Reference Group Data for the Functional Gait Assessment

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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Functional Gait Assessment: Concurrent, Discriminative, and Predictive Validity in Community-Dwelling Older Adults

Physical Therapy ◽

10.2522/ptj.20090069 ◽

2010 ◽

Vol 90 (5) ◽

pp. 761-773 ◽

Cited By ~ 158

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.

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Reliability, Internal Consistency, and Validity of Data Obtained With the Functional Gait Assessment

Physical Therapy ◽

10.1093/ptj/84.10.906 ◽

2004 ◽

Vol 84 (10) ◽

pp. 906-918 ◽

Cited By ~ 267

Author(s):

Diane M Wrisley ◽

Gregory F Marchetti ◽

Diane K Kuharsky ◽

Susan L Whitney

Keyword(s):

Internal Consistency ◽

Concurrent Validity ◽

Physical Therapist ◽

Rank Order ◽

Intraclass Correlation ◽

Correlation Coefficients ◽

Vestibular Disorders ◽

Intraclass Correlation Coefficients ◽

Gait Assessment ◽

Functional Gait

Background and Purpose. The Functional Gait Assessment (FGA) is a 10-item gait assessment based on the Dynamic Gait Index. The purpose of this study was to evaluate the reliability, internal consistency, and validity of data obtained with the FGA when used with people with vestibular disorders. Subjects. Seven physical therapists from various practice settings, 3 physical therapist students, and 6 patients with vestibular disorders volunteered to participate. Methods. All raters were given 10 minutes to review the instructions, the test items, and the grading criteria for the FGA. The 10 raters concurrently rated the performance of the 6 patients on the FGA. Patients completed the FGA twice, with an hour's rest between sessions. Reliability of total FGA scores was assessed using intraclass correlation coefficients (2,1). Internal consistency of the FGA was assessed using the Cronbach alpha and confirmatory factor analysis. Concurrent validity was assessed using the correlation of the FGA scores with balance and gait measurements. Results. Intraclass correlation coefficients of .86 and .74 were found for interrater and intrarater reliability of the total FGA scores. Internal consistency of the FGA scores was .79. Spearman rank order correlation coefficients of the FGA scores with balance measurements ranged from .11 to .67. Discussion and Conclusion. The FGA demonstrates what we believe is acceptable reliability, internal consistency, and concurrent validity with other balance measures used for patients with vestibular disorders.

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The Functional Gait Assessment in Older Adults: Validation Through Rasch Modeling

Physical Therapy ◽

10.2522/ptj.20150167 ◽

2016 ◽

Vol 96 (4) ◽

pp. 456-468 ◽

Cited By ~ 12

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.

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Minimal Clinically Important Difference of the Functional Gait Assessment in Older Adults

Physical Therapy ◽

10.2522/ptj.20130596 ◽

2014 ◽

Vol 94 (11) ◽

pp. 1594-1603 ◽

Cited By ~ 22

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.

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CROSS-CULTURAL ADAPTATION AND RELIABILITY OF THE FUNCTIONAL GAIT ASSESSMENT FOR OLDER BRAZILIANS

10.5327/z2447-21232021res07 ◽

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.

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Construct and criterion validity of the functional gait assessment—Brazil in community-dwelling older adults

Brazilian Journal of Physical Therapy ◽

10.1016/j.bjpt.2020.05.008 ◽

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

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Reliability and Validity of the Functional Gait Assessment in Incomplete Spinal Cord Injury

Topics in Spinal Cord Injury Rehabilitation ◽

10.46292/sci19-00069 ◽

2020 ◽

Vol 26 (4) ◽

pp. 268-274

Author(s):

Jennifer H. Kahn ◽

April Ohlendorf ◽

Alison Olsen ◽

Keith E. Gordon

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Interrater Reliability ◽

Intraclass Correlation ◽

International Standards ◽

Incomplete Spinal Cord Injury ◽

Intrarater Reliability ◽

Gait Assessment ◽

Cord Injury ◽

Functional Gait

Background: There are limited psychometrically sound measures to assess higher level balance in individuals with incomplete spinal cord injury (iSCI). Objectives: To evaluate interrater and intrarater reliability and convergent validity of the Functional Gait Assessment (FGA) in individuals with iSCI. Methods: Twelve participants (11 male, 1 female) 32 to 73 years old with chronic motor iSCI, American Spinal Injury Association Impairment Scale C (n = 2) or D (n = 10), were included. Participants completed five outcome measures during a single test session including lower extremity motor scores from the International Standards for the Neurological Classification of Spinal Cord Injury, FGA, 10-Meter Walk Test (10MWT), Walking Index for Spinal Cord Injury (WISCI-II), and the Spinal Cord Injury Functional Ambulation Profile (SCI-FAP). Results: Inter- and intrarater reliability for the FGA were excellent. Interrater reliability was excellent with intraclass correlation coefficient (ICC) scores greater than 0.92 (p < .001). Interrater reliability against an expert was also excellent for all raters, with an ICC greater than or equal to 0.92 (p < .01). Intrarater reliability was excellent with an ICC score of greater than 0.91 (p < .002) for all raters. Validity of the FGA with 10MWT was −0.90 (p = .000), FGA with WISCI-II was 0.74 (p = .006), and FGA with SCI-FAP was −0.83 (p = .001). Conclusion: The FGA is a reliable and valid outcome measure to use when assessing gait and balance in individuals with motor iSCI. The FGA provides clinicians with a single tool to utilize across a variety of neurologic diagnoses.

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Physical Activity Health Literacy in Iranian Older Adults: Development and Psychometric Testing

Journal of Aging and Physical Activity ◽

10.1123/japa.2021-0221 ◽

2021 ◽

pp. 1-9

Author(s):

Moeini Babak ◽

Barati Majid ◽

Heidarimoghadam Rashid ◽

Tapak Leili ◽

Parsamajd Shahryar

Keyword(s):

Physical Activity ◽

Older Adults ◽

Factor Analysis ◽

Health Literacy ◽

Phase 1 ◽

Intraclass Correlation ◽

Psychometric Testing ◽

Validity And Reliability ◽

Confirmatory Factor ◽

Two Phases

Inadequate health literacy decreases physical activity. This study aimed to develop and examine psychometrics of physical activity health literacy in Iranian older adults. This methodological work was conducted in two phases. Phase 1 consisted of extensive studies review and qualitative study to extract and design the items. The psychometrics were measured in Phase 2 included content, faceconstruct validities, reliability, and stability. The collected data were analyzed in SPSS (version 25.0) and AMOS (version 24.0). The results of the exploratory factor analysis showed four factors— information evaluation, reading skill, perception, and decision making—and used information that explained 70.08% of the variance. The model’s fitness was supported by confirmatory factor analysis. Internal consistency based on Cronbach’s alpha was .89 with composite reliability >0.85. Stability was confirmed through the test–retest method and intraclass correlation coefficient (.89–1). Psychometrics of physical activity health literacy in Iranian older adults supported validity and reliability of the tool.

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THE POSSIBILITY OF LINKING SPONTANEOUS AND INDUCED NEUROCOGNITIVE PLASTICITY: CAN COGNITIVE TRAINING INFLUENCE COMPENSATORY BRAIN ACTIVITY IN OLDER ADULTS? THEORETICAL AND EMPIRICAL PREMISES

Acta Neuropsychologica ◽

10.5604/01.3001.0014.5290 ◽

2020 ◽

Vol 18 (4) ◽

pp. 507-523

Author(s):

Ludmiła Zając-Lamparska

Keyword(s):

Older Adults ◽

Young Adults ◽

Cognitive Performance ◽

Cognitive Training ◽

Study Design ◽

Successful Aging ◽

Reference Group ◽

Brain Activity ◽

Before And After ◽

Theory Of Aging

One of the most important determinants of successful aging is cognitive ability. Although cognitive decline is a well-documented phenomenon characteristic of aging, it is acknowledged that aging can also be related to cognitive neuroplasticity that allows one to compensate the decline and adapt to it. Cognitive neuroplasticity may be spontaneous or induced by external influences. An example of the former is compensatory brain activity in older adults, and the latter – improvement in cognitive functioning under the influence of cognitive training. Both the compensatory brain activity of older adults and the effectiveness of cognitive training in this age group have already been extensively studied. However, it has not yet been examined whether they can be linked. The article indicates theoretical and empirical premises for the possibility of influencing compensatory brain activity in older adults by cognitive training. In the most comprehensive way the phenomenon of compensatory brain activity in older adults is addressed by the STAC model – the Scaffolding Theory of Aging and Cognition, which also provides the theoretical grounds for the possible impact of cognitive training on compensatory brain activity. There are also empirical arguments in favour of such an impact, but they are quite limited in nature. The reason for this is the lack of research directly addressing the problem of the consistency of brain activity changes resulting from cognitive training with the assumptions of compensatory brain activity models, such as STAC. The theoretical grounds for the linkage of compensatory brain activity in older adults with the influence of cognitive training are clear. However, the analysis of the studies discussed in the article suggests that failing to embed the study design within the theoretical framework of compensatory brain activity in older adults may lead to the exclusion of factors important in drawing conclusions about this phenomenon. The following elements of the study design were identified as necessary to include: participation of young adults in the study as a reference group, usage of tasks in different difficulty levels during the measurement of brain activity and consideration of the relation between brain activity and cognitive performance, and comparison of brain activity in relation to cognitive performance before and after training in both, older and young adults.

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Adaptation and validation of the Caregiver Burden Inventory for use with caregivers of elderly individuals

Revista Latino-Americana de Enfermagem ◽

10.1590/0104-1169.3357.2534 ◽

2015 ◽

Vol 23 (1) ◽

pp. 130-138 ◽

Cited By ~ 21

Author(s):

Daiany Borghetti Valer ◽

Marinês Aires ◽

Fernanda Lais Fengler ◽

Lisiane Manganelli Girardi Paskulin

Keyword(s):

Older Adults ◽

Correlation Coefficient ◽

Caregiver Burden ◽

Pearson Correlation ◽

Intraclass Correlation ◽

Expert Committee ◽

Five Dimensions ◽

Social And Emotional ◽

Back Translation ◽

Student’S T

OBJECTIVE: to adapt and validate the Caregiver Burden Inventory for use with caregivers of older adults in Brazil.METHOD: methodological study involving initial translation, synthesis of translations, back translation, expert committee review, pre-testing, submission of the final version to the original authors, and assessment of the inventory's psychometric properties. The inventory assesses five dimensions of caregiver burden: time-dependence, developmental, physical, social and emotional dimensions.RESULTS: a total of 120 family caregivers took part in the study. All care-receivers were older adults dependent on assistance to perform activities of daily living, and lived in the central region of the city of Porto Alegre, RS, Brasil. Cronbach's alpha value for the inventory was 0.936, and the Pearson correlation coefficient for the relationship between the scores obtained on the Caregiver Burden Inventory and the Burden Interview was 0.814. The intraclass correlation coefficient was 0.941, and the value of Student's T-test comparing test and retest scores was 0.792.CONCLUSION: the instrument presented adequate reliability and the suitability of its items and factors was confirmed in this study.

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