The Gait Disorientation Test: A New Method for Screening Adults With Dizziness and Imbalance

Colin R. Grove, Bryan C. Heiderscheit, G. Mark Pyle, Brian J. Loyd, Susan L. Whitney

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish
Pages (from-to)582-590
Number of pages9
JournalArchives of Physical Medicine and Rehabilitation
Volume102
Issue number4
DOIs
StatePublished - Apr 2021

Keywords

  • Bilateral vestibulopathy
  • Rehabilitation
  • Sensitivity and specificity
  • Spatial navigation
  • Vestibular diseases

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