Normative spatiotemporal gait parameters in older adults
TL;DR: In this article, a factor analysis was performed on nearly two dozen spatiotemporal gait parameters from healthy, able-bodied men and women over the age of 70, using data from 294 participants enrolled in the Mayo Clinic Study of Aging.
About: This article is published in Gait & Posture.The article was published on 2011-05-01 and is currently open access. It has received 575 citations till now. The article focuses on the topics: Gait (human).
Citations
More filters
TL;DR: A 5-factor model of gait in older adults with domains that preferentially select for motor, cognitive, and behavioral attributes is developed and validated based on a strong theoretical paradigm.
Abstract: BACKGROUND: Gait is an important predictor of survival in older adults. Gait characteristics help to identify markers of incipient pathology, inform diagnostic algorithms and disease progression, and measure efficacy of interventions. However, there is no clear framework to guide selection of gait characteristics. This study developed and validated a model of gait in older adults based on a strong theoretical paradigm. METHODS: One hundred and eighty-nine older adults with a mean (SD) age of 69.5 (7.6) years were assessed for 16 spatiotemporal gait variables using a 7-m instrumented walkway (GAITRite) while walking for 2 minutes. Principal components analysis and factor analysis "varimax" procedure were used to derive a model that was validated using a multimethod approach: replication of previous work; association of gait domains with motor, cognitive, and behavioral attributes; and discriminatory properties of gait domains using age as a criterion. RESULTS: Five factors emerged from the principal components analysis: pace (22.5%), rhythm (19.3%), variability (15.1%), asymmetry (14.5%), and postural control (8.0%), explaining 79.5% of gait variance in total. Age, executive function, power of attention, balance self-efficacy, and physical fatigue were independently and selectively associated with 4 gait domains, explaining up to 40.1% of total variance. Median age discriminated pace, variability, and postural control domains. CONCLUSIONS: This study supports a 5-factor model of gait in older adults with domains that preferentially select for motor, cognitive, and behavioral attributes. Future research is required to validate the model. If successful, it will facilitate hypothesis-driven research to explain underlying gait mechanisms, identify contributory features to gait disturbance, and examine the effect of intervention. Language: en
304 citations
Cites methods or result from "Normative spatiotemporal gait param..."
...We also identified similar domains to Hollman’s (14) model that identified rhythm, phases, variability, pace, and base of support domains....
[...]
...Hollman and colleagues (14) subjected 23 gait variables to factor analysis and yielded a fivefactor model that included rhythm, phases of the gait cycle, variability, pace, and base of support....
[...]
...Differences in our findings compared with earlier work may be due to the inclusion of different gait characteristics (we included five variability characteristics compared with two in Verghese’s model (13) and eight in Hollman’s model (14), and the use of SD rather than coefficient of variation)....
[...]
TL;DR: In this article, the authors quantify a comprehensive range of gait characteristics measured using a single triaxial accelerometer-based monitor, and examine outcomes and monitor performance in measuring gait in older adults and those with Parkinson's disease.
Abstract: Measurement of gait is becoming important as a tool to identify disease and disease progression, yet to date its application is limited largely to specialist centers. Wearable devices enables gait to be measured in naturalistic environments, however questions remain regarding validity. Previous research suggests that when compared with a laboratory reference, measurement accuracy is acceptable for mean but not variability or asymmetry gait characteristics. Some fundamental reasons for this have been presented, (e.g., synchronization, different sampling frequencies) but to date this has not been systematically examined. The aims of this study were to: 1) quantify a comprehensive range of gait characteristics measured using a single triaxial accelerometer-based monitor; 2) examine outcomes and monitor performance in measuring gait in older adults and those with Parkinson's disease (PD); and 3) carry out a detailed comparison with those derived from an instrumented walkway to account for any discrepancies. Fourteen gait characteristics were quantified in 30 people with incident PD and 30 healthy age-matched controls. Of the 14 gait characteristics compared, agreement between instruments was excellent for four (ICCs 0.913–0.983); moderate for four (ICCs 0.508–0.766); and poor for six characteristics (ICCs 0.637–0.370). Further analysis revealed that differences reflect an increased sensitivity of accelerometry to detect motion, rather than measurement error. This is most likely because accelerometry measures gait as a continuous activity rather than discrete footfall events, per instrumented tools. The increased sensitivity shown for these characteristics will be of particular interest to researchers keen to interpret “real-world” gait data. In conclusion, use of a body-worn monitor is recommended for the measurement of gait but is likely to yield more sensitive data for asymmetry and variability features.
257 citations
TL;DR: This review draws on literature from Parkinson's disease, ageing, and neurodegenerative disease to address the issue of variable selection with the goal of moving toward a structured approach to measurement.
Abstract: Gait is emerging as a powerful measurement tool in neurodegenerative disorders to identify markers of incipient pathology, inform diagnostic algorithms and disease progression, and measure the efficacy of interventions. However, it is unclear which of the many gait outcomes is most appropriate for each of these purposes. In this review, we summarise key topics relating to gait measurement. We draw on literature from Parkinson's disease, ageing, and neurodegenerative disease to address the issue of variable selection with the goal of moving toward a structured approach to measurement. Findings from this review identify a wide range of spatiotemporal and dynamic characteristics; however, their suitability differs according to the aim of measurement. Gait speed is useful as a global characteristic of performance but may not capture the nature of underlying pathology. Inconsistent application, reporting, and interpretation of gait outcomes currently preclude a prescriptive approach. Conceptual models of gait may facilitate a reasoned approach to outcome selection. We also recommend harmonisation of protocols, longitudinal cohort studies, and use of novel technologies and methods of analysis to provide a complete picture of gait. Gait characteristics are "fit for purpose" when selected according to a clear rationale and in accordance with their clinimetric properties. Evidence supports the use of gait as a biomarker of disease and to complement diagnosis and inform disease management. A structured approach to measurement is urgently required to fully realise the contribution gait can make to our understanding of neurodegenerative disease.
237 citations
TL;DR: A robust association between gait and cognition is confirmed and argues for a selective, comprehensive measurement approach and results suggest gait may be a surrogate marker of cognitive impairment and cognitive decline.
212 citations
Cites methods from "Normative spatiotemporal gait param..."
...In response, several groups have proposed gait models that group gait characteristics into gait domains using data reduction techniques such as principle components analysis (Verghese et al., 2007; Hollman et al., 2011; Lord et al., 2013; Verlinden et al., 2013b)....
[...]
TL;DR: In community-dwelling older people, executive function/attention and processing speed were associated with many aspects of gait, whereas visuospatial ability may only play a role in double support phase variability.
Abstract: Background. Gait impairments are associated with falls and loss of independence. The study of factors associated with poorer gait may assist in developing methods to preserve mobility in older people. The aim of this study was to examine the associations between a range of cognitive functions and gait and gait variability in a population-based sample of older people. Methods. Gait and intra-individual gait variability measures were obtained using the GAITRite walkway in a sample of older people, aged 60–85 years (N = 422), randomly selected from the Tasmanian electoral roll. Raw scores from a cognitive battery were subjected to principal component analyses deriving four summary domains: executive function/attention, processing speed, memory, and visuospatial ability. Multivariable linear regression was used to examine associations between cognitive domains and gait measures adjusting for age, sex, ambulatory activity, medication use, and mood. Results. The mean age of the sample was 72.0 years (SD = 7.0), with 238 men (56%). Poorer executive function was independently associated with poorer performance in most absolute gait measures and with greater variability in double support phase and step time. Processing speed was associated with absolute gait measures and double support phase variability. Visuospatial ability was only associated with greater double support phase variability, independently of executive function and processing speed. Memory was not independently associated with any gait measure. Conclusions. In community-dwelling older people, executive function/attention and processing speed were associated with many aspects of gait, whereas visuospatial ability may only play a role in double support phase variability.
182 citations
References
More filters
TL;DR: In this pooled analysis of individual data from 9 selected cohorts, gait speed was associated with survival in older adults and predicted survival was as accurate as predicted based on age, sex, use of mobility aids, and self-reported function.
Abstract: Context Survival estimates help individualize goals of care for geriatric patients, but life tables fail to account for the great variability in survival. Physical performance measures, such as gait speed, might help account for variability, allowing clinicians to make more individualized estimates. Objective To evaluate the relationship between gait speed and survival. Design, Setting, and Participants Pooled analysis of 9 cohort studies (collected between 1986 and 2000), using individual data from 34 485 community-dwelling older adults aged 65 years or older with baseline gait speed data, followed up for 6 to 21 years. Participants were a mean (SD) age of 73.5 (5.9) years; 59.6%, women; and 79.8%, white; and had a mean (SD) gait speed of 0.92 (0.27) m/s. Main Outcome Measures Survival rates and life expectancy. Results There were 17 528 deaths; the overall 5-year survival rate was 84.8% (confidence interval [CI], 79.6%-88.8%) and 10-year survival rate was 59.7% (95% CI, 46.5%-70.6%). Gait speed was associated with survival in all studies (pooled hazard ratio per 0.1 m/s, 0.88; 95% CI, 0.87-0.90; P Conclusion In this pooled analysis of individual data from 9 selected cohorts, gait speed was associated with survival in older adults.
3,393 citations
"Normative spatiotemporal gait param..." refers background in this paper
...[5], and even risk of early mortality [6]....
[...]
TL;DR: Findings show both the feasibility of obtaining stride-to-stride measures of gait timing in the ambulatory setting and the potential use ofgait variability measures in augmenting the prospective evaluation of fall risk in community-living older adults.
2,159 citations
"Normative spatiotemporal gait param..." refers background in this paper
...Variability parameters have been used to quantify falls risk, to assess risk of dementia and, under dual task conditions, to examine executive functioning in aging adults [4,5,18,19]....
[...]
...Variability parameters used to examine these capacities have included variability in stride speed [20,21], stride time [18], stride length [4], step time [22], step length [22], swing time [4,23] and step width [22,24]....
[...]
TL;DR: In a cohort of ambulatory older adults, whether spatial‐temporal measures of foot placement during gait can predict the likelihood of future falls or whether these measures are more likely to be indicative of adaptations associated with pre‐existing fear of falling is investigated.
Abstract: OBJECTIVE: To determine, in a cohort of ambulatory older adults, whether spatial-temporal measures of foot placement during gait can predict the likelihood of future falls or whether these measures are more likely to be indicative of adaptations associated with pre-existing fear of falling.
DESIGN: Prospective cohort study.
SETTING: Baseline gait measurements were performed in a gait and balance laboratory; subsequent history of falling was monitored prospectively for 1 year in two self-care facilities.
PARTICIPANTS: Fourteen male and 61 female consecutive volunteers (mean age = 82, SD = 6) who were independent in activities of daily living and able to walk 10 m unaided.
MEASUREMENTS: Spatial gait parameters were derived from digitized “footprints”; temporal parameters were derived using footswitches. A clinical activity-based gait assessment was also performed. The dependent variables were pre-existing fear of falling (reported at baseline) and future falling (experiencing one or more falls during the 1-year follow-up).
MAIN RESULTS: Reduced stride length, reduced speed, increased double-support time, and poorer clinical gait scores were associated with fear but showed little evidence of an independent association with falling. Conversely, increased stride-to-stride variability in stride length, speed, and double-support was associated independently with falling but showed little evidence of relationship to fear. Increased stride width showed some evidence of association with both falling and fear. Stride-to-stride variability in speed was the single best independent predictor of falling.
CONCLUSIONS: Changes in gait cited previously as risk factors for falling, i.e., decreased stride length and speed and prolonged double support, may in fact be stabilizing adaptations related to fear of falling. Stride-to-stride variability in the control of gait is an independent predictor of falling and may be a useful measure for identifying high-risk individuals and evaluating preventive interventions. Stride width may also be a useful outcome measure. Contrary to common expectation, a wider stride does not necessarily increase stability but instead seems to predict an increased likelihood of experiencing falls.
1,621 citations
"Normative spatiotemporal gait param..." refers background in this paper
...The variability domain may also best predict falls in older adults [5]....
[...]
...[5], and even risk of early mortality [6]....
[...]
...Variability parameters have been used to quantify falls risk, to assess risk of dementia and, under dual task conditions, to examine executive functioning in aging adults [4,5,18,19]....
[...]
TL;DR: To assess the ability of gait speed alone and a three‐item lower extremity performance battery to predict 12‐month rates of hospitalization, decline in health, and decline in function in primary care settings serving older adults.
Abstract: OBJECTIVES: To assess the ability of gait speed alone and a three-item lower extremity performance battery to predict 12-month rates of hospitalization, decline in health, and decline in function in primary care settings serving older adults.
DESIGN: Prospective cohort study.
SETTING: Primary care programs of a Medicare health maintenance organization (HMO) and Veterans Affairs (VA) system.
PARTICIPANTS: Four hundred eighty-seven persons aged 65 and older.
MEASUREMENTS: Lower extremity performance Established Population for Epidemiologic Studies of the Elderly (EPESE) battery including gait speed, chair stands, and tandem balance tests; demographics; health care use; health status; functional status; probability of repeated admission scale (Pra); and primary physician's hospitalization risk estimate.
RESULTS: Veterans had poorer health and higher use than HMO members. Gait speed alone and the EPESE battery predicted hospitalization; 41% (21/51) of slow walkers (gait speed 1.0 m/s) (P < .0001). The relationship was stronger in the HMO than in the VA. Both performance measures remained independent predictors after accounting for Pra. The EPESE battery was superior to gait speed when both Pra and primary physician's risk estimate were included. Both performance measures predicted decline in function and health status in both health systems. Performance measures, alone or in combination with self-report measures, were more able to predict outcomes than self-report alone.
CONCLUSION: Gait speed and a physical performance battery are brief, quantitative estimates of future risk for hospitalization and decline in health and function in clinical populations of older adults. Physical performance measures might serve as easily accessible “vital signs” to screen older adults in clinical settings.
1,141 citations
"Normative spatiotemporal gait param..." refers background in this paper
...Introduction Gait may be used to assess quality of life [1], health status [2], and physical function [3] in older adults....
[...]
...Gait speed, for example, has been recommended as a “vital sign” for physical performance in older persons [1, 3] and 10 cm/s decreases in gait speed are associated with higher falls risk in older persons [13]....
[...]
TL;DR: Clinical relevant cutpoints for usual gait speed are defined and their predictive value for health‐related events in older persons is investigated.
Abstract: OBJECTIVES: To define clinically relevant cutpoints for usual gait speed and to investigate their predictive value for health-related events in older persons. DESIGN: Prospective cohort study. SETTING: Health, Aging and Body Composition Study. PARTICIPANTS: Three thousand forty-seven well-functioning older persons (mean age 74.2). MEASUREMENTS: Usual gait speed on a 6-m course was assessed at baseline. Participants were randomly divided into two groups to identify (Sample A; n = 2,031) and then validate (Sample B; n = 1,016) usual gait-speed cutpoints. Rates of persistent lower extremity limitation events (mean follow-up 4.9 years) were calculated according to gait speed in Sample A. A cutpoint (defining high- (<1 m/s) and low risk (≥1 m/s) groups) was identified based on persistent lower extremity limitation events. The predictive value of the identified cutpoints for major health-related events (persistent severe lower extremity limitation, death, and hospitalization) was evaluated in Sample B using Cox regression analyses. RESULTS: A graded response was seen between risk groups and health-related outcomes. Participants in the high-risk group had a higher risk of persistent lower extremity limitation (rate ratio (RR) = 2.20, 95% confidence interval (CI) = 1.76-2.74), persistent severe lower extremity limitation (RR = 2.29, 95% CI = 1.63-3.20), death (RR = 1.64, 95% CI = 1.14-2.37), and hospitalization (RR = 1.48, 95% CI = 1.02-2.13) than those in the low-risk group. CONCLUSION: Usual gait speed of less than 1 m/s identifies persons at high risk of health-related outcomes in well-functioning older people. Provision of a clinically meaningful cutpoint for usual gait speed may facilitate its use in clinical and research settings.
1,025 citations
"Normative spatiotemporal gait param..." refers background in this paper
...Reported values of mean gait speed in adults aged 70–79 range from approximately 90 to 130 cm/s [2,7–11]....
[...]
...Introduction Gait may be used to assess quality of life [1], health status [2], and physical function [3] in older adults....
[...]
...Moreover, normative data for many parameters are lacking and in studies that report reference values, there is a great deal of variability among the data reported [2,7–11]....
[...]
...Normative studies [2,9–11] typically report higher values than population-based studies [7,8], presumably because the normative studies describe gait in healthy individuals whereas population-based studies include participants who may have pathological conditions affecting their gait performance....
[...]
...Discussion While several studies have provided reference values for gait [2,7–11], we believe the present study represents one of the most comprehensive analyses of normative spatiotemporal gait data in older adults....
[...]