[논문]Intrarater and Interrater Reliability of the Dynamic Gait Index in Persons With Parkinson's Disease

Hwang, Su-Jin; Woo, Young-Keun

Intrarater and Interrater Reliability of the Dynamic Gait Index in Persons With Parkinson's Disease 원문보기

한국전문물리치료학회지 = Physical Therapy Korea, v.17 no.4, 2010년, pp.55 - 60

Hwang, Su-Jin (Institute of Health Science, Yonsei University) , Woo, Young-Keun (Dept. of Physical Therapy, Andong Science College)

Abstract ▼ AI-Helper

Clinical measures that Quantify falling risk factors are needed for the accurate evaluation of patients and to plan an intervention strategy. The purpose of this study was to examine the test-retest and interrater reliability of the dynamic gait index (DGI) for persons with Parkinson's disease (PD). A total of 22 idiopathic PD patients were recruited from rehabilitation hospital, Korea in this study. The DGI was assessed in two sessions that were, three days apart. We also measured Berg balance test (BBT) and geriatric depression scale (GDS) for concurrent validity with DGI. Intrarater and interrater reliability (.96 and .98 respectively) for DGI were high. indicating good agreement. The DGI was showed a good positive correlation with the BBS (r=.852). but not GDS (r=-.462). Intrarater and interrater reliability of DGI were high in people with PD. The DGI could be a reliable measure to evaluate functional postural control during gait activities in the PD population, and the ability of DGI to detect real change is acceptable in research and clinical settings.

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문제 정의

However, it is not appropriate to use the DGI for the evaluation of dynamic balance in populations with PD, because its reliability has not been tested in this population. The major purpose of this study was to examine the test-retest and interrater reliability of the DGI in persons with PD. We also aimed to better characterize the properties of the DGI and the factors that contribute to the outcome of this commonly used test in persons with PD.
This study was designed to assess the reliability of the DGI and to better characterize the properties of the DGI and the factors that contribute to its outcome in PD patients. The results of this study revealed several significant findings.
This study was to examine the test-retest and interrater reliability of the DGI in persons with PD. The DGI, BBT, and geriatric depression scale (GDS) were assessed for interrater reliability and concurrent validity by two physical therapists.

제안 방법

Clinical measures were assessed while the subjects were in the ‘on’ phase of their medication cycle, generally 1～3 h after taking their anti-Parkinson’s medications.
The DGI consists of the following 8 walking tasks: walking, walking while changing speed, walking while turning the head horizontally and vertically, walking with pivot turn, walking over and around obstacles, and stair climbing (Herman et al, 2009). Each task is scored on a 4-point ordinal scale ranging from 0～3, with 0 indicating severe impairment and 3 indicating normal ability. The DGI has a maximum possible score of 24, and a score of 19 or less indicates an increased risk of falling.
Clinical measures were assessed while the subjects were in the ‘on’ phase of their medication cycle, generally 1～3 h after taking their anti-Parkinson’s medications. The subjects performed clinical measures to two-session protocol; the DGI, BBT, and geriatric depression scale (GDS) were assessed for interrater reliability and concurrent validity by two physical therapists in the first session. And then DGI was assessed for intrarater reliability by rater in the second session that was 3 days apart.
The raters were not allowed to consult each other during the test and had no access to previous test results. The tests were performed in a quiet and well-organized therapy room and subjects were given the standard verbal instructions of the DGI and BBT. Although the verbal instructions were given once, they were given again if required by the study subjects.
This study assigned numerical values to postural stability, dynamic balance and depression level. DGI is one of most popular clinical measures for the evaluation of functional stability during gait activities in older people, and in those with multiple sclerosis, stroke and vestibular disorders (Jonsdottir and Cattaneo, 2007; McConvey and Bennett, 2005; Shumway-Cook and Woollacott, 2007; Whitney et al, 2003).
To investigate the reliability of the DGI for PD patients, three clinical measures (DGI, BBT, and GDS) were evaluated by clinical observation and interview. The DGI consists of the following 8 walking tasks: walking, walking while changing speed, walking while turning the head horizontally and vertically, walking with pivot turn, walking over and around obstacles, and stair climbing (Herman et al, 2009).

대상 데이터

All subjects provided an informed consent before participation according to the guidelines of the Glory Institutional Review Board. Data collection was performed in the outpatient physical therapy of adult rehabilitation unit in Glory hospital (Incheon, Korea). Twenty-two idiopathic PD patients participated in this study.
Data collection was performed in the outpatient physical therapy of adult rehabilitation unit in Glory hospital (Incheon, Korea). Twenty-two idiopathic PD patients participated in this study. General characteristics of subjects were showed in Table 1.

데이터처리

Pearson’s correlations were used to quantify the bivariate associations between the DGI and other measures.
To determine the correlation between the total score of DGI and GDS as well as BBT, we calculated Spearman’s correlation coefficients.

성능/효과

First, the total DGI scores showed good intrarater reliability and each item’s score had good reliability.
Second, interrater reliability for the total DGI scores was in good agreement and each item’s score had good reliability.
DGI is one of most popular clinical measures for the evaluation of functional stability during gait activities in older people, and in those with multiple sclerosis, stroke and vestibular disorders (Jonsdottir and Cattaneo, 2007; McConvey and Bennett, 2005; Shumway-Cook and Woollacott, 2007; Whitney et al, 2003). The result of this study showed good agreement for DGI in people with PD and the reliability of each test item was acceptable. Item 8 (steps) had the lowest agreement of the items.
We also administered BBT and GDI in this study. The total DGI score was moderately correlated with the total BBT score, but not with the GDS. The result indicates that the DGI and BBT provide valuable information for the maintenance of functional balance in people with PD.
The DGI, BBT, and geriatric depression scale (GDS) were assessed for interrater reliability and concurrent validity by two physical therapists. This results suggested that the DGI is potentially a clinical measure that could help identify PD patients at risk factors of falls, and could be a reliable measure to evaluate functional postural control during gait activities in the PD population.

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