# Translation, reliability, and validation of the Dutch Safe Use of Mobility Aid Checklist (SUMAC-NL) for walker use in people living with dementia

## TL;DR

This paper introduces and validates a Dutch version of a tool to assess walker use in people with dementia, aiming to reduce fall risks.

## Contribution

The SUMAC-NL is a newly developed and validated Dutch instrument for assessing functional walking skills with a walker in people with dementia.

## Key findings

- The SUMAC-NL shows good to excellent inter-rater and test-retest reliability for both PF and EQ domains.
- Content validity was confirmed with CVI >0.79 and CVR scores of 0.53 (PF) and 0.78 (EQ).
- The tool is promising for assessing walker use in people with dementia in the Netherlands.

## Abstract

Background: People with dementia have a yearly risk of falling of 60 to 80 percent. Therefore, a walker is often recommended. However, the use of a walker in people with dementia is associated with a threefold increased odds of falls compared to their healthy peers. Better advice and training could reduce fall risk. Therefore, a tool to assess functional walking skills with a walker is needed. The SUMAC was developed to fill this gap. So far, there is no Dutch instrument available that can assess functional walking skills with a walker in people with dementia.

Methods: Reliability was evaluated by scoring videos of people with dementia (n = 9) using a walker performing the SUMAC-NL. ICC was used to assess inter-rater and test-retest reliability. An expert panel (n = 8) evaluated the content validity using the content validity index (CVI) and the content validity ratio (CVR).

Results: Inter-rater reliability of the SUMAC-NL was statistically significant for the PF domain (ICC = 0.94, 95%CI (0.84, 0.98, p < 0.001) and for the EQ domain (ICC = 0.79, 95%CI (0.49 – 0.95), p < 0.001). Test-retest reliability was statistically significant for both the PF domain (ICC = 0.95, 95%CI (0.89, 0.99), p < 0.001) and EQ domain (ICC = 0.92, 95%CI (0.82, 0.98), p < 0.001). The SUMAC-NL shows content validity with a CVI >0.79 for both domains and a CVR of 0.53 on the PF domain and 0.78 on the EQ domain.

Conclusions: The SUMAC-NL shows good to excellent reliability and content validity for both the PF and the EQ domain. The SUMAC-NL seems to be a promising tool to assess walking with a walker in people with dementia in the Netherlands.