Highlights
- •Persons with vestibular disorders have impaired spatial navigation.
- •The gait disorientation test (GDT) is a reliable and valid screening test in adults.
- •Results for the GDT discriminate healthy from vestibular-impaired adults.
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
List of abbreviations:
95% CI (95% confidence interval), ABCS (Activities-specific Balance Confidence Scale), AUC (area under the curve), COMP (composite score), DHI (Dizziness Handicap Inventory), DOR (diagnostic odds ratio), DVAT (dynamic visual acuity test), FGA (Functional Gait Assessment), FGA1 (Functional Gait Assessment, item 1), FGA8 (Functional Gait Assessment, item 8), FTSTST (Five-times Sit-to-stand Test), GDT (Gait Disorientation Test), hDVAT (horizontal dynamic visual acuity test), hHIT (horizontal head impulse test), HSN (head shaking nystagmus), LR (likelihood ratio), LR+ (likelihood ratio for a positive test), LR− (likelihood ratio for a negative test), MDC (minimal detectable change), RC (rotational chair), ROC (receiver operator characteristic), SOM (somatosensory score), SOT (Sensory Organization Test), vDVAT (vertical dynamic visual acuity test), VNG (videonystagmography)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 15, 2020
Footnotes
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.
Disclosures: Colin R. Grove is a consultant for Wicab, Inc. Susan L. Whitney is a paid speaker for Interacoustics and Medbridge and a consultant for IAI, Inc. Bryan C. Heiderscheit has an ownership interest in NxtMile, LLC, as well as Science of Running Medicine, LLC, and is a consultant for Altec, Inc and Mountain Land Rehabilitation. The other authors have nothing to disclose.
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© 2020 by the American Congress of Rehabilitation Medicine
