Dataset Information

The Ziegler Test is Reliable and Valid for Measuring Freezing of Gait in People With Parkinson Disease.

ABSTRACT:

Objective

The purpose of this study was to determine interrater and test-retest reliability of the Ziegler test to measure freezing of gait (FOG) severity in people with Parkinson disease. Secondary aims were to evaluate test validity and explore Ziegler test duration as a proxy FOG severity measure.

Methods

Physical therapists watched 36 videos of people with Parkinson disease and FOG perform the Ziegler test and rated FOG severity using the rating scale in real time. Two researchers rated 12 additional videos and repeated the ratings at least 1 week later. Interrater and test-retest reliability were calculated using intraclass correlation coefficients (ICCs). Bland-Altman plots were used to visualize agreement between the researchers for test-retest reliability. Correlations between the Ziegler scores, Ziegler test duration, and percentage of time frozen (based on video annotations) were determined using Pearson r.

Results

Twenty-four physical therapists participated. Overall, the Ziegler test showed good interrater (ICC2,1 = 0.80; 95% CI = 0.65 to 0.92) and excellent test-retest (ICC3,1 = 0.91; 95% CI = 0.82 to 0.96) reliability when used to measure FOG. It was also a valid measure, with a high correlation (r = 0.72) between the scores and percentage of time frozen. Ziegler test duration was moderately correlated (r = 0.67) to percentage of time frozen and may be considered a proxy FOG severity measure.

Conclusion

The Ziegler test is a reliable and valid tool to measure FOG when used by physical therapists in real time. Ziegler test duration may be used as a proxy for measuring FOG severity.

SUBMITTER: Goh L

PROVIDER: S-EPMC10071484 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Publications

The Ziegler Test Is Reliable and Valid for Measuring Freezing of Gait in People With Parkinson Disease.

Goh Lina L Paul Serene S SS Canning Colleen G CG Ehgoetz Martens Kaylena A KA Song Jooeun J Campoy Stephanie L SL Allen Natalie E NE

Physical therapy 20221201 12

<h4>Objective</h4>The purpose of this study was to determine interrater and test-retest reliability of the Ziegler test to measure freezing of gait (FOG) severity in people with Parkinson disease. Secondary aims were to evaluate test validity and explore Ziegler test duration as a proxy FOG severity measure.<h4>Methods</h4>Physical therapists watched 36 videos of people with Parkinson disease and FOG perform the Ziegler test and rated FOG severity using the rating scale in real time. Two researc ...[more]

PMID: 36130220

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Project description:ObjectiveFreezing of gait (FOG) is an episodic, debilitating phenomenon that is common among people with Parkinson disease. Multiple approaches have been used to quantify FOG, but the relationships among them have not been well studied. In this cross-sectional study, we evaluated the associations among FOG measured during unsupervised daily-living monitoring, structured in-home FOG-provoking tests, and self-report.MethodsTwenty-eight people with Parkinson disease and FOG were assessed using self-report questionnaires, percentage of time spent frozen (%TF) during supervised FOG-provoking tasks in the home while off and on dopaminergic medication, and %TF evaluated using wearable sensors during 1 week of unsupervised daily-living monitoring. Correlations between those 3 assessment approaches were analyzed to quantify associations. Further, based on the %TF difference between in-home off-medication testing and in-home on-medication testing, the participants were divided into those responding to Parkinson disease medication (responders) and those not responding to Parkinson disease medication (nonresponders) in order to evaluate the differences in the other FOG measures.ResultsThe %TF during unsupervised daily living was mild to moderately correlated with the %TF during a subset of the tasks of the in-home off-medication testing but not the on-medication testing or self-report. Responders and nonresponders differed in the %TF during the personal "hot spot" task of the provoking protocol while off medication (but not while on medication) but not in the total scores of the self-report questionnaires or the measures of FOG evaluated during unsupervised daily living.ConclusionThe %TF during daily living was moderately related to FOG during certain in-home FOG-provoking tests in the off-medication state. However, this measure of FOG was not associated with self-report or FOG provoked in the on-medication state. These findings suggest that to fully capture FOG severity, it is best to assess FOG using a combination of all 3 approaches.ImpactThese findings suggest that several complementary approaches are needed to provide a complete assessment of FOG severity.

Project description:This study investigated the risk factors for freezing of gait (FOG) in the early stage of Parkinson disease in China, using a sample of 248 patients who were followed for 3 years. Part III of the Unified Parkinson Disease Rating Scale and the modified Hoehn-Yahr grading scale were used to evaluate the severity of motor symptoms. Nonmotor symptoms were assessed using the Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale (HAMD), and Non-Motor Symptoms Scale (NMSS). The end-point was the presence of FOG at the end of follow-up; patients with FOG were classified as freezers. The risk factors for FOG were analyzed at the end of the first, second, and third years after baseline. There were 40 freezers (16.13%) 1 year later, 98 (39.52%) 2 years later, and 128 (51.61%) 3 years later. FOG 3 years later was associated with the following variables: depression (P = 0.003), older age, living in the countryside, lower education, akinetic-rigid style, lower limbs as site of onset, early use of levodopa, higher daily dose of levodopa, and not using amantadine or selegiline and dopamine receptor agonists (P < 0.001). Early use of amantadine, selegiline, and dopamine receptor agonists was negatively related to FOG (P < 0.001). Binary logistic regression found that FOG was associated with lower education (odds ratio [OR] = 0.012, P < 0.001), akinetic-rigid style (OR = 4.881, P = 0.024), not using dopamine receptor agonists (OR = 4.324, P = 0.035), cognitive disturbances (OR = 0.331, P = 0.007), and sleep disorders (OR = 2.418, P = 0.036). However, the cardiovascular domain of the NMSS (OR = 2.729, P = 0.001) was the only risk factor for FOG 1 year later. Two years later, FOG was associated with mixed style (OR = 0.189, P = 0.005), lower limbs as site of onset (OR = 4.772, P = 0.008), not using dopamine receptor agonists (OR = 0.031, P < 0.001), and the anxiety/somatic domain of the HAMD (OR = 0.596, P = 0.033). Scores at baseline, patients with Parkinson disease were more likely to experience FOG if: they were older, or from the countryside; had an akinetic-rigid style, anxiety, or higher NMSS scores; they used levodopa early or did not use amantadine or selegiline; their lower limbs were the site of onset; or they had more severe motor disability or higher HAMD scores at baseline.