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Time To Navigate (TTN): A practical objective clinical measure for freezing of gait severity in people with Parkinson's disease
Journal article   Peer reviewed

Time To Navigate (TTN): A practical objective clinical measure for freezing of gait severity in people with Parkinson's disease

Aileen Eugenia Scully, Dawn May Leng Tan, Beatriz Ito Ramos de Oliveira, Keith David Hill, Ross Clark and Yong Hao Pua
Archives of Physical Medicine and Rehabilitation, Vol.106(2), pp.247-254
2025
DOI: https://doi.org/10.1016/j.apmr.2024.09.003
PMID: 39304078

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Abstract

clinical assessment freezing of gait objective measure Parkinson's disease
Objectives To provide an easy-to-use measure, as existing objective assessments for freezing of gait (FOG) severity may be unwieldy for routine clinical practice, this study explored time taken to complete the recently-validated FOG Severity Tool and its components. Design Cross-sectional Setting Outpatient clinics of a tertiary hospital Participants People with Parkinson's who could independently ambulate eight-metres, understand instructions, and without co-morbidities affecting gait were consecutively recruited. Thirty-five participants were included [82.9%(n=29)male; Median(IQR): age – 73.0(11.0)years; disease duration – 4.0(4.5)years]. Interventions Not applicable Main outcome measures Participants were assessed with FOG Severity Tool in a test-retest design, with time taken for each component recorded using a stopwatch during video-analysis. Validity of total FOG Severity Tool time, time taken to complete its turning and narrow-space components (i.e., Time To Navigate, TTN), and an adjusted-TTN were examined through correlations with validated FOG severity outcomes. To facilitate clinical interpretation, TTN cutoff was determined using scatterplot smoothing (LOESS) regression whilst minimal important change (MIC) was calculated using predictive modelling. Results FOG Severity Tool time, TTN, and adjusted-TTN similarly demonstrated moderate correlations with the FOG Questionnaire and percentage-FOG, and very-high correlations with FOG Severity Tool-Revised. TTN was nonlinearly related to FOG severity, with a positive relationship observed in the first 300-seconds and plateauing after. MIC for TTN was 15.4-seconds reduction in timing (95%CI 3.2 to 28.7). Conclusions TTN is a feasible, interpretable, and valid test of FOG severity. In busy clinical settings, TTN can provide a viable alternative when use of existing objective FOG measures is (often) unfeasible.

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