Journal of Neurologic Physical Therapy:
CSM ABSTRACTS: Platforms, Thematic Posters, & Posters for CSM 2006: PLATFORMS: Parkinson Disease Saturday 1: 30-3: 30
Kegelmeyer, D.1; Kloos, A. D.1; Kostyk, S. K.2; Thomas, K. M.2
1Physical Therapy, The Ohio State University, Columbus, OH, 2Movement Disorders Division, The Ohio State University, Columbus, OH.
Purpose/Hypothesis: Individuals with Parkinson disease (PD) develop progressive gait and balance problems that often result in falls. The Tinetti Mobility Test (TMT) is a clinical balance and gait test that predicts fall risk in elderly individuals. The aims of this study were to determine the inter-rater (Part 1) and intrarater (Part 2) reliability of TMT scores of individuals with PD, the construct validity of the TMT as a measure of balance and gait impairment severity (Part 3), and the predictive validity of the Tinetti Mobility Test as a screening tool to identify individuals with PD at risk for falls (Part 4).
Number of Subjects: Thirty individuals with a diagnosis of PD (mean age=65.47 ± 11.17;male/female ratio=23/7; mean Hahn and Yahr score =2.41 ± .39) who attended the Madden/NPF Center of Excellence (Columbus, Ohio) were recruited to voluntarily participate in all portions of this study. Inclusion criteria were Hoehn and Yahr stages I-III or early stage IV, and ability to independently ambulate with or without the use of an assistive device. Subjects who had any other neurological diagnosis or paralysis from another condition were excluded.
Materials/Methods: Two physical therapists and 3 physical therapy students rated subjects live performances of the TMT (Part 1). During the gait portion of the test, time for each subject to ambulate 25 feet was recorded. Two physical therapists and 4 physical therapy students rated subjects videotaped performances of the TMT on two separate days one week apart (Part 2). One of two physicians administered the Unified Parkinson Disease Rating Scale Motor Exam (Section III) and scores obtained were correlated with the TMT scores (Part 3).A falls history was obtained for each subject and the discriminative power of the TMT to predict fallers was assessed using statistical tests (Part 4). Data were analyzed using intraclass correlation coefficients (Parts 1&2), Spearman correlation coefficients (Part 3), and statistical tests of sensitivity, specificity, positive and negative predictive values (Part 4).
Results: Interrater reliability of total TMT scores was good to excellent between all raters (ICC=.87), physical therapist raters (ICC=.84), student raters (ICC=.88), and between physical therapist and student raters (ICC range=.82-.94). Preliminary results showed moderate to excellent intrarater reliability of total scores for two raters (ICCs=.99 and .67). Mean total TMT scores were moderately correlated with UPDRS motor exam scores (Spearman correlation=−.45) and comfortable gait speed (Spearman correlation =.53), but did not predict falls (sensitivity=13% and speci-ficity=86% at cutoff score of 19).
Conclusions: Our findings suggest that the TMT is a reliable and valid measure of balance performance during functional activities in individuals with PD. Analysis is in progress to determine if individual test items are predictive of falls.
Clinical Relevance: To identify individuals with PD at risk of falling, physical therapists need valid and reliable examination tools that objectively measure functional mobility and balance in PD.