The Reliability and Validity of Measures of Gait Variability in Community-Dwelling Older Adults

doi:10.1016/j.apmr.2008.06.010

Archives of Physical Medicine and Rehabilitation

Volume 89, Issue 12, December 2008, Pages 2293-2296

Presented at the International Society for Posture and Gait Research, Burlington, VT, July 14–18, 2007.

https://doi.org/10.1016/j.apmr.2008.06.010 Get rights and content

Abstract

Brach JS, Perera S, Studenski S, Newman AB. The reliability and validity of measures of gait variability in community-dwelling older adults.

Objective

To examine the test-retest reliability and concurrent validity of variability of gait characteristics.

Design

Cross-sectional study.

Setting

Research laboratory.

Participants

Older adults (N=558) from the Cardiovascular Health Study.

Interventions

Not applicable.

Main Outcome Measures

Gait characteristics were measured using a 4-m computerized walkway. SD determined from the steps recorded were used as the measures of variability. Intraclass correlation coefficients (ICC) were calculated to examine test-retest reliability of a 4-m walk and two 4-m walks. To establish concurrent validity, the measures of gait variability were compared across levels of health, functional status, and physical activity using independent t tests and analysis of variances.

Results

Gait variability measures from the two 4-m walks demonstrated greater test-retest reliability than those from the single 4-m walk (ICC=.22–.48 and ICC=.40–.63, respectively). Greater step length and stance time variability were associated with poorer health, functional status and physical activity (P<.05).

Conclusions

Gait variability calculated from a limited number of steps has fair to good test-retest reliability and concurrent validity. Reliability of gait variability calculated from a greater number of steps should be assessed to determine if the consistency can be improved.

Section snippets

Study Sample

Gait characteristics were assessed in ambulatory older adults from the Pittsburgh site of the CHS at the tenth follow-up visit (between 1998 through 1999). CHS is a population-based, ongoing longitudinal multicenter study of coronary heart disease and stroke risk in community-dwelling older adults age 65 years and older.14, 15 At the initiation of the CHS in 1989 through 1990, individuals were identified from the Health Care Financing Administration sampling frame. Individuals who were 65 years

Results

Table 1 provides the participant characteristics. The mean age of the sample was 79.4 years. Approximately 18% of the sample reported having fallen in the previous year and only a small percentage of the participants (<10%) used a cane for ambulation. On average the participants demonstrated a mean gait speed that was slightly less than the desired gait speed of 1.2m.21, 22, 23, 24

The gait variability measures from the two 4-meter walks demonstrated greater test-retest reliability than those

Discussion

Gait variability calculated from a limited number of steps measured using a computerized walkway has poor to good test-retest reliability. Step length and stance time variability seem to be more consistent measures than step width variability. This is consistent with a model proposed by Gabell and Nayak.²⁵ They hypothesize that the variability in step width, an indicator of balance control, is a reflection of the adaptive power of the balance system, necessary for maintaining balance. This

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In this cross-sectional study, we examined the relationships between FOF and gait quality.
Older adults (N=232; age 77±6; 65 % females) reported FOF by a single yes/no question. Gait quality was quantified as (1) harmonic ratio (smoothness) and other time-frequency spatiotemporal variables from triaxial accelerometry (Vertical-V, Mediolateral-ML, Anterior-Posterior -AP) during six-minute walk; (2) gait speed, step-time CoV (variability), and walk-ratio (step-length/cadence) on a 4-m instrumented walkway. Mann Whitney U-tests and Random forest classifier compared gait between those with and without FOF. Selected gait variables were used to build Support Vector Machine (SVM) classifier and performance was evaluated using AUC-ROC.
Individuals with FOF had slower gait speed (103.66 ± 17.09 vs. 110.07 ± 14.83 cm/s), greater step time CoV (4.17 ± 1.66 vs. 3.72 ± 1.24 %), smaller walk-ratio (0.53 ± 0.08 vs. 0.56 ± 0.07 cm/steps/minute), smaller standard deviation V (0.15 ± 0.06 vs. 0.18 ± 0.09 m/s²), and smaller harmonic-ratio V (2.14 ± 0.73 vs. 2.38 ± 0.58), all p<.01. Linear SVM yielded an AUC-ROC of 67 % on test dataset, coefficient values being gait speed (-0.19), standard deviation V (-0.23), walk-ratio (-0.36), and smoothness V (-0.38) describing associations with presence of FOF.
Older adults with FOF have reduced gait speed, acceleration adaptability, walk-ratio, and smoothness. Disrupted gait patterns during fear of falling could provide insights into psychosocial distress in older adults. Longitudinal studies are warranted.
Examining Psychological Factors as Contributors to Pain, Disability, and Physical Function in Geriatric Chronic Low Back Pain: A Prospective Analysis of the Delaware Spine Studies Cohort
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In younger populations, risk factors from psychologically-focused theoretical models have become accepted as primary drivers behind the persistence of low back pain (LBP), but these risk factors have not been thoroughly assessed in older adult populations (60–85 years). To address this knowledge gap, we sought to examine longitudinal associations between both general and pain-related psychological risk factors and future pain intensity, LBP-related disability, and physical function (gait speed) outcomes in older adults with chronic LBP (n = 250). Questionnaires for general (ie, depressive symptoms) and pain-related psychological risk factors (ie, fear-avoidance beliefs, pain catastrophizing, and kinesiophobia) were collected at baseline. Questionnaire values were entered into principal component analysis to yield a combined psychological component score. LBP intensity (pain thermometers), LBP-related disability (Quebec Back Pain Disability Scale), and gait speed were measured at baseline and 12-month follow-up. Multiple linear regression was used to examine adjusted associations between baseline psychological component scores and each prospective outcome. The baseline psychological component score failed to independently predict 12-month LBP-related disability and gait speed after adjustment for baseline outcomes. Though the psychological component score was associated with 12-month LBP intensity after adjusting for baseline LBP intensity, this association diminished with full adjustment for other baseline characteristics. Cumulatively, general and pain-related psychological risk factors did not independently predict longitudinal pain, disability, and physical function outcomes in this cohort. Compared to younger populations with this condition, general and pain-related psychological risk factors may have less influence on the maintenance of chronic LBP in older adults.
This article failed to establish consistent independent relationships between psychological factors and worse longitudinal pain, disability, and physical function outcomes in older adults with chronic LBP. The findings highlight a need to determine other age-specific biopsychosocial risk factors that may impact the maintenance of chronic pain in this patient population.
A normative study of the gait features measured by a wearable inertia sensor in a healthy old population
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Gait function impairments are associated with the risk of various medical conditions in older adults. As gait function declines with advancing age, normative data are required for proper interpretation of gait function in older adults.
This study aimed to construct age-stratified normative data of non-dimensionally normalized temporal and spatial gait features in healthy older adults.
We recruited 320 community-dwelling healthy adults aged 65 years or older from two prospective cohort studies. We stratified them into four age groups (65–69, 70–74, 75–79, and 80–84 years). Each age group comprised 40 men and 40 women. We obtained six gait features (cadence, step time, step time variability, step time asymmetry, gait speed, and step length) using a wearable inertia measurement unit attached on the skin overlying L3-L4 on the back. To mitigate the influence of body shape, we non-dimensionally normalized the gait features into unitless values using height and gravity.
The effect of age group was significant in all raw gait features (p < 0.001 for step time variability, speed and step length; p < 0.05 for cadence, step time and step time asymmetry), and that of sex was significant in the five raw gait features, except for step time asymmetry(p < 0.001 for cadence, step time, speed, and step length; p < 0.05 for step time asymmetry). When gait features were normalized, the effect of age group remained (p < 0.001 for all gait features), whereas that of sex disappeared (p > 0.05 for all gait features).
Our dimensionless normative data on gait features may be useful in comparative studies of gait function between sexes or ethnicities with different body shapes.
Movement-Evoked Pain Versus Widespread Pain: A Longitudinal Comparison in Older Adults With Chronic Low Back Pain From the Delaware Spine Studies
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It is currently unknown which pain-related factors contribute to long-term disability and poorer perceived health among older adults with chronic low back pain (LBP). This investigation sought to examine the unique influence of movement-evoked pain (MeP) and widespread pain (WP) on longitudinal health outcomes (ie, gait speed, perceived disability, and self-efficacy) in 250 older adults with chronic LBP. MeP was elicited with 3 standardized functional tests, while presence of WP was derived from the McGill Pain Map. Robust regression with HC3 standard errors was used to examine associations between these baseline pain variables and health outcomes at 12-month follow-up. Covariates for these models included age, sex, body mass index, resting and recall LBP intensity, LBP duration, depression, pain catastrophizing, and baseline outcome (eg, baseline gait speed). Greater MeP was independently associated with worse 12-month LBP-related disability (b = .384, t = 2.013, P = .046) and poorer self-efficacy (b = -.562, t = -2.074, P = .039); but not gait speed (P > .05). In contrast, WP and resting and recall LBP intensity were not associated with any prospective health outcome after adjustment (all P > .05). Compared to WP and resting and recall LBP intensity, MeP is most strongly related to longitudinal health outcomes in older adults with chronic LBP.
This article establishes novel independent associations between MeP and worse perceived disability and self-efficacy at 12-months in older adults with chronic LBP. MeP likely has biopsychosocial underpinnings and consequences and may therefore be an important determinant of health outcomes in LBP and other geriatric chronic pain populations.
Effects of rhythmic auditory cueing on gait variability and voluntary control of walking -a cross-sectional study-
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Citation Excerpt :
Second, it is possible that the gait cycle was not sufficient for calculating STV. In a previous study, the test–retest reliability of STV determined using 12 gait cycles was reported as an ICC = 0.40–0.63 (Brach et al., 2008). However, one study used a maximum of 42 gait cycles to calculate STV (Balasubramanian et al., 2009b).
Temporal gait variability is strongly associated with motor function and falls in the context of numerous diseases. Rhythmic auditory cueing (RAC) can influence stride-to-stride time, although its effects on temporal gait variability remain unclear. Therefore, the aim of the present cross-disease study was to examine the effects of RAC on stride time variability (STV), as well as the factors affecting changes in STV during walking with RAC. Participants with post-stroke (n = 12) and orthopedic disease (n = 23) performed a random block design under four conditions: comfortable walking speed (CWS) and walking with RAC (RAC 0%, RAC +10%, RAC -10%). STV was measured along with co-contraction and inter-muscular coherence of the shank muscles during walking for each condition. The contributions of the muscle activity pattern and voluntary control to the change in STV between the CWS and RAC 0% conditions were examined using hierarchical multiple regression analysis. STV was significantly lower in the RAC 0% condition than in the CWS condition (p = 0.03). Hierarchical multiple regression analysis revealed that the change in STV was explained by STV in the CWS condition (β = −0.36) and by changes in co-contraction (β = 0.43) and inter-muscular coherence (β = 0.38) during the stance phase between the CWS and RAC 0% conditions (R² = 0.56, p < 0.001). These findings indicate that walking training with RAC is effective in reducing gait variability and immediately improves muscle activity patterns and excessive corticospinal activity.
Components of gait in people with and without mild cognitive impairment
2022, Gait and Posture
Several objective gait parameters are associated with cognitive impairment, but there is limited knowledge of gait models in people with mild cognitive impairment (MCI).
How can 18 objective gait characteristics be used to define different components of gait in people with MCI (with suspected incipient neurocognitive disorder) and cognitively unimpaired people (CU), respectively?
Spatiotemporal gait data were collected by using an electronic walkway (GAITRite®), i.e. assessments in comfortable gait speed. Using cross-sectional gait data, two principal component analyses (PCA) were performed (varimax rotation) to define different components of gait in people with MCI (n = 114) and CU (n = 219), respectively, from the BioFINDER-2 study.
Both PCAs produced four components, here called Variability, Pace/Stability, Rhythm and Asymmetry. Total variance explained was 81.0% (MCI) versus 80.3% (CU). The Variability component explained the largest amount of variance (about 25%) in both groups. The highest loading gait parameter was the same for both groups in three out of four components, i.e. step velocity variability (Variability), mean step length (Pace/Stability) and mean step time (Rhythm). In the asymmetry component, stance time asymmetry (MCI) and swing time asymmetry (CU) loaded the highest.
The gait components seem similar in people with and without MCI, although there were some differences. This study may aid the identification of gait variables that represent different components of gait. Gait parameters such as step velocity variability, mean step length, mean step time as well as swing and stance time asymmetry could serve as interesting core variables of different gait components in future research in people with MCI (with suspected incipient neurocognitive disorder) and CU. However, the selection of gait variables depends on the purpose. It needs to be noted that assessment of variability measures requires more advanced technology than is usually used in the clinic.

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: Supported by the National Institutes of Health Public Health Service (grant no. TG32 AG00181) and the National Institutes of Health contracts (grant no. N01-HC-75150, N01-HC-45133, N01-HC-85079 through 85085, and HL 87079 through 87086); and the University of Pittsburgh Older American's Independence Center (grant no. P30 AG024827); the National Institutes of Health Public Health Service (grant no. TG32 AG00181); a National Institutes on Aging and American Federation of Aging Research Paul Beeson Career Development Award (grant no. K23 AG026766). The sponsor had no direct role in the design, methods, subject recruitment, data collection, analysis, or preparation of the manuscript.

: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

: Reprints are not available from the author.

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Original articleThe Reliability and Validity of Measures of Gait Variability in Community-Dwelling Older Adults

Abstract

Objective

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Study Sample

Results

Discussion

Arch Phys Med Rehabil

Arch Phys Med Rehabil

J Biomechanics

Gait Posture

Ann Epidemiol

Ann Epidemiol

Arch Phys Med Rehabil

J Biomech

J Biomech

Gait changes in older adults: predictors of falls or indicators of fear?

J Am Geriatr Soc

Too much or too little step width variability is associated with a fall history in older persons who walk at or near normal gait speed

J Neuroeng Rehabil

Gait variability and the risk of incident mobility disability

J Gerontol Med Sci

Measurement and Clinical Practice: Theory and application

Original article
The Reliability and Validity of Measures of Gait Variability in Community-Dwelling Older Adults