Dual Task Turning in Place: A Reliable, Valid, and Responsive Outcome Measure of Freezing of Gait

Abstract Background Freezing of gait (FOG) is a complex symptom in Parkinson's disease (PD) that is both elusive to elicit and varied in its presentation. These complexities present a challenge to measuring FOG in a sensitive and reliable way, precluding therapeutic advancement. Objective We investigated the reliability, validity, and responsiveness of manual video annotations of the turning‐in‐place task and compared it to the sensor‐based FOG ratio. Methods Forty‐five optimally medicated people with PD and FOG performed rapid alternating 360° turns without and with an auditory stroop dual task, thrice over two consecutive days. The tasks were video recorded, and inertial sensors were placed on the lower back and shins. Interrater reliability between three raters, criterion validity with self‐reported FOG, and responsiveness to single‐session split‐belt treadmill (SBT) training were investigated and contrasted with the sensor‐based FOG ratio. Results Visual ratings showed excellent agreement between raters for the percentage time frozen (%TF) (ICC [intra‐class correlation coefficient] = 0.99), the median duration of a FOG episode (ICC = 0.90), and the number of FOG episodes (ICC = 0.86). Dual tasking improved the sensitivity and validity of visual FOG ratings resulting in increased FOG detection, criterion validity with self‐reported FOG ratings, and responsiveness to a short SBT intervention. The sensor‐based FOG ratio, on the contrary, showed complex FOG presentation‐contingent relationships with visual and self‐reported FOG ratings and limited responsiveness to SBT training. Conclusions Manual video annotations of FOG during dual task turning in place generate reliable, valid, and sensitive outcomes for investigating therapeutic effects on FOG. © 2021 International Parkinson and Movement Disorder Society