Scully Aileen E, Tan Dawn, Oliveira Beatriz Ito Ramos de, Hill Keith D, Clark Ross, Pua Yong Hao
School of Physiotherapy and Exercise Science, Curtin University, Bentley, Western Australia, Australia.
Health and Social Sciences, Singapore Institute of Technology, Singapore, Singapore.
Physiother Res Int. 2023 Oct;28(4):e2016. doi: 10.1002/pri.2016. Epub 2023 May 18.
To improve existing clinical assessments for freezing of gait (FOG) severity, a new clinician-rated tool which integrates the varied types of freezing (FOG Severity Tool-Revised) was developed. This cross-sectional study investigated its validity and reliability.
People with Parkinson's disease who were able to independently ambulate eight-metres and understand study instructions were consecutively recruited from outpatient clinics of a tertiary hospital. Those with co-morbidities severely affecting gait were excluded. Participants were assessed with the FOG Severity Tool-Revised, three functional performance tests, the FOG Questionnaire, and outcomes measuring anxiety, cognition, and disability. The FOG Severity Tool-Revised was repeated for test-retest reliability. Exploratory factor analysis and Cronbach's alpha were computed for structural validity and internal consistency. Reliability and measurement error were estimated with ICC (two-way, random), standard error of measurement, and smallest detectable change (SDC ). Criterion-related and construct validity were calculated with Spearman's correlations.
Thirty-nine participants were enrolled [79.5% (n = 31) male; Median (IQR): age-73.0 (9.0) years; disease duration-4.0 (5.8) years], with fifteen (38.5%) who reported no medication state change contributing a second assessment for reliability estimation. The FOG Severity Tool-Revised demonstrated sufficient structural validity and internal consistency (α = 0.89-0.93), and adequate criterion-related validity compared to the FOG Questionnaire (ρ = 0.73, 95% CI 0.54-0.85). Test-retest reliability (ICC = 0.96, 95%CI 0.86-0.99) and random measurement error (%SDC = 10.4%) was acceptable in this limited sample.
The FOG Severity Tool-Revised appeared valid in this initial sample of people with Parkinson's. While its psychometric properties remain to be confirmed in a larger sample, it may be considered for use in the clinical setting.
为改进现有的步态冻结（FOG）严重程度临床评估方法，开发了一种整合多种冻结类型的新型临床医生评定工具（FOG严重程度工具修订版）。本横断面研究调查了其有效性和可靠性。
从一家三级医院的门诊连续招募能够独立行走8米且理解研究指示的帕金森病患者。排除有严重影响步态的合并症患者。使用FOG严重程度工具修订版、三项功能性能测试、FOG问卷以及测量焦虑、认知和残疾的指标对参与者进行评估。重复使用FOG严重程度工具修订版以评估重测信度。计算探索性因子分析和克朗巴哈系数以评估结构效度和内部一致性。使用组内相关系数（双向随机）、测量标准误和最小可检测变化（SDC）估计信度和测量误差。使用斯皮尔曼相关性计算与标准相关的效度和结构效度。
共纳入39名参与者[79.5%（n = 31）为男性；中位数（四分位间距）：年龄73.0（9.0）岁；病程4.0（5.8）年]，其中15名（38.5%）报告药物状态无变化的参与者为评估信度提供了第二次评估。FOG严重程度工具修订版显示出足够的结构效度和内部一致性（α = 0.89 - 0.93），与FOG问卷相比，具有足够的与标准相关的效度（ρ = 0.73，95%可信区间0.54 - 0.85）。在这个有限的样本中，重测信度（组内相关系数 = 0.96，95%可信区间0.86 - 0.99）和随机测量误差（%SDC = 10.4%）是可以接受的。
FOG严重程度工具修订版在这个帕金森病患者的初始样本中似乎是有效的。虽然其心理测量特性仍有待在更大样本中得到证实，但可考虑在临床环境中使用。
