Time to Navigate: A Practical Objective Clinical Measure for Freezing of Gait Severity in People With Parkinson Disease

Aileen Eugenia Scully; Dawn May Leng Tan; Beatriz Ito Ramos de Oliveira; Keith David Hill; Ross Clark; Yong Hao Pua

doi:10.1016/j.apmr.2024.09.003

Time to Navigate: A Practical Objective Clinical Measure for Freezing of Gait Severity in People With Parkinson Disease

Arch Phys Med Rehabil. 2024 Sep 18:S0003-9993(24)01234-6. doi: 10.1016/j.apmr.2024.09.003. Online ahead of print.

Authors

Aileen Eugenia Scully¹, Dawn May Leng Tan², Beatriz Ito Ramos de Oliveira³, Keith David Hill⁴, Ross Clark⁵, Yong Hao Pua⁶

Affiliations

¹ Health and Social Sciences, Singapore Institute of Technology, Singapore. Electronic address: aileen.scully@singaporetech.edu.sg.
² Health and Social Sciences, Singapore Institute of Technology, Singapore; Department of Physiotherapy, Singapore General Hospital, Singapore.
³ Curtin School of Allied Health, Curtin University, Western Australia, Australia.
⁴ Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Melbourne, Australia.
⁵ School of Health, University of the Sunshine Coast, Sunshine Coast, Australia.
⁶ Department of Physiotherapy, Singapore General Hospital, Singapore; Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore.

PMID: 39304078
DOI: 10.1016/j.apmr.2024.09.003

Abstract

Objectives: To provide an easy-to-use measure, as existing objective assessments for freezing of gait (FOG) severity may be unwieldy for routine clinical practice, this study explored time taken to complete the recently validated FOG severity tool and its components.

Design: A cross-sectional study.

Setting: Outpatient clinics of a tertiary hospital.

Participants: People with Parkinson disease who could independently ambulate 8-meters, understand instructions, and without co-morbidities affecting gait were consecutively recruited. Thirty-five participants were included (82.9% [n=29] male; median [IQR]: age of 73.0 [11.0] years and disease duration of 4.0 [4.5] years).

Interventions: Not applicable.

Main outcome measures: Participants were assessed with the FOG severity tool in a test-retest design, with time taken for each component recorded using a stopwatch during video-analysis. Validity of total FOG severity tool time, time taken to complete its turning and narrow-space components (i.e., time to navigate [TTN]), and an adjusted TTN were examined through correlations with validated FOG severity outcomes. To facilitate clinical interpretation, the TTN cut-off was determined using scatterplot smoothing regression, whereas minimal important change was calculated using predictive modeling.

Results: The FOG severity tool time, TTN, and adjusted TTN similarly demonstrated moderate correlations with the FOG questionnaire and percentage-FOG, and very high correlations with FOG severity tool-revised. The TTN was nonlinearly related to FOG severity, with a positive relationship observed in the first 300 seconds and plateauing after. minimal important change for TTN was 15.4 seconds reduction in timing (95% CI, 3.2-28.7).

Conclusions: The TTN is a feasible, interpretable, and valid test of FOG severity. In busy clinical settings, TTN can provide a viable alternative when use of existing objective FOG measures is (often) unfeasible.

Keywords: Clinical assessment; Freezing of gait; Objective measure; Parkinson disease.