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The Modified Gait Abnormality Rating Scale for Recognizing the Risk of Recurrent Falls in Community-Dwelling Elderly Adults

JM VanSwearingen, PhD, PT, is Assistant Professor, Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260 (USA) (jessievs+@pitt.edu), and Consulting Physical Therapist, Geriatric Evaluation and Management Program, University Drive Veterans Administration Medical Center, Pittsburgh, PA 15261.
KA Paschal, PT, is Assistant Professor and Director of Clinical Education, Department of Physical Therapy, School of Pharmacy and Allied Health, Creighton University, 2500 California Plaza, Omaha, NE 68178. She was Consulting Physical Therapist, Geriatric Evaluation and Management Program, University Drive Veterans Administration Medical Center, at the time of this study.
P Bonino, MD, is Associate Professor of Medicine and Epidemiology and Associate Chief of Staff for Geriatrics and Extended Care, University of Pittsburgh School of Medicine and University Drive Veterans Administration Medical Center.
JF Yang, PT, holds a teaching position in Department of Rehabilitation Medicine, Medical College, National Cheng-Kung University, Tainan, Taiwan. He was completing the Master of Science degree, Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, when he participated in this study.

Background and Purpose. The purpose of this study was to determine the reliability and validity of measurements obtained with a seven-item modified version of the Gait Abnormality Rating Scale (GARS-M), an assessment of gait designed to predict risk of falling among community-dwelling, frail older persons. Subjects. Fifty-two community-dwelling, frail older persons, with a mean age of 74.8 years (SD=6.75), participated. Methods. A history of falls was determined from self-report or by proxy report. The GARS-M was scored from videotapes of subjects walking at self-selected paces. Gait characteristics were recorded during a timed walk on a 6-m brown-paper walkway. Results. Scores obtained by three raters for 23 subjects demonstrated moderate to substantial intrarater and interrater reliability. Concurrent validity, as assessed by Spearman rank-order correlation coefficients, was demonstrated for the relationship between GARS-M scores and stride length (r=–.754) and for the relationship between GARS-M scores and walking speed (r=–.679). Mean GARS-M scores distinguished between frail older persons with and without a history of recurrent falls (mean GARS-M scores of 9.0 and 3.8, respectively). Conclusion and Discussion. The GARS-M is a reliable and valid measure for documenting gait features associated with an increased risk of falling among community-dwelling, frail older persons and may provide a clinically useful alternative to established quantitative gait-assessment methods.

Key Words: Accidental falls • Assessment • Gait analysis • Geriatrics

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