Walking speed best explains perceived locomotion ability in ambulatory people with chronic stroke, assessed by the ABILOCO questionnaire

Reductions in Muscle Strength and Range of Motion Cause Locomotion Disability via Locomotion-Related Functional Limitation in Japanese Older Adults: A Cross-Sectional Study

Background

Functional issues (impairments, functional limitations, and disabilities) gradually occur with age. Nonetheless, maintaining physical capability may help prevent locomotion disabilities at an older age. The present study aimed to determine whether reductions in muscle strength and range of motion (ROM) cause locomotion disability via locomotion-related functional limitations among healthy older adults.

Methods

Data from a total of 144 participants (61 men, 83 women) were analyzed. To assess locomotion disability, the locomotor domain of the activities of daily living (ADLs) survey from the Ministry of Education, Culture, Sports, Science, and Technology of Japan was used. Muscle strength (grip strength) and two ROMs (hip flexion and knee flexion) were measured. To measure locomotion-related functional limitations, participants underwent a 10 m hurdle walking test and side-step test. Thereafter, path analysis was conducted for testing the hypothetical model. The goodness of fit in the model was assessed using statistical parameters, such as the chi-square value, goodness of fit index (GFI), adjusted goodness of fit index (AGFI), comparative fit index (CFI), and root mean square error of approximation (RMSEA).

Results

The analysis revealed a nonsignificant chi-square value (chi-square = 41.885; p=0.113), as well as high values of GFI (0.944), AGFI (0.904), CFI (0.970), and RMSEA (0.046), indicating that locomotion disability was caused by locomotion-related functional limitations, which were influenced by muscle strength and ROM.

Conclusions

The present study demonstrated that decreased muscle strength and ROM caused locomotion disability via locomotion-related functional limitations. Older adults should participate in physical exercise programs that focus on strengthening muscles and improving ROM to counteract age-related locomotion disability.

Self-reported functional ambulation is related to physical mobility status in polio survivors; a cross-sectional observational study

BACKGROUND

The condensed 3-level version of the self-reported ambulation classification by Perry is a validated, simple-to-use instrument in clinical practice to classify functional ambulation.

OBJECTIVE

To further validate the clinical meaning of the classification for polio survivors, we compared physical mobility status across 3 functional ambulation categories and investigated the relation between physical mobility and functional ambulation category.

METHODS

We investigated a convenience sample of 140 individuals with polio [mean (SD) age 59.4 (12.1) years; 74 men] who were able to walk at least indoors. For indicators of physical mobility status, we assessed the walked distance (m) and walking energy cost (Jkg^-1m^-1) during a 6-min walk test at a comfortable speed. Furthermore, self-reported physical functioning and fatigue were assessed with the 36-item Short Form Health Survey physical functioning scale (SF36-PF) and Fatigue Severity Scale (FSS), respectively. Self-reported functional ambulation was classified as household walker, limited community walker or full community walker.

RESULTS

The mean (SD) walked distance, energy cost, and SF36-PF and FSS scores significantly differed between household walkers (n=48) and limited community walkers (n=63) [275 (67) m; 6.35 (1.80) Jkg^-1m^-1; 27.7 (13.5), 5.53 (1.06), respectively, and 323 (73) m; 5.49 (1.50) Jkg^-1m^-1; 40.1 (15.1); 4.81 (1.38) (P<0.018)] and full community walkers (n=29) [383 (66) m; 4.68 (0.85) Jkg^-1m^-1; 63.9 (18.5), 3.85 (1.54) (P<0.001)], with significant differences also present between limited and full community walkers (P<0.05). Walked distance and SF36-PF score were significantly associated with functional ambulation level, determining 46% of the variance in ambulation level.

CONCLUSION

The simple, self-reported classification of functional ambulation in 3 levels is clinically meaningful for polio survivors because it consistently corresponds to differences in objective and self-reported indicators of physical mobility and, as such, can be used to better manage rehabilitation treatment.