AUC = 0.84, Sensitivity = 0.89, Specificity = 0.48, +LR = 1.86 (1.38-2.55), -LR = 0.22 (0.10-0.49)
  • Strongest positive LR as compared to Functional Reach test, Berg Balance Test and TUG. Author recommended DGI be administered as first test to detect fall risk in community dwelling persons with PD
Content Validity:
Community-dwelling male veterans:
(Chiu et al, 2006; n = 84, 64-88 years, mean age 75 + 6.47 years)
  • Eash original 4 rating scale categories distinctly identified subjects at different ability levels
  • Clear difficulty hierarchical order
  • 8 items on the DGI appear to represent a single construct
Face Validity:
Not Established
Floor/Ceiling Effects:

Community-dwelling older adults:

(Pardasaney et al, 2012)

  • No floor effect
  • Poor ceiling effect
    • 40% at maximum score at baseline
    • 70% at maximum score after intervention

Multiple Sclerosis:

(Cattaneo et al, 2006, MS)

  • Adequate ceiling effects (7.8%)

Stroke:

(Lin et al, 2010, Acute and Chronic Stroke)

  • Excellent indicates minimal floor effects
  • Adequate indicates relatively little ceiling effects

Floor and Ceiling Effects:

Time Point

Floor Effect %

 Ceiling Effect %

1st week of  PT

2.2

4.4

2 months after PT

0

10.3

5 months after PT

0

11.4

Responsiveness:

Community-dwelling older adults:

(Pardasaney et al, 2012)

  • Poor responsiveness
    • Effect size 0.27
    • Standardized response mean 0.45
    • Only people in the lower balance subgroups demonstrated change scores > MCID

Multiple Sclerosis:

 

(Cattaneo et al, 2006, MS)

 

  • Scores of less than 12 discriminated between fallers and non fallers, however, Cattaneo (2006) reported that the BBS and DGI measures were not as good at discriminating between fallers and non-fallers compared to the Equiscale Test.

Parkinson's Disease:

(Cakit et al, 2007)

  • Was moderately responsive to change (mean change = 4.72 SD = 0.88) in training group following locomotor treadmill training intervention compared to control group (p < 0.05)

(Kadivar et al, 2011)

  • Moderate responsiveness of DGI scores to cued step training with significant differences between the cued and noncued groups (effect size in cued RAS training group = 1.77, in non-cued group = 1.05)

(Landers et al, 2008)

 

  • Sensitivity = 0.680
  • Specificity = 0.708

 

Stroke:

 

(Lin et al, 2010, Acute and Chronic Stroke)

 

  • Moderate responsiveness in depicting change at 2 months and 5 months after therapy (effect size 0.56, 0.62 respectively)
Considerations:
  • Although psychometrics have not been evaluated in SCI population, this measure has been used to assess dynamic balance in 2 SCI studies (Fritz et al, 2011 & Day et al, 2012)
  • FGA shows less ceiling effect and is recommended over DGI is stroke population (Lin et al, 2010)
  • The DGI has a ceiling effect in people with vestibular dysfunction. (Wrisley 2003)

Dynamic Gait Index translations:

Spanish (p5-7):
http://ift.tt/28L18ks

Arabic: The Arabic version of the DGI can be requested for free from alia.alghwiri@gmail.com

These translations, and links to them, are subject to the Terms and Conditions of Use of the Rehab Measures Database. RIC is not responsible for and does not endorse the content, products or services of any third-party website, and does not make any representations regarding its quality, content or accuracy. If you would like to contribute a language translation to the RMD, please contact us at rehabmeasures@ric.org.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Bibliography:

Badke, M. B., Sherman, J., et al. (2011). "Tongue-based biofeedback for balance in stroke: results of an 8-week pilot study." Arch Phys Med Rehabil 92(9): 1364-1370. Find it on PubMed

Brown, K. E., Whitney, S. L., et al. (2001). "Physical therapy outcomes for persons with bilateral vestibular loss." Laryngoscope 111(10): 1812-1817. Find it on PubMed

Cakit, B. D., Saracoglu, M., et al. (2007). "The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinson's disease." Clin Rehabil 21(8): 698-705. Find it on PubMed

Cattaneo, D., Jonsdottir, J., et al. (2007). "Reliability of four scales on balance disorders in persons with multiple sclerosis." Disabil Rehabil 29(24): 1920-1925. Find it on PubMed

Cattaneo, D., Regola, A., et al. (2006). "Validity of six balance disorders scales in persons with multiple sclerosis." Disability and Rehabilitation 28(12): 789-795. Find it on PubMed

Chiu, Y. P., Fritz, S. L., et al. (2006). "Use of item response analysis to investigate measurement properties and clinical validity of data for the dynamic gait index." Physical Therapy 86(6): 778-787. Find it on PubMed

Day, K. V., Kautz, S. A., et al. (2012). "Foot placement variability as a walking balance mechanism post-spinal cord injury." Clin Biomech (Bristol, Avon) 27(2): 145-150. Find it on PubMed

Dibble, L. E., Christensen, J., et al. (2008). "Diagnosis of fall risk in Parkinson disease: an analysis of individual and collective clinical balance test interpretation." Physical therapy 88(3): 323-332.

Dibble, L. E. and Lange, M. (2006). "Predicting falls in individuals with Parkinson disease: a reconsideration of clinical balance measures." Journal of Neurologic Physical Therapy 30(2): 60-67.

Fritz, S. L., Pittman, A. L., et al. (2007). "An intense intervention for improving gait, balance, and mobility for individuals with chronic stroke: a pilot study." J Neurol Phys Ther 31(2): 71-76. Find it on PubMed

Hall, C. D. and Herdman, S. J. (2006). "Reliability of clinical measures used to assess patients with peripheral vestibular disorders." J Neurol Phys Ther 30(2): 74-81. Find it on PubMed

Herdman, S. J., Schubert, M. C., et al. (2003). "Recovery of dynamic visual acuity in unilateral vestibular hypofunction." Arch Otolaryngol Head Neck Surg 129(8): 819-824. Find it on PubMed

Huang, S. L., Hsieh, C. L., et al. (2011). "Minimal detectable change of the timed "up & go" test and the dynamic gait index in people with Parkinson disease." Phys Ther 91(1): 114-121. Find it on PubMed

Hwang, S., Jeon, H. S., et al. (2010). "Locomotor imagery training improves gait performance in people with chronic hemiparetic stroke: a controlled clinical trial." Clin Rehabil 24(6): 514-522. Find it on PubMed

Jonsdottir, J. and Cattaneo, D. (2007). "Reliability and validity of the dynamic gait index in persons with chronic stroke." Archives of Physical Medicine and Rehabilitation 88(11): 1410-1415. Find it on PubMed

Jonsson, L. R., Kristensen, M. T., et al. (2011). "Intra- and interrater reliability and agreement of the Danish version of the Dynamic Gait Index in older people with balance impairments." Archives of Physical Medicine and Rehabilitation 92(10): 1630-1635. Find it on PubMed

Kadivar, Z., Corcos, D. M., et al. (2011). "Effect of step training and rhythmic auditory stimulation on functional performance in Parkinson patients." Neurorehabilitation and Neural Repair 25(7): 626-635.

Landers, M. R., Backlund, A., et al. (2008). "Postural instability in idiopathic Parkinson's disease: discriminating fallers from nonfallers based on standardized clinical measures." J Neurol Phys Ther 32(2): 56-61. Find it on PubMed

Lin, J. H., Hsu, M. J., et al. (2010). "Psychometric comparisons of 3 functional ambulation measures for patients with stroke." Stroke 41(9): 2021-2025. Find it on PubMed

McConvey, J. and Bennett, S. E. (2005). "Reliability of the Dynamic Gait Index in individuals with multiple sclerosis." Archives of Physical Medicine and Rehabilitation 86(1): 130-133. Find it on PubMed

Medley, A., Thompson, M., et al. (2006). "Predicting the probability of falls in community dwelling persons with brain injury: a pilot study." Brain Inj 20(13-14): 1403-1408. Find it on PubMed

Pardasaney, P. K., Latham, N. K., et al. (2012). "Sensitivity to change and responsiveness of four balance measures for community-dwelling older adults." Physical therapy 92(3): 388-397.

Romero, S., Bishop, M. D., et al. (2011). "Minimum detectable change of the Berg Balance Scale and Dynamic Gait Index in older persons at risk for falling." Journal of Geriatric Physical Therapy 34(3): 131-137.

Shumway-Cook, A., Baldwin, M., et al. (1997). "Predicting the probability for falls in community-dwelling older adults." Physical Therapy 77(8): 812-819. Find it on PubMed

Shumway-Cook, A., Gruber, W., et al. (1997). "The effect of multidimensional exercises on balance, mobility, and fall risk in community-dwelling older adults." Physical Therapy 77(1): 46-57. Find it on PubMed

Tinetti, M. E. (1986). "Performance-oriented assessment of mobility problems in elderly patients." J Am Geriatr Soc 34(2): 119-126. Find it on PubMed

Tinetti, M. E., Mendes de Leon, C. F., et al. (1994). "Fear of falling and fall-related efficacy in relationship to functioning among community-living elders." J Gerontol 49(3): M140-147. Find it on PubMed

Vereeck, L., Wuyts, F., et al. (2008). "Clinical assessment of balance: normative data, and gender and age effects." Int J Audiol 47(2): 67-75. Find it on PubMed

Whitney, S. L., Hudak, M. T., et al. (2000). "The dynamic gait index relates to self-reported fall history in individuals with vestibular dysfunction." J Vestib Res 10(2): 99-105. Find it on PubMed

Wrisley, D. M. and Kumar, N. A. (2010). "Functional gait assessment: concurrent, discriminative, and predictive validity in community-dwelling older adults." Physical therapy 90(5): 761-773.

Wrisley, D. M., Walker, M. L., et al. (2003). "Reliability of the dynamic gait index in people with vestibular disorders." Arch Phys Med Rehabil 84(10): 1528-1533. Find it on PubMed

Year published: 2001
Instrument in PDF Format: Yes


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