Beninato Marianne, Ludlow Larry H
M. Beninato, PT, DPT, PhD, Department of Physical Therapy, MGH Institute of Health Professions, 36 1st Ave, Boston, MA 02129 (USA).
L.H. Ludlow, PhD, Department of Educational Research, Measurement and Evaluation, Lynch School of Education, Boston College, Chestnut Hill, Massachusetts.
Phys Ther. 2016 Apr;96(4):456-68. doi: 10.2522/ptj.20150167. Epub 2015 Sep 3.
The 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.
The 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.
A retrospective chart review was conducted.
Functional Gait Assessment scores from 179 older adults referred for physical therapy for balance retraining were analyzed by Rasch modeling.
The 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.
The sample was limited to older adults who were community dwelling and independently ambulating. Findings cannot be generalized to other patient groups.
The 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.
功能性步态评估（FGA）是一种步行平衡能力的测量方法，旨在消除动态步态指数（DGI）中观察到的天花板效应。在原来的8项DGI任务中增加了3项可能更具难度的任务，并删除了1项较简单的任务。此前尚未分析这些修改对项目层次结构的影响。
本研究的目的是确定：（1）10项FGA任务的排序以及它们在临床逻辑难度连续体上的映射程度；（2）任务的分布范围是否足以测量不同功能能力水平的患者而无天花板效应；（3）新增的3项任务在任务难度连续体上的位置；（4）各个FGA任务的心理测量特性。
进行了一项回顾性图表审查。
通过Rasch模型分析了179名因平衡再训练而接受物理治疗的老年人的功能性步态评估分数。
FGA任务层次符合临床预期，但“在平地上行走”任务除外，该任务位于难度连续体的中间位置。没有天花板效应。新增的3项任务中有2项是最难的FGA任务。最难任务（“窄支撑面步态”）的表现比Rasch模型预测的更具变异性。
样本仅限于社区居住且能够独立行走的老年人。研究结果不能推广到其他患者群体。
FGA修订后的评分标准可能影响了项目层次结构。结果表明，FGA是一种临床上适用于测量老年人步行平衡能力且具有结构效度的方法。FGA的实施方式可能需要进一步改进以提高实施效率。
