The Gait Disorientation Test: A New Method for Screening Adults With Dizziness and Imbalance

Abstract

Objective: To develop and evaluate a new method for identifying gait disorientation due to vestibular dysfunction.

Design: The gait disorientation test (GDT) involves a timed comparison of the ability to walk 6.096 m with eyes open versus eyes closed. In this prospective study, participants were grouped based on vestibular function. All participants completed a clinical examination, self-report- and performance-based measures relevant to vestibular rehabilitation, and the tasks for the GDT. Vestibular-impaired participants underwent the criterion standard, videonystagmography and/or rotational chair testing.

Setting: Ambulatory clinic, tertiary referral center.

Participants: Participants (N=40) (20 vestibular-impaired, 30 women, 49.9±16.1years old) were enrolled from a convenience/referral sample of 52 adults.

Main outcome and measure(s): We determined test-retest reliability using the intraclass correlation coefficient model 3,1; calculated the minimal detectable change (MDC); examined concurrent validity through Spearman correlation coefficients; assessed criterion validity with the area under the curve (AUC) from receiver operator characteristic analysis; and computed the sensitivity, specificity, diagnostic odds ratio (DOR), likelihood ratios for positive (LR+) and negative (LR-) tests, and posttest probabilities of a diagnosis of vestibulopathy. The 95% confidence interval demonstrates measurement uncertainty.

Results: Test-retest reliability was 0.887 (0.815, 0.932). The MDC was 3.7 seconds. Correlations with other measures ranged from 0.59 (0.34, 0.76) to -0.85 (-0.92, -0.74). The AUC was 0.910 (0.822, 0.998), using a threshold of 4.5 seconds. The sensitivity and specificity were 0.75 (0.51, 0.91) and 0.95 (0.75, 1), respectively. The DOR=57 (6, 541.47), LR+ =15 (2.18, 103.0), and LR- =0.26 (0.12, 0.9). Positive posttest probabilities were 89%-94%.

Conclusions and relevance: The GDT has good reliability, excellent discriminative ability, strong convergent validity, and promising clinical utility.

Keywords: Bilateral vestibulopathy; Rehabilitation; Sensitivity and specificity; Spatial navigation; Vestibular diseases.

Fig 1

Data collection flowchart. These data are reported for time point A in the main study. The criteria for abnormal or positive results on VNG, RC, and the GDT are provided in supplemental appendix S1. All healthy and vestibular-impaired participants underwent a thorough clinical examination to screen for previously undetected vestibular dysfunction in healthy participants or to confirm vestibular loss in impaired participants, as well as to rule out somatosensory, visual, musculoskeletal, and neuromuscular conditions that might interfere with testing (see supplemental appendix S1). Abbreviation: Hx/o, history of musculoskeletal or neurological exclusion criteria.