human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose : Abnormal postural sway is associated with an increase in risk of falls but is difficult for clinicians to accurately quantify without access to laboratory equipment . Instrumenting clinical outcome measures using body-worn movement monitors is a low-cost alternative . This is the first study to compare the modified Clinical Test of Sensory Integration for Balance ( i-mCTSIB ) to the laboratory test of the Sensory Organization Test ( SOT ) with dynamic posturography in a group of participants with Parkinson 's disease ( PD ) and subtle balance limitations . The purpose of this study was to ( 1 ) determine the concurrent validity of the i-mCTSIB with the SOT ( 6 and 4 conditions ) and ( 2 ) compare the i-mCTSIB and the SOT to differentiate between individuals with and without recent falls within the previous 6 months . Methods : This cross-sectional study examined 26 participants with idiopathic PD who had a Motor Unified Parkinson 's Disease Rating Scale score of 32.7 ( 13.5 ) out of 108 . Results : The composite and conditions 1 and 4 of the i-mCTSIB and SOT scores were significantly correlated : composite scores r = −0.64 ( P ⩽ .001 ) , C1 r = −0.43 ( P = .03 ) , C3 r = −0.60 ( P ⩽ .01 ) , and C4 r = −0.54 ( P ⩽ .001 ) . A significant difference was observed in mean i-mCTSIB composite scores between fallers and nonfallers ( P = .04 ) . In contrast , the SOT composite was not significantly different between fallers and nonfallers ( P = 0.31 ) . Discussion : The results suggest that the i-mCTSIB may be a valid and clinical ly meaningful measure of sensory organization in persons with PD , even those with mild postural instability as measured by the median Hoehn and Yahr score ( 2.0 ) . Future research should evaluate predictive validity of the i-mCTSIB for prospect i ve falls . Conclusion : The instrumented mCTSIB with portable , body-worn movement allows clinicians to quantify abnormal postural sway without the ceiling effects of clinical balance testing or the expense and importability of force plate technology in the SOT . Instrumenting mCTSIB may also distinguish between fallers and nonfallers Background The minimal detectable change ( MDC ) is the smallest amount of difference in individual scores that represents true change ( beyond r and om measurement error ) . The MDCs of the Timed “ Up & Go ” Test ( TUG ) and the Dynamic Gait Index ( DGI ) in people with Parkinson disease ( PD ) are largely unknown , limiting the interpretability of the change scores of both measures . Objective The purpose of this study was to estimate the MDCs of the TUG and the DGI in people with PD . Design This investigation was a prospect i ve cohort study . Methods Seventy-two participants were recruited from special clinics for movement disorders at a university hospital . Their mean age was 67.5 years , and 61 % were men . All participants completed the TUG and the DGI assessment s twice , about 14 days apart . The MDC was calculated from the st and ard error of measurement . The percentage MDC ( MDC% ) was calculated as the MDC divided by the mean of all scores for the sample . Furthermore , the intraclass correlation coefficient was used to examine the reproducibility between testing sessions ( test-retest reliability ) . Results The respective MDC and MDC% of the TUG were 3.5 seconds and 29.8 , and those of the DGI were 2.9 points and 13.3 . The test-retest reliability values for the TUG and the DGI were high ; the intraclass correlation coefficients were .80 and .84 , respectively . Limitations The study sample was a convenience sample , and the participants had mild to moderately severe PD . Conclusions The results showed that the TUG and the DGI have generally acceptable r and om measurement error and test-retest reliability . These findings should help clinicians and research ers determine whether a change in an individual patient with PD is a true change Background and Purpose : Distinguishing between a clinical ly significant change and change due to measurement error can be difficult . The purpose of this study was to determine test-retest reliability and minimal detectable change for the Berg Balance Scale ( BBS ) , forward and backward functional reach , the  Romberg Test and the Sharpened Romberg Test ( SRT ) with eyes open and closed , the Activities-specific Balance Confidence ( ABC ) Scale , the  Six-Minute Walk Test ( 6MWT ) , comfortable and fast gait speed , the  Timed “ Up & Go ” Test ( TUG ) , the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) , and the Unified Parkinson Disease Rating Scale ( UPDRS ) in people with parkinsonism . Subjects : Thirty-seven community-dwelling adults with parkinsonism ( mean age=71 years ) participated . The Hoehn and Yahr Scale median score of 2 was on the lower end of the scale ; however , the scores ranged from 1 to 4 . Methods : Subjects were tested twice by the same raters , with 1 week between tests . Test-retest reliability was calculated using intraclass correlation coefficients ( ICCs ) . Minimal detectable change was calculated using a 95 % confidence interval ( MDC95 ) . Results : The ICCs for test-retest reliability were above .90 for the BBS , ABC Scale , SRT with eyes closed , 6MWT , and comfortable and fast gait speeds . The MDC95 values for those functional tests were : BBS=5/56 , ABC Scale=13 % , SRT with eyes closed=19 seconds , 6MWT=82 m , comfortable gait speed=0.18 m/s , and fast gait speed=0.25 m/s . The ICCs for test-retest reliability of SF-36 scores were above .80 , with the exception of the social functioning subscale . The MDC95 values for the SF-36 ranged between 19 % and 45 % . The MDC95 values for the UPDRS Activities of Daily Living section , Motor Examination section , and total scores were 4/52 , 11/108 , and 13/176 , respectively . Discussion and Conclusion : Minimal detectable change values are useful to therapists in rehabilitation and wellness programs in determining whether change during or after intervention is clinical ly significant . High test-retest reliability of scores for the BBS , ABC Scale , SRT with eyes closed , 6MWT , and gait speed make them trustworthy functional assessment s in people with parkinsonism . The SF-36 and UPDRS provide quality -of-life and disease severity rating values in the ongoing assessment of people with parkinsonism Introduction . We analyzed the ability of four balance assessment s to predict falls in people with Parkinson Disease ( PD ) prospect ively over six and 12 months . Material s and Methods . The BESTest , Mini-BESTest , Functional Gait Assessment ( FGA ) , and Berg Balance Scale ( BBS ) were administered to 80 participants with idiopathic PD at baseline . Falls were then tracked for 12 months . Ability of each test to predict falls at six and 12 months was assessed using ROC curves and likelihood ratios ( LR ) . Results . Twenty-seven percent of the sample had fallen at six months , and 32 % of the sample had fallen at 12 months . At six months , areas under the ROC curve ( AUC ) for the tests ranged from 0.8 ( FGA ) to 0.89 ( BESTest ) with LR+ of 3.4 ( FGA ) to 5.8 ( BESTest ) . At 12 months , AUCs ranged from 0.68 ( BESTest , BBS ) to 0.77 ( Mini-BESTest ) with LR+ of 1.8 ( BESTest ) to 2.4 ( BBS , FGA ) . Discussion . The various balance tests were effective in predicting falls at six months . All tests were relatively ineffective at 12 months . Conclusion . This pilot study suggests that people with PD should be assessed biannually for fall risk PURPOSE The aims of this study were to determine test-retest reliability and responsiveness of short-distance walking speed tests for persons with Parkinson disease ( PD ) . Discriminant and convergent validity of walking speed tests were also examined . METHODS Eighty-eight participants with PD ( mean age , 66 years ) with mild to moderate severity ( stages 1 - 4 on the Hoehn and Yahr Scale ) were tested on medications . Measures of activity included the  comfortable and fast 10-m walk tests ( CWT , FWT ) , 6-min walk test ( 6MWT ) , mini balance evaluations systems test ( mini-BEST Test ) , fear of falling ( FoF ) , and the Activity-Specific Balance Confidence Scale ( ABC ) . The mobility subsection of the PD quality of life-39 ( PDQ39-M ) served as a participation-based measure . RESULTS Test-retest reliability was high for both walking speed measures ( CWT , ICC(2,1 ) = 0.98 ; FWT , ICC(2,1 ) = 0.99 ) . Minimal detectable change ( MDC(95 ) ) for the CWT and FWT was 0.09 m/s and 0.13 m/s respectively . Participants at Hoehn & Yahr levels 3/4 demonstrated significantly slower walking speed with the CWT and FWT than participants at Hoehn & Yahr levels 1 and 2 ( P < .01 ) . The CWT and FWT were both significantly ( P ≤ .002 ) correlated with all activity and participation-based measures . CONCLUSIONS Short-distance walking speed tests are clinical ly useful measures for persons with PD . The CWT and FWT are highly reliable and responsive to change in persons with PD . Short distance walking speed can be used to discriminate differences in gait function between persons with mild and moderate PD severity . The CWT and FWT had moderate to strong associations with other activity and participation based measures demonstrating convergent validity BACKGROUND Assessment of fall risk in an individual with Parkinson disease ( PD ) is a critical yet often time consuming component of patient care . Recently a simple clinical prediction tool based only on fall history in the previous year , freezing of gait in the past month , and gait velocity < 1.1 m/s was developed and accurately predicted future falls in a sample of individuals with PD . METHODS We sought to externally vali date the utility of the tool by administering it to a different cohort of 171 individuals with PD .  Falls were monitored prospect ively for 6 months following predictor assessment . RESULTS The tool accurately discriminated future fallers from non-fallers ( area under the curve [ AUC ] = 0.83 ; 95 % CI 0.76 - 0.89 ) , comparable to the developmental study . CONCLUSION The results vali date d the utility of the tool for allowing clinicians to quickly and accurately identify an individual 's risk of an impending fall BACKGROUND AND PURPOSE The Timed " Up & Go " Test ( TUG ) is used to measure the ability of patients to perform sequential locomotor tasks that incorporate walking and turning . This study investigated the retest reliability , interrater reliability , and sensitivity of scores obtained with the TUG in detecting changes in mobility in subjects with idiopathic Parkinson disease ( PD ) . SUBJECTS The performance of 12 people with PD was compared with that of 12 age-matched comparison subjects without PD . METHODS The subjects with PD completed 5 trials of the TUG after withdrawal of levodopa for 12 hours ( " off " phase of the medication cycle ) as well as an additional 5 trials 1 hour after levodopa was administered ( " on " phase of the medication cycle ) . They were scored on the Modified Webster Scale at both sessions . The comparison subjects also performed 5 TUG trials . All trials were videotaped and timed by 2 experienced raters . The videotape was later rated by 3 experienced clinicians and 3 inexperienced clinicians . RESULTS For the subjects with PD , within-session performance was highly consistent , with correlations ( r ) ranging from.80 to.98 for the " off " phase and from.73 to.99 for the " on " phase . The performance of the comparison subjects across the 5 trials was also highly consistent ( r=.90-.97 ) . Comparisons showed differences between trials 1 and 2 on the TUG for both groups . Removal of data for trial 1 ( the practice trial ) further enhanced retest reliability . There was close agreement in TUG scores among raters despite different levels of experience ( intraclass correlation coefficient [3,1]=.87-.99 ) . Mean TUG scores were different between the " on " and " off " phases of the levodopa cycle and between subjects with PD and comparison subjects during the " on " phase . CONCLUSION AND DISCUSSION Retest reliability and interrater reliability of the TUG measurements were high , and the measurements reflected changes in performance according to levodopa use . The TUG can also be used to detect differences in performance between people with PD and elderly people without PD Background The Functional Gait Assessment ( FGA ) is a vali date d measurement of gait-related activities in certain population s and may be potentially useful to assess balance and gait disorders in patients with Parkinson disease ( PD ) . Objective The purpose of this study was to determine the construct , concurrent , and predictive validity of the FGA in in patients with PD . Design This was a prospect i ve cohort study . Methods One hundred twenty-one in patients with PD were prospect ively enrolled . The FGA and other relevant appraisal s of gait , balance , disease severity , and activities of daily living were performed . Six months later , the patients were interviewed by telephone to have their fall information collected . Principal component analysis was used to determine construct validity . Spearman correlation 
    Output:
    
agent
These measures assess balance and falls risk prediction at the body , structure and function level , falls risk and balance , and falls risk at the activity level .
The motor examination of the Unified Parkinson ’s Disease Rating Scale ( UPDRS-ME ) with robust psychometric analysis is a condition-specific measure with acceptable properties .
Conclusion : Six of the 68 outcome measures have strong psychometric properties for the assessment of balance and falls risk prediction in PD .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background and Purpose : Abnormal postural sway is associated with an increase in risk of falls but is difficult for clinicians to accurately quantify without access to laboratory equipment . Instrumenting clinical outcome measures using body-worn movement monitors is a low-cost alternative . This is the first study to compare the modified Clinical Test of Sensory Integration for Balance ( i-mCTSIB ) to the laboratory test of the Sensory Organization Test ( SOT ) with dynamic posturography in a group of participants with Parkinson 's disease ( PD ) and subtle balance limitations . The purpose of this study was to ( 1 ) determine the concurrent validity of the i-mCTSIB with the SOT ( 6 and 4 conditions ) and ( 2 ) compare the i-mCTSIB and the SOT to differentiate between individuals with and without recent falls within the previous 6 months . Methods : This cross-sectional study examined 26 participants with idiopathic PD who had a Motor Unified Parkinson 's Disease Rating Scale score of 32.7 ( 13.5 ) out of 108 . Results : The composite and conditions 1 and 4 of the i-mCTSIB and SOT scores were significantly correlated : composite scores r = −0.64 ( P ⩽ .001 ) , C1 r = −0.43 ( P = .03 ) , C3 r = −0.60 ( P ⩽ .01 ) , and C4 r = −0.54 ( P ⩽ .001 ) . A significant difference was observed in mean i-mCTSIB composite scores between fallers and nonfallers ( P = .04 ) . In contrast , the SOT composite was not significantly different between fallers and nonfallers ( P = 0.31 ) . Discussion : The results suggest that the i-mCTSIB may be a valid and clinical ly meaningful measure of sensory organization in persons with PD , even those with mild postural instability as measured by the median Hoehn and Yahr score ( 2.0 ) . Future research should evaluate predictive validity of the i-mCTSIB for prospect i ve falls . Conclusion : The instrumented mCTSIB with portable , body-worn movement allows clinicians to quantify abnormal postural sway without the ceiling effects of clinical balance testing or the expense and importability of force plate technology in the SOT . Instrumenting mCTSIB may also distinguish between fallers and nonfallers Background The minimal detectable change ( MDC ) is the smallest amount of difference in individual scores that represents true change ( beyond r and om measurement error ) . The MDCs of the Timed “ Up & Go ” Test ( TUG ) and the Dynamic Gait Index ( DGI ) in people with Parkinson disease ( PD ) are largely unknown , limiting the interpretability of the change scores of both measures . Objective The purpose of this study was to estimate the MDCs of the TUG and the DGI in people with PD . Design This investigation was a prospect i ve cohort study . Methods Seventy-two participants were recruited from special clinics for movement disorders at a university hospital . Their mean age was 67.5 years , and 61 % were men . All participants completed the TUG and the DGI assessment s twice , about 14 days apart . The MDC was calculated from the st and ard error of measurement . The percentage MDC ( MDC% ) was calculated as the MDC divided by the mean of all scores for the sample . Furthermore , the intraclass correlation coefficient was used to examine the reproducibility between testing sessions ( test-retest reliability ) . Results The respective MDC and MDC% of the TUG were 3.5 seconds and 29.8 , and those of the DGI were 2.9 points and 13.3 . The test-retest reliability values for the TUG and the DGI were high ; the intraclass correlation coefficients were .80 and .84 , respectively . Limitations The study sample was a convenience sample , and the participants had mild to moderately severe PD . Conclusions The results showed that the TUG and the DGI have generally acceptable r and om measurement error and test-retest reliability . These findings should help clinicians and research ers determine whether a change in an individual patient with PD is a true change Background and Purpose : Distinguishing between a clinical ly significant change and change due to measurement error can be difficult . The purpose of this study was to determine test-retest reliability and minimal detectable change for the Berg Balance Scale ( BBS ) , forward and backward functional reach , the  Romberg Test and the Sharpened Romberg Test ( SRT ) with eyes open and closed , the Activities-specific Balance Confidence ( ABC ) Scale , the  Six-Minute Walk Test ( 6MWT ) , comfortable and fast gait speed , the  Timed “ Up & Go ” Test ( TUG ) , the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) , and the Unified Parkinson Disease Rating Scale ( UPDRS ) in people with parkinsonism . Subjects : Thirty-seven community-dwelling adults with parkinsonism ( mean age=71 years ) participated . The Hoehn and Yahr Scale median score of 2 was on the lower end of the scale ; however , the scores ranged from 1 to 4 . Methods : Subjects were tested twice by the same raters , with 1 week between tests . Test-retest reliability was calculated using intraclass correlation coefficients ( ICCs ) . Minimal detectable change was calculated using a 95 % confidence interval ( MDC95 ) . Results : The ICCs for test-retest reliability were above .90 for the BBS , ABC Scale , SRT with eyes closed , 6MWT , and comfortable and fast gait speeds . The MDC95 values for those functional tests were : BBS=5/56 , ABC Scale=13 % , SRT with eyes closed=19 seconds , 6MWT=82 m , comfortable gait speed=0.18 m/s , and fast gait speed=0.25 m/s . The ICCs for test-retest reliability of SF-36 scores were above .80 , with the exception of the social functioning subscale . The MDC95 values for the SF-36 ranged between 19 % and 45 % . The MDC95 values for the UPDRS Activities of Daily Living section , Motor Examination section , and total scores were 4/52 , 11/108 , and 13/176 , respectively . Discussion and Conclusion : Minimal detectable change values are useful to therapists in rehabilitation and wellness programs in determining whether change during or after intervention is clinical ly significant . High test-retest reliability of scores for the BBS , ABC Scale , SRT with eyes closed , 6MWT , and gait speed make them trustworthy functional assessment s in people with parkinsonism . The SF-36 and UPDRS provide quality -of-life and disease severity rating values in the ongoing assessment of people with parkinsonism Introduction . We analyzed the ability of four balance assessment s to predict falls in people with Parkinson Disease ( PD ) prospect ively over six and 12 months . Material s and Methods . The BESTest , Mini-BESTest , Functional Gait Assessment ( FGA ) , and Berg Balance Scale ( BBS ) were administered to 80 participants with idiopathic PD at baseline . Falls were then tracked for 12 months . Ability of each test to predict falls at six and 12 months was assessed using ROC curves and likelihood ratios ( LR ) . Results . Twenty-seven percent of the sample had fallen at six months , and 32 % of the sample had fallen at 12 months . At six months , areas under the ROC curve ( AUC ) for the tests ranged from 0.8 ( FGA ) to 0.89 ( BESTest ) with LR+ of 3.4 ( FGA ) to 5.8 ( BESTest ) . At 12 months , AUCs ranged from 0.68 ( BESTest , BBS ) to 0.77 ( Mini-BESTest ) with LR+ of 1.8 ( BESTest ) to 2.4 ( BBS , FGA ) . Discussion . The various balance tests were effective in predicting falls at six months . All tests were relatively ineffective at 12 months . Conclusion . This pilot study suggests that people with PD should be assessed biannually for fall risk PURPOSE The aims of this study were to determine test-retest reliability and responsiveness of short-distance walking speed tests for persons with Parkinson disease ( PD ) . Discriminant and convergent validity of walking speed tests were also examined . METHODS Eighty-eight participants with PD ( mean age , 66 years ) with mild to moderate severity ( stages 1 - 4 on the Hoehn and Yahr Scale ) were tested on medications . Measures of activity included the  comfortable and fast 10-m walk tests ( CWT , FWT ) , 6-min walk test ( 6MWT ) , mini balance evaluations systems test ( mini-BEST Test ) , fear of falling ( FoF ) , and the Activity-Specific Balance Confidence Scale ( ABC ) . The mobility subsection of the PD quality of life-39 ( PDQ39-M ) served as a participation-based measure . RESULTS Test-retest reliability was high for both walking speed measures ( CWT , ICC(2,1 ) = 0.98 ; FWT , ICC(2,1 ) = 0.99 ) . Minimal detectable change ( MDC(95 ) ) for the CWT and FWT was 0.09 m/s and 0.13 m/s respectively . Participants at Hoehn & Yahr levels 3/4 demonstrated significantly slower walking speed with the CWT and FWT than participants at Hoehn & Yahr levels 1 and 2 ( P < .01 ) . The CWT and FWT were both significantly ( P ≤ .002 ) correlated with all activity and participation-based measures . CONCLUSIONS Short-distance walking speed tests are clinical ly useful measures for persons with PD . The CWT and FWT are highly reliable and responsive to change in persons with PD . Short distance walking speed can be used to discriminate differences in gait function between persons with mild and moderate PD severity . The CWT and FWT had moderate to strong associations with other activity and participation based measures demonstrating convergent validity BACKGROUND Assessment of fall risk in an individual with Parkinson disease ( PD ) is a critical yet often time consuming component of patient care . Recently a simple clinical prediction tool based only on fall history in the previous year , freezing of gait in the past month , and gait velocity < 1.1 m/s was developed and accurately predicted future falls in a sample of individuals with PD . METHODS We sought to externally vali date the utility of the tool by administering it to a different cohort of 171 individuals with PD .  Falls were monitored prospect ively for 6 months following predictor assessment . RESULTS The tool accurately discriminated future fallers from non-fallers ( area under the curve [ AUC ] = 0.83 ; 95 % CI 0.76 - 0.89 ) , comparable to the developmental study . CONCLUSION The results vali date d the utility of the tool for allowing clinicians to quickly and accurately identify an individual 's risk of an impending fall BACKGROUND AND PURPOSE The Timed " Up & Go " Test ( TUG ) is used to measure the ability of patients to perform sequential locomotor tasks that incorporate walking and turning . This study investigated the retest reliability , interrater reliability , and sensitivity of scores obtained with the TUG in detecting changes in mobility in subjects with idiopathic Parkinson disease ( PD ) . SUBJECTS The performance of 12 people with PD was compared with that of 12 age-matched comparison subjects without PD . METHODS The subjects with PD completed 5 trials of the TUG after withdrawal of levodopa for 12 hours ( " off " phase of the medication cycle ) as well as an additional 5 trials 1 hour after levodopa was administered ( " on " phase of the medication cycle ) . They were scored on the Modified Webster Scale at both sessions . The comparison subjects also performed 5 TUG trials . All trials were videotaped and timed by 2 experienced raters . The videotape was later rated by 3 experienced clinicians and 3 inexperienced clinicians . RESULTS For the subjects with PD , within-session performance was highly consistent , with correlations ( r ) ranging from.80 to.98 for the " off " phase and from.73 to.99 for the " on " phase . The performance of the comparison subjects across the 5 trials was also highly consistent ( r=.90-.97 ) . Comparisons showed differences between trials 1 and 2 on the TUG for both groups . Removal of data for trial 1 ( the practice trial ) further enhanced retest reliability . There was close agreement in TUG scores among raters despite different levels of experience ( intraclass correlation coefficient [3,1]=.87-.99 ) . Mean TUG scores were different between the " on " and " off " phases of the levodopa cycle and between subjects with PD and comparison subjects during the " on " phase . CONCLUSION AND DISCUSSION Retest reliability and interrater reliability of the TUG measurements were high , and the measurements reflected changes in performance according to levodopa use . The TUG can also be used to detect differences in performance between people with PD and elderly people without PD Background The Functional Gait Assessment ( FGA ) is a vali date d measurement of gait-related activities in certain population s and may be potentially useful to assess balance and gait disorders in patients with Parkinson disease ( PD ) . Objective The purpose of this study was to determine the construct , concurrent , and predictive validity of the FGA in in patients with PD . Design This was a prospect i ve cohort study . Methods One hundred twenty-one in patients with PD were prospect ively enrolled . The FGA and other relevant appraisal s of gait , balance , disease severity , and activities of daily living were performed . Six months later , the patients were interviewed by telephone to have their fall information collected . Principal component analysis was used to determine construct validity . Spearman correlation 
    Output:
    