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

doi:10.1016/j.apmr.2020.11.010

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

School of Physical Therapy and Rehabilitation Science

Research output: Contribution to journal › Article › peer-review

11 Scopus citations

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 language	English
Pages (from-to)	582-590
Number of pages	9
Journal	Archives of Physical Medicine and Rehabilitation
Volume	102
Issue number	4
DOIs	https://doi.org/10.1016/j.apmr.2020.11.010
State	Published - Apr 2021

Funding

Supported by the Clinical and Translational Science Award program, through the NIH National Center for Advancing Translational Sciences (grant nos. UL1TR000427 and TL1TR002375 ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Additional funding for Colin R. Grove was provided by the University of Wisconsin through a research assistantship in the Department of Surgery and a research grant from the Department of Orthopedics and Rehabilitation. Brian J. Loyd received funding from the Foundation for Physical Therapy Research: New Investigator Fellowship Training Initiative and US Army Advanced Medical Technology Initiative. These funding sources were not involved in the study design, data collection, data analysis and interpretation, the writing of this article, or the decision to submit this article for publication. Supported by the Clinical and Translational Science Award program, through the NIH National Center for Advancing Translational Sciences (grant nos. UL1TR000427 and TL1TR002375). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Additional funding for Colin R. Grove was provided by the University of Wisconsin through a research assistantship in the Department of Surgery and a research grant from the Department of Orthopedics and Rehabilitation. Brian J. Loyd received funding from the Foundation for Physical Therapy Research: New Investigator Fellowship Training Initiative and US Army Advanced Medical Technology Initiative. These funding sources were not involved in the study design, data collection, data analysis and interpretation, the writing of this article, or the decision to submit this article for publication.

Funders	Funder number
University of Wisconsin-Madison
TL1TR002375, UL1TR000427
University of Wisconsin-Madison

Keywords

Bilateral vestibulopathy
Rehabilitation
Sensitivity and specificity
Spatial navigation
Vestibular diseases

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10.1016/j.apmr.2020.11.010

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@article{d64c7fa7af4c474ba4e481d975c6f907,

title = "The Gait Disorientation Test: A New Method for Screening Adults With Dizziness and Imbalance",

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.",

keywords = "Bilateral vestibulopathy, Rehabilitation, Sensitivity and specificity, Spatial navigation, Vestibular diseases",

author = "Grove, \{Colin R.\} and Heiderscheit, \{Bryan C.\} and Pyle, \{G. Mark\} and Loyd, \{Brian J.\} and Whitney, \{Susan L.\}",

note = "Publisher Copyright: {\textcopyright} 2020 American Congress of Rehabilitation Medicine",

year = "2021",

month = apr,

doi = "10.1016/j.apmr.2020.11.010",

language = "English",

volume = "102",

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AU - Grove, Colin R.

AU - Heiderscheit, Bryan C.

AU - Pyle, G. Mark

AU - Loyd, Brian J.

AU - Whitney, Susan L.

PY - 2021/4

Y1 - 2021/4

N2 - 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.

AB - 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.

KW - Bilateral vestibulopathy

KW - Rehabilitation

KW - Sensitivity and specificity

KW - Spatial navigation

KW - Vestibular diseases

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JO - Archives of Physical Medicine and Rehabilitation

JF - Archives of Physical Medicine and Rehabilitation

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

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