Objective: This study aimed to determine clinician’s ratings of the most important triggering circumstances to be examined and aspects of freezing of gait (FOG) to be measured, in order to develop a clinician-rated tool for FOG severity with content validity.

Background: More than 50% of people with Parkinson’s disease experience FOG. This disabling symptom has been associated with falls and poorer quality of life. Objective clinical assessment of FOG severity is challenging because of its episodic nature, but remains important for confirming the subjective information obtained from patient-reported outcome measures. There has been no agreement on the tasks to be performed and measures to be recorded in an objective clinical assessment of FOG severity. Tasks such as turning, negotiating obstacles, passing through narrow spaces, and dual-tasking have been used in isolation or combination. Measures such as type of freezing observed, number of freezing episodes, and duration of freezing episodes have been recorded.

Method: A three-round Delphi study was carried out to obtain consensus of the Delphi experts. Healthcare professionals with at least five years’ experience in assessing and managing FOG in people with Parkinson’s disease in the clinical setting were recruited via snowball sampling. Those who were unable to understand written English were excluded. No geographical limits were placed to allow breadth of opinion.

The study was completely web-based. In Round 1, participants (n=28) rated items on a 5-point Likert scale, based on priority for inclusion in a clinician-rated tool for freezing of gait severity. Participants (n=18) were required to rank the remaining items based on priority for inclusion in Round 2. Round 3 required participants (n=18) to judge the ability of the selected items to screen for freezing of gait, detect changes in freezing of gait severity, and distinguish between differing degrees of severity by providing responses on a binary scale (Yes / No).

Results: Participants agreed the triggering circumstances of turning hesitation, narrow space hesitation, start hesitation, cognitive dual-tasking, and open space hesitation should be examined; and the aspects of gait freezing to be measured included freezing type, number of freezing episodes, and average duration of freezing episodes.

Conclusion: This study successfully attained a consensus for the items to be included in a clinician-rated tool for FOG severity.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/determining-the-content-of-a-clinician-rated-tool-for-freezing-of-gait-severity/