Jump to content

New Freezing of Gait Questionnaire (NFOG-Q)

Original Editor - Marleen MollTop Contributors - Uchechukwu Chukwuemeka, Simisola Ajeyalemi, Marleen Moll, Vidya Acharya and Alexandra Stead

Introduction

Freezing of gait (FOG) is an episodic gait disturbance characterised by brief episodes of inability to step or by extremely short steps that typically occur during gait initiation or turning.[1] FOG affects approximately 40% of patients with Parkinson's disease (PD), increasing to over 70% in advanced disease, and contributes significantly to falls and reduced quality of life.[2][3][4] Due to its episodic nature, FOG may not manifest during clinical examinations, necessitating patient-reported outcome measures.[5] The original Freezing of Gait Questionnaire (FOG-Q) was developed by Giladi et al. in 2000 as a six-item self-administered questionnaire.[6] The New Freezing of Gait Questionnaire (NFOG-Q) was developed by Nieuwboer et al. in 2009, expanding to 9 items with enhanced psychometric properties and a video demonstrating FOG types[7]

Objective

The New Freezing of Gait Questionnaire (NFOG-Q) is a self-reported questionnaire consisting of 9 items that measure FOG. The NFOG-Q is the renewed version of the FOG-Q, which originally consisted of 6 items.

Intended Population

Patients with Parkinson's Disease and other Parkinson-related Symptoms.

Method of Use

The NFOG-Q doesn't require any equipment and is simple to administer. When rating the frequency of FOG over the previous month, patients independently complete the questionnaire, reporting both ON and OFF medication states.[7][8] Responses to all but item 1 are added up to determine the final score, which ranges from 0 to 28. Higher ratings indicate greater impact and intensity of freezing episodes.[8] Patients who respond negatively to item 1, which functions as a screening question, may be categorised as non-freezers.[9]

Evidence

Reliability

According to Nieuwboer et al.,[7] the NFOG-Q has practically perfect internal consistency in identifying freezing of gait and a strong inter-rater agreement between patients and caretakers (ICC = 0.78). Nevertheless, a high minimal detectable change (35.5%) and relatively moderate test-retest reliability were discovered in later research by Hulzinga et al.[8] Because of this, the NFOG-Q is less useful for identifying minute clinical changes in individual patients, even though it is useful for group-level studies.

Validity

The NFOG-Q successfully captures different features of FOG severity and functional effects, exhibiting excellent construct validity and high internal consistency (Cronbach's alpha = 0.84 to 0.87).[7] Giladi et al. found that it was more sensitive than the Unified Parkinson's Disease Rating Scale (UPDRS) motor test, detecting 85.9% of "freezers" as opposed to just 44.1%.[9] Additionally, compared to typical clinical scales, the questionnaire is more sensitive to particular gait abnormalities and has a good correlation with more general Parkinson's mobility measurements.[9]

Responsiveness

There is little data on the NFOG-Q's responsiveness. According to Hulzinga et al., the measure may not be sensitive enough to identify clinically significant changes after intervention because the minimal detectable change values were comparatively large in comparison to the treatment effects that were seen.[8] Their study's standardised response mean revealed low responsiveness, casting doubt on the NFOG-Q's usefulness as the main outcome measure in therapeutic studies.[8] To determine whether the NFOG-Q can identify changes in response to pharmaceutical and rehabilitative therapies, more research is required.

References

  1. ↑ Nutt JG, Bloem BR, Giladi N, Hallett M, Horak FB, Nieuwboer A. Freezing of gait: moving forward on a mysterious clinical phenomenon. Lancet Neurol. 2011;10(8):734-44. doi: 10.1016/S1474-4422(11)70143-0.
  2. ↑ Perez-Lloret S, Negre-Pages L, Damier P, Delval A, Derkinderen P, Destée A, et al. Prevalence, determinants, and effect on quality of life of freezing of gait in Parkinson disease. JAMA Neurol. 2014;71(7):884-90. doi: 10.1001/jamaneurol.2014.753.
  3. ↑ Amboni M, Stocchi F, Abbruzzese G, Morgante L, Onofrj M, Ruggieri S, et al. Prevalence and associated features of self-reported freezing of gait in Parkinson disease: The DEEP FOG study. Parkinsonism Relat Disord. 2015;21(6):644-9. doi: 10.1016/j.parkreldis.2015.03.028.
  4. ↑ Zhang WS, Gao C, Tan YY, Chen SD. Prevalence of freezing of gait in Parkinson's disease: a systematic review and meta-analysis. J Neurol. 2021;268(11):4138-4150. doi: 10.1007/s00415-021-10685-5. Erratum in: J Neurol. 2021;268(11):4151. doi: 10.1007/s00415-021-10756-7.
  5. ↑ Snijders AH, Nijkrake MJ, Bakker M, Munneke M, Wind C, Bloem BR. Clinimetrics of freezing of gait. Mov Disord. 2008;23 Suppl 2:S468-74. doi: 10.1002/mds.22144. Erratum in: Mov Disord. 2008 Aug 15;23(11):1639-40.
  6. ↑ Giladi N, Shabtai H, Simon ES, Biran S, Tal J, Korczyn AD. Construction of freezing of gait questionnaire for patients with Parkinsonism. Parkinsonism Relat Disord. 2000;6(3):165-170. doi: 10.1016/s1353-8020(99)00062-0.
  7. ↑ 7.0 7.1 7.2 7.3 Nieuwboer A, Rochester L, Herman T, Vandenberghe W, Emil GE, Thomaes T, et al. Reliability of the new freezing of gait questionnaire: agreement between patients with Parkinson's disease and their carers. Gait Posture. 2009;30(4):459-63. doi: 10.1016/j.gaitpost.2009.07.108.
  8. ↑ 8.0 8.1 8.2 8.3 8.4 Hulzinga F, Nieuwboer A, Dijkstra BW, Mancini M, Strouwen C, Bloem BR, Ginis P. The New Freezing of Gait Questionnaire: Unsuitable as an Outcome in Clinical Trials? Mov Disord Clin Pract. 2020 Jan 14;7(2):199-205.
  9. ↑ 9.0 9.1 9.2 Giladi N, Tal J, Azulay T, Rascol O, Brooks DJ, Melamed E, et al. Validation of the freezing of gait questionnaire in patients with Parkinson's disease. Mov Disord. 2009;24(5):655-61. doi: 10.1002/mds.21745.
Retrieved from "https://www.physio-pedia.com/w/index.php?title=New_Freezing_of_Gait_Questionnaire_(NFOG-Q)&oldid=375488"