A. Forsberg, PhD, RPT, Family Medicine Research Centre, Örebro County Council, PO Box 16 13, 701 16 Örebro, Sweden, and School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
Phys Ther. 2013 Oct;93(10):1369-76. doi: 10.2522/ptj.20120284. Epub 2013 May 2.
Evaluation of walking capacity and risk of falls in people with multiple sclerosis often are performed in rehabilitation. The Dynamic Gait Index (DGI) evaluates walking during different tasks, but the feasibility in identifying people at risk for falls needs to be further investigated.
The objective of this study was to investigate (1) the construct validity (known groups, convergent, and discriminant) of the DGI and (2) the accuracy of predicting falls and establishing a cutoff point to identify fallers.
This trial was a multicenter, cross-sectional study.
A convenience sample was composed of 81 people with multiple sclerosis with subjective gait and balance impairment who were able to walk 100 m (comparable to Expanded Disability Status Scale 1-6). Mean age of the participants was 49 years; 76% were women. The 25-Foot Timed Walk Test, Timed "Up & Go" Test, Four Square Step Test, Timed Sit-to-Stand Test, MS Walking Scale, Multiple Sclerosis Impact Scale, and self-reported falls during the previous 2 months were used for validation, to establish cutoff points for identifying fallers, and to investigate predictive values.
Significantly lower DGI scores (P≤.001) were found for participants reporting falls (n=31). High sensitivity (87%) in identifying fallers was found, with a cutoff score ≤19. The positive predictive value was 50%, and the negative predictive value was 87%. The positive likelihood ratio was 1.77, and the negative likelihood ratio was 0.26. The convergent validity was moderate to strong (ρ=0.58-0.80), with the highest correlation coefficient found for the 25-Foot Timed Walk Test. Discriminant validity was shown with low correlation for the psychological subscale of the Multiple Sclerosis Impact Scale.
The sample included ambulatory people participating in a randomized controlled trial investigating balance training.
The DGI is a valid measure of dynamic balance during walking for ambulatory people with multiple sclerosis. With the cutoff point of ≤19, sensitivity was high in identifying people at risk of falls.
评估多发性硬化症患者的步行能力和跌倒风险通常在康复中进行。动态步态指数（DGI）评估不同任务下的行走能力，但需要进一步研究其识别跌倒风险的能力。
本研究旨在调查（1）DGI 的结构效度（已知组、收敛和判别），（2）预测跌倒的准确性并确定识别跌倒者的截止点。
这是一项多中心、横断面研究。
采用方便抽样法，纳入 81 名有主观步态和平衡障碍且能行走 100 米（相当于扩展残疾状况量表 1-6）的多发性硬化症患者。参与者的平均年龄为 49 岁，76%为女性。使用 25 英尺计时步行测试、计时“起身和行走”测试、四方步测试、计时坐立测试、多发性硬化症步行量表、多发性硬化症影响量表以及前 2 个月的自我报告跌倒情况进行验证，以确定识别跌倒者的截止点，并调查预测值。
报告跌倒的参与者 DGI 评分明显较低（P≤0.001）。识别跌倒者的敏感性较高（87%），截定点为≤19。阳性预测值为 50%，阴性预测值为 87%。阳性似然比为 1.77，阴性似然比为 0.26。收敛效度为中度至高度（ρ=0.58-0.80），与 25 英尺计时步行测试的相关系数最高。判别效度显示，多发性硬化症影响量表的心理分量表相关性较低。
该样本包括参加平衡训练随机对照试验的活动能力参与者。
DGI 是评估多发性硬化症活动能力患者动态步行平衡的有效工具。使用≤19 的截止点，识别跌倒风险的敏感性较高。
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