Movement disorders clinical practice · 2025
Role of the Functional Gait Assessment in Validating Item Difficulty Hierarchy and Fall Risk for Idiopathic Normal Pressure Hydrocephalus.
СтатьяВалидационное исследованиеНазвание и аннотация: Перевод в очереди
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Nikaido Yasutaka, Urakami Hideyuki, Ishida Naoya, Okada Yohei, Kawami Yuki, Inui Takaki, Kameda Masahiro, Kajimoto Yoshinaga, Saura Ryuichi
Аннотация
BACKGROUND: Falls along with gait-balance disturbances are important symptoms of idiopathic normal pressure hydrocephalus (iNPH).
OBJECTIVES: This study aimed to validate the Functional Gait Assessment (FGA) item-difficulty hierarchy, determine its optimal fall cutoff value, and identify key items for assessing fall risk in iNPH.
METHODS: One hundred eighty-eight iNPH patients underwent pre-intervention assessments using the FGA, timed up-and-go (TUG), 10-Meter Gait Speed (10MGS) tests, and their falls history in the past 6 months. Rasch analysis confirmed the validity of the FGA item-difficulty hierarchy and established the relationship between total scores and logit estimates. Logistic regression identified the optimal FGA cutoff value and key fall-related items.
RESULTS: The FGA's item-difficulty hierarchy was confirmed to range from item 5 ("gait and pivot turn") at -2.58 logits (easiest) to item 7 ("gait with narrow base of support") at 5.35 logits (most difficult). Total scores corresponded to logits from -10.39 (score 0) to 11.64 (score 30). The fall rate was 63.3%. The optimal FGA cutoff value was ≤15 points (area under curve [AUC]: 0.901, P < 0.001), outperforming TUG (AUC: 0.712) and 10MGS (AUC: 0.742). Key fall-related items (R2: 0.545, P < 0.001) were item 2 ("change in gait speed"), item 7 ("gait with narrow base of support"), item 1 ("gait on level surface"), item 10 ("stair steps"), and item 5 ("gait and pivot turn").
CONCLUSIONS: Our findings may facilitate early diagnosis and timely interventions, including tailored rehabilitation and fall prevention strategies, by leveraging the item difficulty and characteristics of the FGA for iNPH patients.
OBJECTIVES: This study aimed to validate the Functional Gait Assessment (FGA) item-difficulty hierarchy, determine its optimal fall cutoff value, and identify key items for assessing fall risk in iNPH.
METHODS: One hundred eighty-eight iNPH patients underwent pre-intervention assessments using the FGA, timed up-and-go (TUG), 10-Meter Gait Speed (10MGS) tests, and their falls history in the past 6 months. Rasch analysis confirmed the validity of the FGA item-difficulty hierarchy and established the relationship between total scores and logit estimates. Logistic regression identified the optimal FGA cutoff value and key fall-related items.
RESULTS: The FGA's item-difficulty hierarchy was confirmed to range from item 5 ("gait and pivot turn") at -2.58 logits (easiest) to item 7 ("gait with narrow base of support") at 5.35 logits (most difficult). Total scores corresponded to logits from -10.39 (score 0) to 11.64 (score 30). The fall rate was 63.3%. The optimal FGA cutoff value was ≤15 points (area under curve [AUC]: 0.901, P < 0.001), outperforming TUG (AUC: 0.712) and 10MGS (AUC: 0.742). Key fall-related items (R2: 0.545, P < 0.001) were item 2 ("change in gait speed"), item 7 ("gait with narrow base of support"), item 1 ("gait on level surface"), item 10 ("stair steps"), and item 5 ("gait and pivot turn").
CONCLUSIONS: Our findings may facilitate early diagnosis and timely interventions, including tailored rehabilitation and fall prevention strategies, by leveraging the item difficulty and characteristics of the FGA for iNPH patients.