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RehabMeasures Instrument

Dynamic Gait Index

Last Updated

Purpose

The DGI assesses individual’s ability to modify balance while walking in the presence of external demands.

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Instrument Details

Acronym DGI

Area of Assessment

Balance – Vestibular
Balance – Non-vestibular
Functional Mobility
Gait

Assessment Type

Observer

Administration Mode

Paper & Pencil

Cost

Free

Diagnosis/Conditions

  • Multiple Sclerosis
  • Parkinson's Disease + Neurologic Rehabilitation
  • Stroke Recovery
  • Vestibular Disorders

Key Descriptions

  • The DGI can be performed with a marked distance of 20 feet, and it can be performed with or without an assistive device.
  • Scores are based on a 4-point scale:
    3) No gait dysfunction
    2) Minimal impairment
    1) Moderate impairment
    0) Severe impairment
  • Highest possible score is 24 points, and tasks include:
    1) Steady state walking
    2) Walking with changing speeds
    3) Walking with head turns both horizontally and vertically
    4) Walking while stepping over and around obstacles
    5) Pivoting while walking
    6) Stair climbing

Number of Items

8

Equipment Required

  • Shoe box
  • Two obstacles (must be same size)
  • Stairs
  • 20 foot (6.1 meter) pathway

Time to Administer

Less than 10 minutes

May vary with patient's abilities

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Jason Raad, MS in 2010; Updated with references for the PD, chronic stroke, vestibular, and brain injury populations by Ali Garmisa, SPT and Melanie Goldstick, SPT in 2011; Updated by Candy Tefertiller PT, DPT, ATP, NCS, Jennifer Kahn PT, DPT, NCS and the SCI EDGE task force of the Neurology section of the APTA in 2012; Updated with references from the TBI population by Katie Hays, PT, DPT and the TBI EDGE task force of the Neurology Section of the APTA in 2012; updated by Cathy Harro PT, MS, NCS and PD EDGE task force of the Neurology Section, APTA. Reviewed and updated by Diane Wrisley, PT, PhD, NCS and Elizabeth Dannenbaum, MScPT for Vestibular EDGE task force of the Neurology section of the APTA in 2013.

ICF Domain

Activity

Measurement Domain

Motor

Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:  http://www.neuropt.org/go/healthcare-professionals/neurology-section-outcome-measures-recommendations

Abbreviations:

 

HR

Highly Recommend

R

Recommend

LS / UR

Reasonable to use, but limited study in target group  / Unable to Recommend

NR

Not Recommended


Recommendations for use based on acuity level of the patient:

 

Acute

(CVA < 2 months post)

(SCI < 1 month post) 

(Vestibular < 6 weeks post)

Subacute

(CVA 2 to 6 months)

(SCI 3 to 6 months)

Chronic

(> 6 months)

(Vestibular > 6 weeks post)

SCI EDGE

LS

LS

LS

StrokEDGE

HR

HR

HR

Vestibular EDGE

HR

 

HR

Recommendations Based on Parkinson Disease Hoehn and Yahr stage:

 

I

II

III

IV

V

PD EDGE

HR

HR

HR

HR

NR

Recommendations based on level of care in which the assessment is taken:

 

Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility

Outpatient

Rehabilitation

Home Health

MS EDGE

R

R

R

R

R

StrokEDGE

HR

HR

HR

HR

HR

TBI EDGE

LS

LS

LS

LS

LS

Recommendations based on SCI AIS Classification:

 

AIS A/B

AIS C/D

SCI EDGE

LS

LS

Recommendations for use based on ambulatory status after brain injury:

 

Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant

TBI EDGE

LS

LS

LS

NR

 

Recommendations based on EDSS Classification:

 

EDSS 0.0 – 3.5

EDSS 4.0 – 5.5

EDSS 6.0 – 7.5

EDSS 8.0 – 9.5

MS EDGE

R

R

NR

NR

Recommendations based on vestibular diagnosis

 

Peripheral

Central

Benign Paroxysmal Positional Vertigo (BPPV)

Other

Vestibular EDGE

HR

HR

LS

LS

Recommendations for entry-level physical therapy education and use in research:

 

Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)

MS EDGE

Yes

Yes

Yes

No

PD EDGE

No

No

Yes

Not reported

SCI EDGE

No

Yes

No

Not reported

StrokEDGE

Yes

Yes

Yes

Not reported

TBI EDGE

Yes

Yes

No

Not reported

Vestibular EDGE

Yes

Yes

Yes

Yes

Considerations

  • Although psychometrics have not been evaluated in SCI population, this measure has been used to assess dynamic balance in 2 SCI studies (Fritz et al, 2011 & Day et al, 2012)

  • FGA shows less ceiling effect and is recommended over DGI is stroke population (Lin et al, 2010)

  • The DGI has a ceiling effect in people with vestibular dysfunction. (Wrisley 2003)

Dynamic Gait Index translations:

Arabic: The Arabic version of the DGI can be requested for free from alia.alghwiri@gmail.com

These translations, and links to them, are subject to the Terms and Conditions of Use of the Rehab Measures Database. RIC is not responsible for and does not endorse the content, products or services of any third-party website, and does not make any representations regarding its quality, content or accuracy. If you would like to contribute a language translation to the RMD, please contact us at rehabmeasures@ric.org.

Do you see an error or have a suggestion for this instrument summary? Please e-mail us!

Older Adults and Geriatric Care

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Standard Error of Measurement (SEM)

Community Dwelling Elderly:

(Romero et al 2011; n = 42; mean age = 75.6 (range 59-88) years, Community Dwelling Elderly) 

  • SEM = 1.04 points

Minimal Detectable Change (MDC)

Community Dwelling Elderly: 

(Romero et al, 2011, Community Dwelling Elderly) 

  • MDC = 2.9 points

Minimally Clinically Important Difference (MCID)

Community-dwelling Older adults:

(Pardasaney et al, 2012; = 111 aged 65 or older; mean age 75.9 + 7 years, 68.5% female)

  • 1.90 points for total sample

  • 1.80 for subjects with DGI scores < 21/24

  • 0.60 for subjects with DGI scores > 21/24

Cut-Off Scores

Community Dwelling Elderly:=

(Shumway-Cook et al,1997; n = 44; age > 65, Community Dwelling Elderly)

  • < 19 indicative of increased fall risks (Sensitivity 59%, Specificity 64%) 

 

Community-Dwelling Older Adults:

(Wrisley and Kumar, 2010; = 35, mean age 72.9 + 7.8 years followed for prospective falls)

  • < 19 indicates increased risk of falls (Sensitivity 67%, specificity 86%)

Interrater/Intrarater Reliability

Community Dwelling Older Adults with Baseline Impairment:

(Jønsson et al, 2011; n = 24 (Hospital), mean age = 79.4 (6.8) years; n = 26 (outpatient rehabilitation), mean age = 76.8 (6.4) years; assessed at a 1.5 hour interval, rated by 3 PT's at each site; Danish language sample, Community Dwelling Older Adults)

Hospital:

  • Excellent intrarater reliability (ICC = 0.90)
  • Excellent interrater reliability (ICC = 0.92)

Outpatient Rehabilitation:

  • Excellent intrarater reliability (ICC = 0.89)
  • Excellent interrater reliability (ICC = 0.82)

Criterion Validity (Predictive/Concurrent)

Community Dwelling Older Adults: 

(Shumway-Cook et al, 1997; n = 44; aged 65 to 94 years, Community Dwelling Older Adults)

  • Excellent, Balance Self-Perceptions Test and DGI (r = 0.76)
  • Excellent, Berg Balance Scale and DGI (r = 0.67)
  • Adequate, Assistive Devices History and DGI (r = -0.44)
  • Adequate, History of imbalance and DGI (r = -0.46)

Content Validity

Community-dwelling male veterans:

(Chiu et al, 2006; n = 84, 64-88 years, mean age 75 + 6.47 years)

  • Eash original 4 rating scale categories distinctly identified subjects at different ability levels
  • Clear difficulty hierarchical order
  • 8 items on the DGI appear to represent a single construct

Floor/Ceiling Effects

Community-dwelling older adults: 

(Pardasaney et al, 2012)

  • No floor effect

  • Poor ceiling effect

    • 40% at maximum score at baseline

    • 70% at maximum score after intervention

Responsiveness

Community-dwelling older adults:

(Pardasaney et al, 2012)

  • Poor responsiveness

    • Effect size 0.27

    • Standardized response mean 0.45

    • Only people in the lower balance subgroups demonstrated change scores > MCID

Stroke

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Standard Error of Measurement (SEM)

Stroke:

(Jonsdottir & Cattaneo, 2007, n = 25; mean age = 61.6 (13.1) years; mean time since stroke = 4.2 (7.5) years, range 0.5-35.3 years; Italian sample, Chronic Stroke)

  • SEM for inter-rater reliability = 0.97 points 
  • SEM for interrater reliability = 0.94 points

Minimal Detectable Change (MDC)

Chronic Stroke:

(calculated from Jonsdottir and Cattaneo, 2007)

  • MDC (calculated from SEM) = 2.6 points
 

Stroke:

(Lin et al, 2010; n = 45; mean age = 60.7 (12.2) years; median time since stroke = 9 months (range 3 to 36 months); Taiwanese sample, Stroke) 

  • MDC = 4 points 
  • Percent change = 16.6%

Normative Data

Stroke:

(Lin et al, 2010, Acute and Chronic Stroke)

Median Scores for DGI:

 

 

 

 

1 week

2 months

5 months

Median score

Median score

Median score

Median score

13

13

13

13

 

(Hwang et al, 2010; = 11; mean age = 48.09 (5.85) years; mean time post stroke = 24.36 (10.84) months, Chronic Hemiparetic Stroke)

Mean DGI Score:

 

 

 

Mean

SD

Pretest

10.64

2.01

Posttest

11.64

3.36

Test/Retest Reliability

Stroke:

(Lin et al, 2010; tested in separate sample of 48 patients with chronic stroke; mean age = 54.9 (10.2) years, Acute and Chronic Stroke)

  • Excellent test-retest reliability (ICC > 0.94; 0.91-0.97)

(Jonsdottir & Cattaneo, 2007; n = 25 mean age = 61.6 (13.1) years, Chronic Stroke)

  • Excellent total score test re-test reliability (ICC = 0.96)
    • Individual items varied from 0.56 (gait and pivot turns) to 1.00 (stair climbing)

Interrater/Intrarater Reliability

Stroke:

(Jonsdottir & Cattaneo, 2007, Chronic Stroke)

  • Excellent interrater reliability (ICC = 0.96)

Criterion Validity (Predictive/Concurrent)

Stroke:

(Jonsdottir and Cattaneo, 2007, Chronic Stroke)

  • Excellent concurrent validity with Berg Balance Scale (r = 0.83)
  • Excellent concurrent validity with the ABC (r = 0.68)

(Lin et al, 2010, Acute and Chronic Stroke)

  • Excellent concurrent validity amongst DGI, 4 itme DGI, and FGA (r > 0.91)

Construct Validity

Acute and Chronic Stroke:

(Lin et al, 2010) 

  • Excellent with the 10 meter walk (r = -0.68, -0.87, -0.83) test and Postural Assessment Scale (= 0.85, 0.76, 0.83) for Stroke at 1st week of PT, 2 months after PT, and 5 months after PT

Floor/Ceiling Effects

Stroke:

(Lin et al, 2010, Acute and Chronic Stroke)

  • Excellent indicates minimal floor effects

  • Adequate indicates relatively little ceiling effects

Floor and Ceiling Effects:

 

 

Time Point

Floor Effect %

 Ceiling Effect %

1st week of  PT

2.2

4.4

2 months after PT

0

10.3

5 months after PT

0

11.4

Responsiveness

Stroke:

(Lin et al, 2010, Acute and Chronic Stroke) 

  • Moderate responsiveness in depicting change at 2 months and 5 months after therapy (effect size 0.56, 0.62 respectively)

Parkinson's Disease

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Minimal Detectable Change (MDC)

Parkinson’s Disease:

(Huang et al, 2011, n = 72; mean age = 67.5 (11.6); range of disease duration = 2 months-15 years; Hoehn-Yahr range I-III(Stage I = 17, II = 33, III = 22), Taiwanese sample)

  • MDC = 2.9 points 
  • MDC% = 13.3%

Cut-Off Scores

Parkinson’s Disease:

(Dibble et al, 2008; total = 70, mean age = 73.9(6.45), mean J&Y=2.5 (range 1-4), 36 fallers & 34 nonfallers; fallers (= 36, mean age = 75.25(5.15)), mean duration of PD = 8.32 (8.67), mean modified H&Y=2.5, 28 male/8 female); and non-fallers (= 34, mean age = 72.50(7.4)), mean duration of PD = 6.49(4.93), mean modified H&Y = 2.0

  • Adequate discriminative ability between fallers and non-fallers based on cutoff score < 19 (sensitivity = 0.64, specificity = 0.85, +LR = 4.26, -LR = 0.42)

(Landers et al 2008, JNPT) (Total = 49, mean age = 70.9(8.9) yrs, 20 female/29 male; 25 of participants were fallers (mean duration of diagnosis = 75.6(66.9) months, mean UPDRS = 41.8(9.6), mean H&Y = 3.0(0.55)) and 24 participants were non-fallers (mean age = 70.1(6.9) yrs, mean duration since Dx = 45.4(36.9) months, mean UPDRS = 26.8(10.0), mean H&Y = 2.1(0.61)} 

  • Adequate discriminative ability between fallers and nonfallers using cut score = 18.5 (AUC = 0.758, Sensitivity = 0.68, Specificity = 0.708, +LR = 2.33, -LR = 0.45; post-test probability = 0.708, Odds ratio 5.20(1.54-17.56) 95%CI)

Normative Data

Parkinson’s Disease:

(Cakit et al, 2007; = 31; mean age 71.8 (6.4) years, Parkinson's Disease)

Mean DGI Score:

 

 

 


Mean

SD

Baseline

16.3

5.2

Outcome

16.54

3.35

 

Test/Retest Reliability

Parkinson’s Disease:

(Huang et al, 2010, Parkinson's Disease)

  • Excellent test-retest reliability (ICC = 0.84)

(Kadivar et al, 2011) (= 16, age range 59-81 yrs, 5 female/11 males, H&Y stage (range 2-4)) 

  • Excellent test retest reliability (ICC > 0.99)

Criterion Validity (Predictive/Concurrent)

Parkinson’s Disease:

(Cakit et al. 2007; = 31, mean age = 71.8(6.4), mean duration of PD = 5.58(2.9), mean UPDRS motor subscale = 18.4(9.32)) 

  • Adequate concurrent validity with UPDRS-motor subscale scores (= -0.567, < 0.001)
  • Excellent correlation with history of falls in PD (r = 0.643, < 0.01)

Construct Validity

Parkinson’s Disease:

(Landers et al, 2008) 

  • Significant difference in total DGI scores between fallers (16.1, SD = 3.4) and non-fallers (19.6, SD = 2.6) in PD cohort, < 0.01

 

(Dibble et al, 2006; = 45 with idiopathic PD, mean age = 69.94(11.8), mean duration of PD = 7.43(5.62) years, mean H&Y level = 2.6(0.66); fallers = 25 and non-fallers = 20;  faller subgroup characteristics (mean age = 73.25(8.58), mean duration of PD = 9.07(6.13), mean H&Y = 2.95(0.62)); non-faller subgroup characteristics (mean age = 65.91(9.89), mean duration of PD = 5.43(4.25), mean H&Y = 2.17(0.42)) 

  • Significant difference in DGI scores between fallers {17.92 (4.36) 95% CI = 16.23-19.62} and non-fallers {21.82 (3.42) 95%CI 21.02-22.63 
  • Adequate discriminative ability between fallers and non-fallers based on cutoff score = 22 {AUC = 0.84, Sensitivity = 0.89, Specificity = 0.48, +LR = 1.86 (1.38-2.55), -LR = 0.22 (0.10-0.49)
  • Strongest positive LR as compared to Functional Reach test, Berg Balance Test and TUG. Author recommended DGI be administered as first test to detect fall risk in community dwelling persons with PD

Responsiveness

Parkinson’s Disease:

(Cakit et al, 2007) 

  • Was moderately responsive to change (mean change = 4.72 SD = 0.88) in training group following locomotor treadmill training intervention compared to control group (< 0.05) 

(Kadivar et al, 2011) 

  • Moderate responsiveness of DGI scores to cued step training with significant differences between the cued and noncued groups (effect size in cued RAS training group = 1.77, in non-cued group = 1.05)

(Landers et al, 2008) 

  • Sensitivity = 0.680 
  • Specificity = 0.708

 

Multiple Sclerosis

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Standard Error of Measurement (SEM)

Multiple Sclerosis:

(Cattaneo et al, 2007; n = 25, mean age = 41.7 (12.5) years; mean time since onset = 8.7 (8.8) years; Italian sample, MS)

  • SEM inter-rater reliability = 1.51 points 
  • SEM intra-rater relibaility = 2.00 points

Minimal Detectable Change (MDC)

Multiple Sclerosis:

(Cattaneo et al, 2007, MS)

  • MDC (Calculated from SEM) = 4.19-5.54

Cut-Off Scores

Multiple Sclerosis:

(Cattaneo et al, 2006; n = 51; relapsing-remitting or secondary progressive MS; mean age 45.3 (18.1) years; mean time since onset 15.6 (7.6) years, MS)

  • < 12 indicative of fall-risk (Sensitivity 45%, Specificity 80%)

Test/Retest Reliability

Multiple Sclerosis:

(Cattaneo et al, 2007, Multiple Sclerosis)

  • Excellent test-retest reliability (ICC = 0.85)

Interrater/Intrarater Reliability

Multiple Sclerosis:

(McConvey and Bennett, 2005, MS)

  • Excellent interrater reliability (ICC = 0.983)
  • Range from r = 0.910-0.976 for individual test terms
  • Excellent intrarater reliability (ICC = 0.760-0.98)

Criterion Validity (Predictive/Concurrent)

Multiple Sclerosis:

(Cattaneo et al, 2006; Cattaneo et al, 2007, MS)

  • Excellent concurrent validity with the Berg Balance Scale, TUG, DI, and ABC respectively (Spearman coefficient = 0.78, -0.80, -0.54)
  • Poor concurrent validity with the DHI (Spearman coefficient = -0.39)

Construct Validity

Multiple Sclerosis:

(Cattaneo et al, 2006) 

  • Statistically significant difference of three points noted between fallers and non-fallers (P = 0.025)

Floor/Ceiling Effects

Multiple Sclerosis:

(Cattaneo et al, 2006, MS)

  • Adequate ceiling effects (7.8%)

Responsiveness

Multiple Sclerosis:

(Cattaneo et al, 2006, MS)

  • Scores of less than 12 discriminated between fallers and non fallers, however, Cattaneo (2006) reported that the BBS and DGI measures were not as good at discriminating between fallers and non-fallers compared to the Equiscale Test.

Vestibular Disorders

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Standard Error of Measurement (SEM)

Peripheral Vestibular Disorders: 

(Calculated from Hall & Herdman, 2006; n = 16; age 51.8 (13.4) years, diagnosis of unilateral or bilateral vestibular hypofunction)

  • SEM calculated = 2.8 points

Minimal Detectable Change (MDC)

Vestibular Disorders:

(Calculated from Hall & Herdman, 2006, Peripheral Vestibular Disorders) 

  • MDC calculated = 3.2 points

Cut-Off Scores

Vestibular Disorders:

(Whitney et al, 2000; n = 247, age 14-95 years, mean 62.4 years, central and peripheral vestibular dysfunction)

  • Subjects with scores of < 19/24 are 2.58 times more like to have reported a fall in the previous 6 months than subjects with scores above 19

Test/Retest Reliability

Vestibular Population:

(Hall et al, 2006; n = 16 patients with vestibular disorders; mean age = 51.8 (13.4) years)

  • Excellent test-retest reliability (ICC = 0.86 (total score) (individual items ranged from 0.04-0.90))

Interrater/Intrarater Reliability

Vestibular:

(Wrisley et al, 2003; = 30, age range 27-88 years referred for vestibular rehabilitation)

  • Adequate inter-rater reliability (k = 0.64)

Criterion Validity (Predictive/Concurrent)

Vestibular Population:

(Hall & Herdman, 2006; n = 16 patients with confirmed peripheral vestibular disorders; mean age = 51.8 (13.4) years, Vestibular Population)

  • Berg Balance Scale and DGI scores agreed 63% of the time on fall risk criteria
  • DGI appears to be more sensitive than the Berg Balance Scale in identifying fall risk in patients with vestibular disorders

(Whitney et al. 2000 (n = 30 patients (aged 27 to 88) diagnosed with vestibular disorders, Vestibular Population)

  • Excellent concurrent validity (r = 0.71) between the DGI and the Berg Balance Scale

Brain Injury

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Criterion Validity (Predictive/Concurrent)

Brain Injury:

(Medley, A. et al, 2006; n = 26; mean age = 41.9 (12.4) years, Brain Injury)

  • Found that a person who scores 19 out of 24 points on the DGI has a 28% probability of falling. A person who scores 24 out of 24 points would have a 6% chance of falling and a person who scores 0 out of 24 points would have a 100% change of falling

(McConvey and Bennet, 2005)

  • Excellent concurrent validity with 6.1m timed walked test (r = -0.81)

Non-Specific Patient Population

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Normative Data

Healthy Adults:

(Vereeck et al, 2008; n = 318; mean age = 49.2(18.7), Healthy Adults)

Decade

Mean

SD

5th Percentile

Range

3

24.0

0.2

24

23-24

4

24.0

0.2

24

23-24

5

23.9

0.4

23

22-24

6

23.9

0.4

23

22-24

7

23.2

0.9

21

21-24

8

22.0

2.0

18

13-24

Bibliography

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