Assessment Handout

Assessment Psychometrics

Stroke

There are no recommendations for use based on acuity level of the patient, or level of care in which the assessment is taken. Below are psychometrics for the FGA in the CVA population:

• Concurrent Validity: Excellent correlation with 10MWT and PASS (r=-0.66-0.83), Excellent correlation with Functional Ambulatory Category (r=0.83), gait speed (r=0.82), Berg Balance Scale (r=0.93), Rivermead Mobility Index (r=0.85) and Barthel Index (r=0.71)

• Construct Validity: Excellent with 10MWT (r=-0.66, -0.85, -0.81) and PASS (r=0.83, 0.75, 0.83) at 1 week, 2 months, and 5 months after therapy

• Cutoff Score: None reported

• Floor/Ceiling Effects: Minimal floor and ceiling effects

• Interrater Reliability: Excellent (ICC = 0.94)

• Intrarater Reliability: Excellent (ICC = 0.97)

• MCID: 5

• Mean Data: 13 (1 week), 12 (2 months)

• MDC: 4.2, percent change = 14.1%

• Responsiveness: Moderate responsiveness at 2 and 5 months

• SEM: 1.52

• Test-retest: Excellent (ICC = 0.95)

Multiple Sclerosis

Neuro PT EDGE is unable to recommend (2/4) the use of the FGA in any clinical setting because of the lack of psychometric data for patients with MS. The FGA is also unable to be recommended (2/4) for those with a disability level of 0.0-5.5. It is not recommended for those with an EDSS level >6.0. At this time, it is not recommended that students learn to use this tool for patients with MS because of the lack of psychometric data.

Even though there cannot be a strong recommendation for the use of the FGA in the MS population, the FGA is likely feasible for use in all practice settings. It is considered a core outcome measure which means it is recommended for use in adults with all neurologic conditions. The biggest weakness when looking at the use of this test is that there are no psychometric properties available at this time in any domain for the FGA and people with MS.

Parkinson's Disease

The FGA is highly recommended for use with PD patients in Hoehn and Yahr stages I-IV, but not recommended in Hoehn and Yahr stage V. Students should be taught the FGA and it is appropriate for use in intervention research studies.

• Concurrent Validity: Moderate to strong correlation with BBS, FAC, TUG, ABC, MDS-UPDRS-3, BI, fast walking speed, and modified Hoehn and Yahr scale (r=0.57-0.85)

• Construct Validity: Good ; Scores significantly different on medication vs. off (p < 0.006); Better predictive validity when patients were scored off medication

• Cutoff Score: ≤18/30 identifies fall risk

• Interrater Reliability: Excellent (ICC=0.99)

• Intrarater Reliability: Excellent (ICC=0.99)

• MDC: 4

• Test-retest: Excellent (ICC=0.86)

Spinal Cord Injury

Neuro PT EDGE states that the FGA is reasonable to use (2/4) with the acute and subacute SCI population, but there is no current data reported on the FGA with the SCI population. No data in the chronic neurologic population has been taken on the FGA, so it is not recommended for use (1/4). The FGA is reasonable to use (2/4) with AIS A, B, C, and D classified individuals, but they must be ambulatory to be appropriate for the test. For students, this test should not be learned to administer to the SCI population particularly because of the lack of data. Students should be exposed to this test and more validation studies should be conducted to determine if this outcome measure is appropriate for research.

One recent study published in the fall of 2020 looked at the ability to use the FGA with individuals with incomplete SCI. Interrater reliability was found to be excellent when compared with an expert in this study, ICC=0.92. Intrarater reliability was also excellent, ICC>0.91. Validity of the FGA with the 10 MWT was found to be -0.90 and with the WISCI-II, 0.74. When compared with the SCI-FAP, validity was -0.83. This study concluded that the FGA was a valid and reliable tool that can be used to assess balance in individuals with a motor incomplete SCI. More research must still be done with this population because the sample size of this study was only 12.

TBI

There is not yet evidence to suggest the use of the FGA with patients after a brain injury who are completely independent or mildly dependent, but it is not recommended with those who are moderately or severely dependent. The FGA has limited studies on use in acute care, skilled nursing facilities, inpatient rehabilitation, outpatient rehabilitation, and home health. This measure should be taught to students and is appropriate for use in research. There are no specific psychometrics for the FGA with the TBI population.

Instructional Video

Application Videos