Adapting the Tinetti (Balance and Gait) for Persons with Dementia
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1 Adapting the Tinetti (Balance and Gait) for Persons with Dementia Alison Douglas OT, PhD 1,2 Bettina von Kampen PT, MSc 1 Carri McAiney PhD 1,2 Shelley Wright RN 1 1: McMaster Dept. of Psychiatry & Behavioural Neurosciences 2: St. Joseph s Healthcare, Senior s Mental Health Behavioural Unit
2 Funding Support Professional Advisory Council Research Award
3 Introduction Among available measures of mobility, most require the participant to follow instructions, or use expensive technology. The Tinetti Scale of Balance & Gait 17 items, established reliability & validity Provides the most promise for use with persons with dementia Required modification
4 Tinetti Scale for Balance and Gait (Tinetti, 1986) Our rationale for choosing the Tinetti scale to modify: 1) many of the components of this tool are based on observation of the patient, and 2) it is feasible to administer in ten minutes or less with minimal specialized equipment or training.
5 Tinetti Scale for Balance & Gait Items scored 0/1, or some 0/1/2 Balance Subscale +Gait Subscale =Total Score Total score previously correlated with risk of falls
6 Scale Modification Two Items Omitted: Stand, feet together, nudge 3 times on sternum Stand with eyes closed One Item Modified: Turn Modified to a more easily observable task of turning Any scale modification calls for examination of the impact on the psychometric properties (reliability, validity)
7 Purpose To determine the Inter-rater & Test- retest reliability of the modified Tinetti (Dementia) To test the modified measure in at least 2 settings (e.g. inpatient & long term care)
8 Methods Reliability study in preparation for validity study Participants: inpatients & residents Inclusion: dementia, ambulate with minimal assistance. Exclusion: acute change in medical status within the past two days (e.g. probable delirium, acute infection). Consent from SDM
9 Testing at other sites Additional recruitment sites: ALC unit at Charlton Wentworth Lodge Plan for Parkwood Institute, Geriatric Psychiatry Unit
10 Methods Inter-rater reliability: administered by two staff who had read instructions, practiced 2-3 times with measure (PT, OT & RN) Test-retest reliability: minutes after first administration
11 Sample Description n=22 consent by SDM n=18 valid data n=1 unable to ambulate, n=3 not available on day of visit mean age=77 female n=11 (61%), male n=7 (39%) Most common secondary diagnoses: diabetes, heart disease, Parkinson s MMSE score range 0-22/30
12 Results: Sample Description Tinetti scale mean range Balance subscale 7.9/ Gait subscale 9.4/ Total score 17.3/
13 Results Inter-rater reliability for total score r= 0.94 (p<0.01) Test-retest reliability for total score r= 0.90 (p<0.01)
14 Discussion Results comparable to established reliability of the original Tinetti tool (r>0.8) (Kekelmeyer, Kloos, Thomas & Kostyk, 2007). Results promising for reliability of Tinetti Scale for Balance & Gait (Dementia) Feasible administration in inpatient & LTC settings
15 Discussion Turning easily accomplished by leading person towards end of hallway & able to observe required skill (continuity of steps) Difficult items: Standing up & Sitting down: required significant cueing for some participants Path - marked deviation or straight? Dementia- may be deviated but straight to object of interest
16 Conclusions Reliability of modified measure was high Assessment of functional changes in this population is important for determining the impact of mobilization and least restraint programs for people with dementia. Further study will establish validity of the cut score for predicting falls risk.
17 Special thanks Patients/residents and their SDMs Lisa Cifa (Rehab assistant) Sandra Forster, RN Mary Kay Grolla: PT, ALC Charlton Sheri Burns: Research Assistant
18 Thank you Questions? contact:
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