Scoring festination and gait freezing in people with Parkinson's: The freezing of gait severity tool-revised

Abstract

Background and Purpose: 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. Methods: 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 (SDC95). Criterion-related and construct validity were calculated with Spearman's correlations. Results: 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 (%SDC95 = 10.4%) was acceptable in this limited sample. Discussion and Conclusions: 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.