Colin R Grove1, Bryan C Heiderscheit2, G Mark Pyle3, Brian J Loyd4, Susan L Whitney5. 1. School of Medicine and Public Health, Department of Surgery, University of Wisconsin-Madison, Madison, WI; Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI. Electronic address: crgrove@wisc.edu. 2. Institute for Clinical and Translational Research, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI; Department of Orthopedics and Rehabilitation, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI. 3. School of Medicine and Public Health, Department of Surgery, University of Wisconsin-Madison, Madison, WI. 4. Department of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, MT; Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT. 5. Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
Abstract
OBJECTIVE: To develop and evaluate a new method for identifying gait disorientation due to vestibular dysfunction. DESIGN: The gait disorientation test (GDT) involves a timed comparison of the ability to walk 6.096 m with eyes open versus eyes closed. In this prospective study, participants were grouped based on vestibular function. All participants completed a clinical examination, self-report- and performance-based measures relevant to vestibular rehabilitation, and the tasks for the GDT. Vestibular-impaired participants underwent the criterion standard, videonystagmography and/or rotational chair testing. SETTING: Ambulatory clinic, tertiary referral center. PARTICIPANTS: Participants (N=40) (20 vestibular-impaired, 30 women, 49.9±16.1years old) were enrolled from a convenience/referral sample of 52 adults. MAIN OUTCOME AND MEASURE(S): We determined test-retest reliability using the intraclass correlation coefficient model 3,1; calculated the minimal detectable change (MDC); examined concurrent validity through Spearman correlation coefficients; assessed criterion validity with the area under the curve (AUC) from receiver operator characteristic analysis; and computed the sensitivity, specificity, diagnostic odds ratio (DOR), likelihood ratios for positive (LR+) and negative (LR-) tests, and posttest probabilities of a diagnosis of vestibulopathy. The 95% confidence interval demonstrates measurement uncertainty. RESULTS: Test-retest reliability was 0.887 (0.815, 0.932). The MDC was 3.7 seconds. Correlations with other measures ranged from 0.59 (0.34, 0.76) to -0.85 (-0.92, -0.74). The AUC was 0.910 (0.822, 0.998), using a threshold of 4.5 seconds. The sensitivity and specificity were 0.75 (0.51, 0.91) and 0.95 (0.75, 1), respectively. The DOR=57 (6, 541.47), LR+ =15 (2.18, 103.0), and LR- =0.26 (0.12, 0.9). Positive posttest probabilities were 89%-94%. CONCLUSIONS AND RELEVANCE: The GDT has good reliability, excellent discriminative ability, strong convergent validity, and promising clinical utility.
OBJECTIVE: To develop and evaluate a new method for identifying gait disorientation due to vestibular dysfunction. DESIGN: The gait disorientation test (GDT) involves a timed comparison of the ability to walk 6.096 m with eyes open versus eyes closed. In this prospective study, participants were grouped based on vestibular function. All participants completed a clinical examination, self-report- and performance-based measures relevant to vestibular rehabilitation, and the tasks for the GDT. Vestibular-impaired participants underwent the criterion standard, videonystagmography and/or rotational chair testing. SETTING: Ambulatory clinic, tertiary referral center. PARTICIPANTS: Participants (N=40) (20 vestibular-impaired, 30 women, 49.9±16.1years old) were enrolled from a convenience/referral sample of 52 adults. MAIN OUTCOME AND MEASURE(S): We determined test-retest reliability using the intraclass correlation coefficient model 3,1; calculated the minimal detectable change (MDC); examined concurrent validity through Spearman correlation coefficients; assessed criterion validity with the area under the curve (AUC) from receiver operator characteristic analysis; and computed the sensitivity, specificity, diagnostic odds ratio (DOR), likelihood ratios for positive (LR+) and negative (LR-) tests, and posttest probabilities of a diagnosis of vestibulopathy. The 95% confidence interval demonstrates measurement uncertainty. RESULTS: Test-retest reliability was 0.887 (0.815, 0.932). The MDC was 3.7 seconds. Correlations with other measures ranged from 0.59 (0.34, 0.76) to -0.85 (-0.92, -0.74). The AUC was 0.910 (0.822, 0.998), using a threshold of 4.5 seconds. The sensitivity and specificity were 0.75 (0.51, 0.91) and 0.95 (0.75, 1), respectively. The DOR=57 (6, 541.47), LR+ =15 (2.18, 103.0), and LR- =0.26 (0.12, 0.9). Positive posttest probabilities were 89%-94%. CONCLUSIONS AND RELEVANCE: The GDT has good reliability, excellent discriminative ability, strong convergent validity, and promising clinical utility.
Authors: Thomas Brandt; Franz Schautzer; Derek A Hamilton; Roland Brüning; Hans J Markowitsch; Roger Kalla; Cynthia Darlington; Paul Smith; Michael Strupp Journal: Brain Date: 2005-09-01 Impact factor: 13.501
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