Backward walk test: a reliable and valid tool to assess gait and balance in older adults with dementia

Background and Purpose: The backward walk test (BWT) has been used to evaluate the balance, gait and fall risk for older adults, but its psychometric properties in older adults with dementia have not been investigated. This study aims at examining the test-retest and inter-rater reliability, construct and known-group validity, and absolute and relative minimal detectable changes at the 95% level of confidence (MDC95) of the BWT in older adults with dementia. Methods: This study was a cross-sectional study with repeated measures. Older adults with a mean age of 83.3 years and a diagnosis of dementia who were able to walk backward independently for at least 3 meters were recruited from day care and residential care units. The BWT was conducted on three separate testing occasions within two weeks under two independent raters using a modified progressive cueing system. The 10-meter walk test (10MWT), Berg Balance Scale (BBS), and Timed Up and Go Test (TUG) were used to assess the gait, balance and mobility performances of the participants. Sample Size: 30 Year of Study: 2019 Results and Discussion: The BWT had excellent test-retest reliability [intra-class correlation coefficient (ICC) = 0.96] and inter-rater reliability (ICC = 0.97–0.97) in the participants. Moderate correlations between the BWT and BBS [Spearman’s rho (ρ) = 0.60], and strong correlations between the BWT and 10MWT (ρ = 0.84) and TUG (ρ = -0.82) were found. The BWT could distinguish between the participants who ambulated with walking aids and those who did not (p < 0.001). The participants who had experienced a fall in the past year did not differ significantly in the BWT compared with those who had not fallen (p = 0.13). The absolute and relative MDC95 of the BWT in the participants were 0.10 m/s and 39.3%, respectively. Conclusions: The BWT is reliable and valid in assessing balance and gait performances in older adults with dementia. Further investigation is needed to determine whether the BWT can identify those with an increased risk of falls.