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RehabMeasures Instrument

Freezing of Gait Questionnaire

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Purpose

The FOGQ assesses Freezing of Gait (FOG) severity unrelated to falls in patients with Parkinson’s Disease (PD), FOG frequency, disturbances in gait, and relationship to clinical features conceptually associated with gait and motor aspects (e.g., turning).

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Instrument Details

Acronym FOGQ

Area of Assessment

Balance – Non-vestibular
Functional Mobility
Gait
Life Participation

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

Cost Description

A copy of the measure can be found in Giladia et al (2000)

Diagnosis/Conditions

  • Parkinson's Disease + Neurologic Rehabilitation

Key Descriptions

  • Currently, the FOGQ is the only validated tool available to subjectively assess FOG.
  • 6-item version based on statistical criteria (See Giladi et al., 2000 for details):
    A) 4 of the items assess FOG severity
    B) 2 of the items assess gait
  • Responses to each item use a 5-point interval scale ranging from 0, absence of symptoms to 4, most severe stage.
  • Total score ranges from 0 to 24, and higher scores correspond to more severe FOG.
  • Complete the questionnaire during “on” or best stage.
  • Answer items 1, 2, 4, 5, & 6 based on experience over the last week or overall presence of FOG during the entire day.
  • A physiotherapist or occupational therapist should administer, and the administrator should demonstrate FOG to subject.

Number of Items

6

Time to Administer

5-10 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed by Julie Gupta, PT, DPT in 10/2010; Updated by Deb Kegelmeyer for APTA PD EDGE task force in 2013.

Body Part

Lower Extremity

ICF Domain

Activity

Measurement Domain

Activities of Daily Living
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 Based on Parkinson Disease Hoehn and Yahr stage:

 

I

II

III

IV

V

PD EDGE

NR

R

R

R

NR

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)

PD EDGE

No

Yes

Yes

Not reported

Considerations

Parkinson's Disease:

(Nieuwboer et al, 2009)

  • Lack of a gold standard measure of FOG is the largest drawback of examining the validity of any FOG measure at the present time
  • Patients’ self-detection may be more reliable than observation by a lay-person

(Giladi et al, 2009)

  • Sensitive tool for assessment of interventions designed to improve FOG
 

Freezing of Gait Questionnaire translations:

English (Appendix B):
http://web.missouri.edu/proste/tool/PD/Giladia-FOG-Q.pdf

Portuguese:
http://xa.yimg.com/kq/groups/27654579/1789005394/name/Question%C3%A1rios.doc

Spanish (Table 1):
http://www.medigraphic.com/pdfs/arcneu/ane-2011/ane114b.pdf

Swedish:
http://www.ncbi.nlm.nih.gov/pubmed/?term=Freezing+of+Gait+Questionnaire%3A+validity+and+reliability+of+the+Swedish+version

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!

Parkinson's Disease

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Cut-Off Scores

Parkinson's Disease:

(Giladi et al, 2009; n = 454 patients with PD who were randomly assigned to receive Rasagiline (1 mg/day; n = 150), Entacapone (200 mg with each dose of Levodopa; n = 150), or placebo (n  = 154); patients were assessed at baseline and after 10 weeks using the FOG-Q; mean UPDRS = 32; Mean H & Y score at ON stage = 2.1; mean age = 63 years)

  • Item 3: good single question for screening of FOG frequency

(Moore et al, 2007; n = 118 patients with PD; mean H & Y = 2.7 (0.8);mean UPDRS = 48.4 (17.1); mean age = 65.8 (10.2) years)

  • Item 3: good single question for screening of FOG frequency

(Schaafsma et al, 2003; n = 19 patients with PD who were on Levodopa treatment; mean H & Y score at ON stage = 3; mean UPDRS at ON stage = 27; mean age  = 62 (8.4) years)

  • Answer selections for items 4-6 provide a range to classify the duration of a FOG episode

Normative Data

Parkinson's Disease:

(Nieuwboer et al, 2007; n  = 153 patients with idiopathic PD; n = 76 patients with early stage and 77 patients with late stage PD; Hoehn and Yahr stage II–IV; mean age for early stage = 67.5 (61.5-72) years; mean age for late stage = 69 (62.5-73) years)

Medians and interquartile FOGQ Scores:

 

 

 

 

Stage

Test 1*

Test 2*

Test 3*

Test 4*

Early

8 (4–14)

8 (3–12)

7 (3–11.5)

7 (3–12.5)

Late

8 (4.5–12)

9 (4–12)

8 (3–11)

8 (4–12)

Median (Q1-Q3)

 

 

 

 

Test 1 = three months; Test 2 = three weeks; Test 3 = four weeks; Test 4 = six weeks

 

 

 

 

 

Test/Retest Reliability

Parkinson's Disease:

(Giladi et al, 2009; assessed at baseline and 10 weeks)

  • Excellent test-retest reliability:
    • Placebo group (r = 0.83)
    • Two treatment groups (r = 0.84)

Internal Consistency

Parkinson's Disease: (Giladi et al, 2000; n = 40 patients with PD; mean H & Y at OFF stage = 2.85(0.84); mean UPDRS = 54.7(18.8); mean age = 72.3(9.3) years)

  • Excellent internal consistency (Chronbach's alpha = 0.94)

(Giladi et al, 2009)

  • Excellent internal consistency at baseline  (Chronbach's alpha = 0.89)
  • Excellent internal consistency at 10 weeks  (Chronbach's alpha = 0.90)

Criterion Validity (Predictive/Concurrent)

Parkinson's Disease:

(Giladi et al, 2000)

FOGQ Concurrent Validity with UPDRS Subsacles and H & Y:

 

 

 

Scale

r

p

Strength

UPDRS: Total score

0.48

0.01

Adequate

UPDRS: Mental

0.05

0.08

Poor

UPDRS: ADL

0.43

0.01

Adequate

UPDRS: Motor

0.40

0.01

Adequate

Hoehn & Yahr

0.66

0.01

Excellent

 

Early Stage Parkinson's Disease:

(Amboni et al, 2008; n = 13 patients with early stage PD; H & Y is equal to or less than 2.5 at ON state; mean age = 66.46 (8.21) years; disease duration < 10 years)

  • Excellent correlation:
    • Stroop test – Part II (r = -0.618)
  • Adequate correlation
    • Ten-point clock test (r = -0.429)
    • Phonological verbal fluency (r = -0.464)
    • Frontal assessment battery (r = -0.501)

 

Parkinson’s Disease:

(Nilsson and Hagell, 2009; n = 37 people with PD; median age = 67 (56-73) years; sex = 29 males, 8 females; falls = 20 fallers, 17 non-fallers)

  • Excellent correlation:
    • Off phase H & Y stage (r = 0.65)
    • Part II ADL (r = 0.66)
    • Part IV items 32-35 dyskinesias and items 36-39 motor fluctuations (r =0.62)
  • Adequate correlation:
    • Part III motor (r = 0.59)
    • Item 15 walking (r = 0.56)
    • Item 13 falling unrelated to freezing (r = 0.55)
    • Item 29 gait (r = 0.54)
    • UPDRS – item 30 postural instability (r = 0.47)
    • On phase H & Y stage (r = 0.46)
    • PD duration (r = 0.42)
    • Timed Up and Go (r = 0.40)
    • Comfortable and fast gait speed (r = -0.32)
    • Physical functioning scale of 36-item Short-Form Health Survey (r = -0.48)
    • Falls-Efficacy Scale (r = -0.59)
    • UPDRS – Part I mentation, behavior, and mood (r = 0.35)
  • Poor correlation:
    • Age (r = 0.05)

(Tan D et al, 2011; n = 210 people with PD; median age = 67.9 (9.6) years; sex = 140 males, 70 females; H&Y I-IV mean = 2.5)

  • Moderate relationship between FOGQ and activity limitation as measured by the UPDRS ADL score (p = 0.48; p < 0.001) and the Schwab and England ADL scale (p = -0.48; p < 0.001)

(Shine et al, 2012; n = 24; mean age = 69 (8.41) years; H&Y range 2-4, mean = 2.66 (0.53))

  • Freezing of gait was assessed using multiple tasks during the TUG (usual TUG, TUG with 540 degree turn, TUG with obstacle and TUG with narrow passageway and number of freezes and time spent frozen were assessed using video taped movement analysis
  • Correlation between percentage of time spent “frozen” during TUG tasks and ratings on the FOGQ (= 0.30, p = 0.095) were not significant
  • Correlation between number of freezing events and FOGQ (= 0.11, p = 0.613) was not significant and weak
  • Question 3: “do you feel that your feet get glued to the floor while walking, making a turn or when trying ot initiate walking” was most strongly associated with freezing episodes; (= 0.40, p = 0.178)

(Ellis et al, 2011; n = 263; (150 men, 113 women); mean age 67.7 (9.2) years; H&Y I = 16, 1.5 = 4; 2 = 113; 2.5 = 62; 3 = 52; 4 = 15)

  • Quality of life as assessed by the PDQ-39 had strong correlation with the FOGQ (r = 0.57, p < 0.01)
  • FOGQ predicted PDQ-39 mobility scores (R2 change = 0.23, p < 0.001)

Construct Validity

Parkinson's Disease:

(Giladi et al, 2009)

  • Adequate correlation with United Parkinson’s Disease Rating Scale (UPDRS) (= 0.74)

Floor/Ceiling Effects

Parkinson's Disease: (Nilsson and Hagell, 2009) 

  • Adequate floor and ceiling effects: less than or equal to 5.4%

(Wieler et al, 2005; n = 12 patients with PD and FOG; mean age = 67 (53-79) years; mean disease duration = 12 (5-23) years)

  • The FOGQ may underestimate ceiling effects

Responsiveness

Parkinson’s Disease:

(Giladi et al, 2009)

  • Item 3 of the FOGQ is more sensitive (85.9%) in detecting freezers than item 14 of the UPDRS (44.1%)
  • Item 3 remains sensitive after excluding patients with never and very rare FOG (78.4%)

(Lim et al, 2008; n = 153 patients with PD; 67 (7.5) years)

  • Accuracy of a model derived to determine probability of falling with FOGQ alone 65.3%

(Nieuwboer et al, 2009; n = 102 Non-demented people with Parkinson's disease; mean age = 64.4(10.5) years)

  • Inclusion of general gait items reduces FOGQ specificity

Non-Specific Patient Population

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Criterion Validity (Predictive/Concurrent)

MSA:

(Gurevich and Giladi, 2003; n = 28 patients with clinical diagnosis of MSA; mean age = 66.8 (10.3) years; mean H & Y score = 3.6 (0.6); mean disease duration = 6.4 (4.0) years)

  • Excellent correlation with Hoehn and Yahr (r = 0.98)

Bibliography

Allen, N. E., Canning, C. G., et al. (2010). "The effects of an exercise program on fall risk factors in people with Parkinson's disease: a randomized controlled trial." Mov Disord 25(9): 1217-1225. Find it on PubMed

Amboni, M., Cozzolino, A., et al. (2008). "Freezing of gait and executive functions in patients with Parkinson's disease." Mov Disord 23(3): 395-400. Find it on PubMed

Brichetto, G., Pelosin, E., et al. (2006). "Evaluation of physical therapy in parkinsonian patients with freezing of gait: a pilot study." Clin Rehabil 20(1): 31-35. Find it on PubMed

Ellis, T., Cavanaugh, J. T., et al. (2011). "Which measures of physical function and motor impairment best predict quality of life in Parkinson's disease?" Parkinsonism Relat Disord 17(9): 693-697. Find it on PubMed

Frazzitta, G., Maestri, R., et al. (2009). "Rehabilitation treatment of gait in patients with Parkinson's disease with freezing: a comparison between two physical therapy protocols using visual and auditory cues with or without treadmill training." Mov Disord 24(8): 1139-1143. Find it on PubMed

Giladi, N., Shabtai, H., et al. (2000). "Construction of freezing of gait questionnaire for patients with Parkinsonism." Parkinsonism Relat Disord 6(3): 165-170. Find it on PubMed

Giladi, N., Tal, J., et al. (2009). "Validation of the freezing of gait questionnaire in patients with Parkinson's disease." Mov Disord 24(5): 655-661. Find it on PubMed

Gurevich, T. and Giladi, N. (2003). "Freezing of gait in multiple system atrophy (MSA)." Parkinsonism Relat Disord 9(3): 169-174. Find it on PubMed

Ledger, S., Galvin, R., et al. (2008). "A randomised controlled trial evaluating the effect of an individual auditory cueing device on freezing and gait speed in people with Parkinson's disease." BMC Neurol 8: 46. Find it on PubMed

Lim, I., van Wegen, E., et al. (2008). "Identifying fallers with Parkinson's disease using home-based tests: who is at risk?" Mov Disord 23(16): 2411-2415. Find it on PubMed

Moore, O., Peretz, C., et al. (2007). "Freezing of gait affects quality of life of peoples with Parkinson's disease beyond its relationships with mobility and gait." Mov Disord 22(15): 2192-2195. Find it on PubMed

Naismith, S. L. and Lewis, S. J. (2010). "A novel paradigm for modelling freezing of gait in Parkinson's disease." J Clin Neurosci 17(8): 984-987. Find it on PubMed

Nieuwboer, A., Rochester, L., et al. (2009). "Reliability of the new freezing of gait questionnaire: agreement between patients with Parkinson's disease and their carers." Gait Posture 30(4): 459-463. Find it on PubMed

Nilsson, M. H. and Hagell, P. (2009). "Freezing of Gait Questionnaire: validity and reliability of the Swedish version." Acta Neurol Scand 120(5): 331-334. Find it on PubMed

Pelosin, E., Avanzino, L., et al. (2010). "Action observation improves freezing of gait in patients with Parkinson's disease." Neurorehabil Neural Repair 24(8): 746-752. Find it on PubMed

Schaafsma, J. D., Balash, Y., et al. (2003). "Characterization of freezing of gait subtypes and the response of each to levodopa in Parkinson's disease." Eur J Neurol 10(4): 391-398. Find it on PubMed

Shine, J. M., Moore, S. T., et al. (2012). "Assessing the utility of Freezing of Gait Questionnaires in Parkinson's Disease." Parkinsonism Relat Disord 18(1): 25-29. Find it on PubMed

Snijders, A. H., Nijkrake, M. J., et al. (2008). "Clinimetrics of freezing of gait." Mov Disord 23 Suppl 2: S468-474. Find it on PubMed

Tan, D. M., McGinley, J. L., et al. (2011). "Freezing of gait and activity limitations in people with Parkinson's disease." Arch Phys Med Rehabil 92(7): 1159-1165. Find it on PubMed

Wieler, M., Camicioli, R., et al. (2005). "Botulinum toxin injections do not improve freezing of gait in Parkinson disease." Neurology 65(4): 626-628. Find it on PubMed

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