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Sanders O, Wang B, Kontson K. Concurrent Validity Evidence for Pressure-Sensing Walkways Measuring Spatiotemporal Features of Gait: A Systematic Review and Meta-Analysis. SENSORS (BASEL, SWITZERLAND) 2024; 24:4537. [PMID: 39065933 PMCID: PMC11281155 DOI: 10.3390/s24144537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 06/29/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024]
Abstract
Technologies that capture and analyze movement patterns for diagnostic or therapeutic purposes are a major locus of innovation in the United States. Several studies have evaluated their measurement properties in different conditions with variable findings. To date, the authors are not aware of any systematic review of studies conducted to assess the concurrent validity of pressure-sensing walkway technologies. The results of such an analysis could establish the body of evidence needed to confidently use these systems as reference or gold-standard systems when validating novel tools or measures. A comprehensive search of electronic databases including MEDLINE, Embase, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) was performed. The initial search yielded 7670 papers. After removing duplicates and applying study inclusion/exclusion criteria, 11 papers were included in the systematic review with 10 included in a meta-analysis. There were 25 spatial and temporal gait parameters extracted from the included studies. The results showed there was not a significant bias for nearly all spatiotemporal gait parameters when the walkway system was compared to the reference systems. The findings from this analysis should provide confidence in using the walkway systems as reference systems in future studies to support the evaluation and validation of novel technologies deriving gait parameters.
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Affiliation(s)
- Ozell Sanders
- Office of Product Evaluation and Quality, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD 20993, USA;
| | - Bin Wang
- Office of Clinical Evaluation and Analysis, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD 20993, USA;
| | - Kimberly Kontson
- Office of Science and Engineering Labs, Center for Devices and Radiological Health, US Food and Drug Administration, Silver Spring, MD 20993, USA
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Li R, Ding M, Wang J, Pan H, Sun X, Huang L, Fu C, He C, Wei Q. Effectiveness of robotic-assisted gait training on cardiopulmonary fitness and exercise capacity for incomplete spinal cord injury: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil 2023; 37:312-329. [PMID: 36373899 DOI: 10.1177/02692155221133474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the effects of robotic-assisted gait training on cardiopulmonary fitness and exercise capacity for people with incomplete spinal cord injury. METHODS PubMed, Embase, Web of Science, PEDro, CENTRAL and CINAHL were searched from inception until September 4, 2022. Randomized controlled trials that evaluated the effects of robotic-assisted gait training on cardiopulmonary fitness and exercise capacity for individuals with incomplete spinal cord injury were selected. Mean differences (MD) with 95% confidence interval (CI) were calculated. The methodological quality was evaluated by the Cochrane Risk of Bias 2.0 tool. Subgroup analyses were conducted according to the time since injury. RESULTS In total 19 studies involving 770 patients were eligible for analysis. Individuals with acute incomplete spinal cord injury in robotic-assisted gait training groups showed significantly greater improvements in 6-minute walking test (MD 53.32; 95% CI 33.49 to 73.15; P < 0.001), lower extremity motor scale (MD 5.22; 95% CI 3.63 to 6.80; P < 0.001) and walking index for spinal cord injury II (MD 3.18; 95% CI 1.34 to 5.02; P < 0.001). Robotic-assisted gait training improved peak oxygen consumption to a greater degree for chronic incomplete spinal cord injury patients (MD 4.90; 95% CI 0.96 to 8.84; P = 0.01). CONCLUSION Robot-assisted gait training may be a feasible and effective intervention in terms of cardiopulmonary fitness and exercise capacity for individuals with incomplete spinal cord injury.
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Affiliation(s)
- Ran Li
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Mingfu Ding
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Jiao Wang
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Hongxia Pan
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Xin Sun
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Liyi Huang
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Chenying Fu
- National Clinical Research Center for Geriatrics, 34753West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Aging and Geriatric Mechanism Laboratory, West China Hospital, 12530Sichuan University, Chengdu, People's Republic of China
| | - Chengqi He
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Quan Wei
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
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Olsen S, Rashid U, Allerby C, Brown E, Leyser M, McDonnell G, Alder G, Barbado D, Shaikh N, Lord S, Niazi IK, Taylor D. Smartphone-based gait and balance accelerometry is sensitive to age and correlates with clinical and kinematic data. Gait Posture 2023; 100:57-64. [PMID: 36481647 DOI: 10.1016/j.gaitpost.2022.11.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 11/16/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Gait&Balance (G&B) App has produced valid and reliable measures of gait and balance in young healthy adults but has not been tested in older adults. RESEARCH QUESTION In healthy middle-to-older aged adults, are G&B App measurements sensitive to age, valid against clinical and kinematic measures, and reliable? METHOD Healthy participants (n = 34, 14 male, 42-94 years) completed the G&B App protocol three times within a single session. 3D kinematics were collected concurrently. Clinical balance measures were collected (Modified Clinical Test of Sensory Interaction in Balance (mCTSIB), Mini Balance Evaluation Systems Test (MBT), and Functional Gait Assessment (FGA)). Sensitivity to age was assessed with Pearson's correlations. Validity tests included Pearson's correlations and Bland-Altman limits of agreement. Reliability tests included intra-class correlation coefficients and standard error of the measure. RESULTS During quiet stance on a compliant surface, the G&B App was sensitive to age-related differences not detectable with the mCTSIB. During walking tasks, there was adequate convergent validity between the MBT and G&B App measures of step length, and between the FGA and G&B App measures of walking speed, step length, and periodicity. The G&B App had moderate-to-excellent validity against 3D kinematics for postural stability during quiet stance (r 0.98 [0.98, 0.99]), step time (r 0.97 [0.96, 0.98]), walking speed (r 0.79 [0.7, 0.86]), and step length (r 0.73 [0.61, 0.81]). Test-retest reliability was moderate-to-excellent for G&B App measures of postural stability, walking speed, periodicity, step length, and step time. G&B App measures of step length asymmetry, step length variability, step time asymmetry, and step time variability had poor validity and reliability. SIGNIFICANCE The G&B App was sensitive to age-related differences in balance not detectable with clinical measurement. It provides valid and reliable measures of postural stability, step length, step time, and periodicity, which are not currently available in standard practice.
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Affiliation(s)
- Sharon Olsen
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand.
| | - Usman Rashid
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand; Centre for Chiropractic Research, New Zealand College of Chiropractic, PO Box 113-044, Newmarket, Auckland 1149, New Zealand
| | - Celia Allerby
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Eliza Brown
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Michaela Leyser
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Gabrielle McDonnell
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Gemma Alder
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - David Barbado
- Department of Sport Science, Sports Research Centre, Miguel Hernandez University of Elche, Avda. de la Universidad s/n, Elche 03202, Spain; Institute for Health and Biomedical Research (ISABIAL Foundation), Avda. Pintor Baeza, 12 HGUA, Alicante 03550, Spain
| | - Nusratnaaz Shaikh
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Sue Lord
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Imran Khan Niazi
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand; Centre for Chiropractic Research, New Zealand College of Chiropractic, PO Box 113-044, Newmarket, Auckland 1149, New Zealand; Centre for Sensory-Motor Interaction (SMI), Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Denise Taylor
- Rehabilitation Innovation Centre, Health & Rehabilitation Research Institute, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
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Kim H, Kum D, Lee I, Choi J. Concurrent Validity of GAITRite and the 10-m Walk Test to Measure Gait Speed in Adults with Chronic Ankle Instability. Healthcare (Basel) 2022; 10:healthcare10081499. [PMID: 36011156 PMCID: PMC9407691 DOI: 10.3390/healthcare10081499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/01/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022] Open
Abstract
Since there are many different assessments related to gait speed, it is important to determine the concurrent validity of each measure so that they can be used interchangeably. Our study aimed to investigate the concurrent validity of gait speed measured by the 10 m walk test (10 MWT) and the gold standard gait analysis system, the GAITRite system, for people with chronic ankle instability (CAI). For 16 people with CAI, 4 evaluations of the 10 MWT and 4 evaluations of the GAITRite system were performed (a comfortable gait speed for 2 evaluations; a maximal gait speed for 2 evaluations). We used intraclass correlations [ICC (2,1), absolute agreement] and Bland−Altman plots to analyze the relationship between the gait speed of the two measures. The absolute agreement between the 10 MWT and the GAITRite system is at the comfortable gait speed [ICC = 0.66; p < 0.001)], and the maximal gait speed [ICC = 0.68; p < 0.001)] showed fair to good agreement. Both gait speeds had a proportional bias; the limit of agreement (LOA) was large (0.50 at the comfortable gait speed and 0.60 at the maximal gait speed). Regression-based Bland−Altman plots were created for the comfortable gait speed (R2 = 0.54, p < 0.001) and the maximal gait speed (R2 = 0.78, p < 0.001). The regression-based LOA ranged from 0.45 to 0.66 m/s for the comfortable gait speed and 1.09 to 1.37 m/s for the maximal gait speed. Our study suggests that it is undesirable to mix the 10 MWT and the GAITRite system gait speed measurements in people with CAI. Each measure should not be recorded by the same evaluation tool and referenced to normative data.
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Affiliation(s)
- Ho Kim
- Department of Physical Therapy, Graduate School of Health and Medicine, Daejeon University, Daejeon 34520, Korea
| | - Dongmin Kum
- Department of Physical Therapy, Graduate School of Health and Medicine, Daejeon University, Daejeon 34520, Korea
| | - Insu Lee
- Department of Physical Therapy, Graduate School of Health and Medicine, Daejeon University, Daejeon 34520, Korea
| | - Jongduk Choi
- Department of Physical Therapy, College of Health & Medical Science Daejeon University, Daejeon 34520, Korea
- Correspondence: ; Tel.: +82-42-280-2293
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Parati M, Ambrosini E, DE Maria B, Gallotta M, Dalla Vecchia LA, Ferriero G, Ferrante S. The reliability of gait parameters captured via instrumented walkways: a systematic review and meta-analysis. Eur J Phys Rehabil Med 2022; 58:363-377. [PMID: 34985239 PMCID: PMC9987464 DOI: 10.23736/s1973-9087.22.07037-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Electronic pressure-sensitive walkways are commonly available solutions to quantitatively assess gait parameters for clinical and research purposes. Many studies have evaluated their measurement properties in different conditions with variable findings. In order to be informed about the current evidence of their reliability for optimal clinical and scientific decision making, this systematic review provided a quantitative synthesis of the test-retest reliability and minimal detectable change of the captured gait parameters across different test conditions (single and cognitive dual-task conditions) and population groups. EVIDENCE ACQUISITION A literature search was conducted in PubMed, Embase, and Scopus until November 2021 to identify articles that examined the test-retest reliability properties of the gait parameters captured by pressure-sensitive walkways (gait speed, cadence, stride length and time, double support time, base of support) in adult healthy individuals or patients. The methodological quality was rated using the Consensus-Based Standards for the Selection of Health Measurement Instruments Checklist. Data were meta-analyzed on intraclass correlation coefficient to examine the test-retest relative reliability. Quantitative synthesis was performed for absolute reliability, examined by the weighted average of minimal detectable change values. EVIDENCE SYNTHESIS A total of 44 studies were included in this systematic review. The methodological quality was adequate in half of the included studies. The main finding was that pressure-sensitive walkways are reliable tools for objective assessment of spatial and temporal gait parameters both in single-and cognitive dual-task conditions. Despite few exceptions, the review identified intraclass correlation coefficient higher than 0.75 and minimal detectable change lower than 30%, demonstrating satisfactory relative and absolute reliability in all examined populations (healthy adults, elderly, patients with cognitive impairment, spinocerebellar ataxia type 14, Huntington's disease, multiple sclerosis, Parkinson's disease, rheumatoid arthritis, spinal cord injury, stroke or vestibular dysfunction). CONCLUSIONS Current evidence suggested that, despite different populations and testing protocols used in the included studies, the test-retest reliability of the examined gait parameters was acceptable under single and cognitive dual-task conditions. Further high-quality studies with powered sample sizes are needed to examine the reliability findings of the currently understudied and unexplored pathologies and test conditions.
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Affiliation(s)
- Monica Parati
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy.,Istituti Clinici Scientifici Maugeri IRCCS, Milan, Italy
| | - Emilia Ambrosini
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
| | | | | | | | - Giorgio Ferriero
- Istituti Clinici Scientifici Maugeri IRCCS, Tradate, Varese, Italy -
| | - Simona Ferrante
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, Milan, Italy
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Ali L, Jahangiri FR, Ali A, Belkhair S, Elalamy O, Adeli G, Alghazow M, Krishnan R, Karim F, Iqrar A, Raza A. Emerging Super-specialty of Neurology: Intraoperative Neurophysiological Monitoring (IONM) and Experience in Various Neurosurgeries at a Tertiary Care Hospital in Doha, Qatar. Cureus 2021; 13:e20432. [PMID: 35047269 PMCID: PMC8759984 DOI: 10.7759/cureus.20432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Intraoperative neurophysiological monitoring (IONM) helps in better patient outcomes by minimizing risks related to the functional status of the nervous system during surgical procedures. An IONM alert to the surgical team during the surgery can help them identify the cause and take immediate corrective action. IONM confers possible benefits, including improved surgical morbidity and mortality, better patient care, minimal neurological deficits, reduced hospital stay, medical costs, and litigation risk. In addition, a highly skilled IONM team will make a better patient outcome. Methods We retrospectively reviewed 62 consecutive patients who underwent intracranial and spinal neurosurgical procedures. Multimodality IONM was utilized, including somatosensory evoked potentials, transcranial electrical motor evoked potential, spontaneous and triggered electromyography, electroencephalography, electrocorticography, cortical sensory mapping, and direct electrical cortical stimulation. Of a total of 62 patients, two patients revealed neurotonic EMG discharges during IONM, and most patients woke up without any new neurological deficit. Results Sixty-two patients were included, ranging from age 5 to 77 years (mean 43.5 years), with 54.8% men and 45.2% female. Multimodality IONM was used in all patients. Two EMG alerts were recorded during IONM, during a brain tumor resection, and right acetabular hip surgery with postoperative right foot drop. Conclusion Multimodality IONM is the gold standard of care for any surgical services and is used as real-time monitoring of functional integrity of neural structures at risk. If utilized by trained and expert teams, numerous surgeries may benefit from multimodality intraoperative neurophysiologic monitoring.
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Soulard J, Vaillant J, Baillet A, Gaudin P, Vuillerme N. Gait and Axial Spondyloarthritis: Comparative Gait Analysis Study Using Foot-Worn Inertial Sensors. JMIR Mhealth Uhealth 2021; 9:e27087. [PMID: 34751663 PMCID: PMC8663701 DOI: 10.2196/27087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 05/18/2021] [Accepted: 07/23/2021] [Indexed: 12/15/2022] Open
Abstract
Background Axial spondyloarthritis (axSpA) can lead to spinal mobility restrictions associated with restricted lower limb ranges of motion, thoracic kyphosis, spinopelvic ankylosis, or decrease in muscle strength. It is well known that these factors can have consequences on spatiotemporal gait parameters during walking. However, no study has assessed spatiotemporal gait parameters in patients with axSpA. Divergent results have been obtained in the studies assessing spatiotemporal gait parameters in ankylosing spondylitis, a subgroup of axSpA, which could be partly explained by self-reported pain intensity scores at time of assessment. Inertial measurement units (IMUs) are increasingly popular and may facilitate gait assessment in clinical practice. Objective This study compared spatiotemporal gait parameters assessed with foot-worn IMUs in patients with axSpA and matched healthy individuals without and with pain intensity score as a covariate. Methods A total of 30 patients with axSpA and 30 age- and sex-matched healthy controls performed a 10-m walk test at comfortable speed. Various spatiotemporal gait parameters were computed from foot-worn inertial sensors including gait speed in ms–1 (mean walking velocity), cadence in steps/minute (number of steps in a minute), stride length in m (distance between 2 consecutive footprints of the same foot on the ground), swing time in percentage (portion of the cycle during which the foot is in the air), stance time in percentage (portion of the cycle during which part of the foot touches the ground), and double support time in percentage (portion of the cycle where both feet touch the ground). Results Age, height, and weight were not significantly different between groups. Self-reported pain intensity was significantly higher in patients with axSpA than healthy controls (P<.001). Independent sample t tests indicated that patients with axSpA presented lower gait speed (P<.001) and cadence (P=.004), shorter stride length (P<.001) and swing time (P<.001), and longer double support time (P<.001) and stance time (P<.001) than healthy controls. When using pain intensity as a covariate, spatiotemporal gait parameters were still significant with patients with axSpA exhibiting lower gait speed (P<.001), shorter stride length (P=.001) and swing time (P<.001), and longer double support time (P<.001) and stance time (P<.001) than matched healthy controls. Interestingly, there were no longer statistically significant between-group differences observed for the cadence (P=.17). Conclusions Gait was significantly altered in patients with axSpA with reduced speed, cadence, stride length, and swing time and increased double support and stance time. Taken together, these changes in spatiotemporal gait parameters could be interpreted as the adoption of a so-called cautious gait pattern in patients with axSpA. Among factors that may influence gait in patients with axSpA, patient self-reported pain intensity could play a role. Finally, IMUs allowed computation of spatiotemporal gait parameters and are usable to assess gait in patients with axSpA in clinical routine. Trial Registration ClinicalTrials.gov NCT03761212; https://clinicaltrials.gov/ct2/show/NCT03761212 International Registered Report Identifier (IRRID) RR2-10.1007/s00296-019-04396-4
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Affiliation(s)
- Julie Soulard
- University Grenoble Alpes, AGEIS, La Tronche, France.,Grenoble Alpes University Hospital, Grenoble, France
| | | | - Athan Baillet
- University Grenoble Alpes, CNRS, Grenoble Alpes University Hospital, Grenoble INP, TIMC-IMAG UMR5525, Grenoble, France
| | - Philippe Gaudin
- University Grenoble Alpes, CNRS, Grenoble Alpes University Hospital, Grenoble INP, TIMC-IMAG UMR5525, Grenoble, France
| | - Nicolas Vuillerme
- University Grenoble Alpes, AGEIS, La Tronche, France.,Institut Universitaire de France, Paris, France.,LabCom Telecom4Health, Orange Labs & Univ. Grenoble Alpes, CNRS, Inria, Grenoble INP-UGA, Grenoble, France
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Using wearable sensors to characterize gait after spinal cord injury: evaluation of test-retest reliability and construct validity. Spinal Cord 2020; 59:675-683. [PMID: 33024297 DOI: 10.1038/s41393-020-00559-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 09/18/2020] [Accepted: 09/21/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Quantitative cross-sectional study. OBJECTIVES Evaluate the test-retest reliability and the construct validity of inertial measurement units (IMU) to characterize spatiotemporal gait parameters in individuals with SCI. SETTING Two SCI rehabilitation centers in Canada. METHODS Eighteen individuals with SCI participated in two evaluation sessions spaced 2 weeks apart. Fifteen able-bodied individuals were also recruited. Participants walked 20 m overground under five conditions that challenged balance to varying degrees. Five IMU were attached to the lower-extremities and the sacrum to collect the mean and the coefficient of variation of five gait parameters (gait cycle time, double-support percentage, cadence, stride length, stride velocity). Intra-class correlation coefficients (ICC) were used to evaluate the test-retest reliability. Linear mixed-effects models were used to compare the five walking conditions to evaluate known-group validity while Spearman's correlation coefficients were used to characterize the level of association between gait parameters and the Mini BESTest (MBT). RESULTS Cadence was reliable across all walking conditions. Reliability was higher for the mean (ICC = 0.55-0.98) of the parameters compared to their coefficient of variation (ICC = 0.16-0.97). Cadence collected with IMU had construct validity as their values differed across walking conditions and groups of participants. The coefficient of variation was generally better than the mean to show differences across the five walking conditions. The MBT was moderately to strongly associated with mean cadence (ρ ≥ 0.498) and its coefficient of variation (ρ ≤ -0.49) during most walking conditions. CONCLUSIONS IMU provide reliable and valid measurements of gait parameters in ambulatory individuals with SCI.
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de Jong LAF, van Dijsseldonk RB, Keijsers NLW, Groen BE. Test-retest reliability of stability outcome measures during treadmill walking in patients with balance problems and healthy controls. Gait Posture 2020; 76:92-97. [PMID: 31743873 DOI: 10.1016/j.gaitpost.2019.10.033] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 08/29/2019] [Accepted: 10/23/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Improvement of balance control is an important rehabilitation goal for patients with motor and sensory impairments. To quantify balance control during walking, various stability outcome measures have described differences between healthy controls and patient groups with balance problems. To be useful for the evaluation of interventions or monitoring of individual patients, stability outcome measures need to be reliable. RESEARCH QUESTION What is the test-retest reliability of six stability outcome measures during gait? METHODS Patients with balance problems (n = 45) and healthy controls (n = 20) performed two times a two-minute walk test (2MWT). The intraclass correlation coefficient (ICC) and Bland-Altman analysis (coefficient of repeatability; CR) were used to evaluate the test-retest reliability of six stability outcome measures: dynamic stability margin (DSM), margin of stability (MoS), distance between the extrapolated centre of mass (XCoM) and centre of pressure (CoP) in anterior-posterior (XCoM-CoPAP) and medial-lateral (XCoM-CoPML) direction, and inclination angle between centre of mass (CoM) and CoP in anterior-posterior (CoM-CoPAP-angle) and medial-lateral (CoM-CoPML-angle) direction. A two way mixed ANOVA was performed to reveal measurement- and group-effects. RESULTS The ICCs of all stability outcome measures ranged between 0.51 and 0.97. Significant differences between the measurements were found for the DSM (p = 0.017), XCoM-CoPAP (p = 0.008) and CoM-CoPAP-angle (p = 0.001). Significant differences between controls and patients were found for all stability outcome measures (p < 0.01) except for the MoS (p = 0.32). For the XCoM-CoP distances and CoM-CoP angles, the CRs were smaller than the difference between patients and controls. SIGNIFICANCE Based on the ICCs, the reliability of all stability outcome measures was moderate to excellent. Since the XCoM-CoPML and CoM-CoPML-angle showed no differences between the measurements and smaller CRs than the differences between patients and controls, the XCoM-CoPML and CoM-CoPML-angle seem the most promising stability outcome measures to evaluate interventions and monitor individual patients.
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Affiliation(s)
- L A F de Jong
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - R B van Dijsseldonk
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - N L W Keijsers
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - B E Groen
- Department of Research, Sint Maartenskliniek, Nijmegen, the Netherlands; Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands.
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Wu M, Kim J, Wei F. Facilitating Weight Shifting During Treadmill Training Improves Walking Function in Humans With Spinal Cord Injury: A Randomized Controlled Pilot Study. Am J Phys Med Rehabil 2018; 97:585-592. [PMID: 29547448 PMCID: PMC6051897 DOI: 10.1097/phm.0000000000000927] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to determine whether the integration of dynamic weight shifting into treadmill training would improve the efficacy of treadmill training in humans with spinal cord injury. DESIGN Sixteen humans with spinal cord injury were randomly assigned to receive robotic or treadmill-only training and underwent 6 wks of training. A force was applied to the pelvis for facilitating weight shifting and to the legs for assisting with leg swing for participants in the robotic group. No assistance force was applied for participants in the treadmill-only group. Outcome measures consisted of overground walking speed, 6-min walking distance, and other clinical measures and were assessed before, after 6 wks of training, and 8 wks after the end of training. RESULTS A greater improvement in 6-min walking distance was observed after robotic training than that after treadmill-only training (P = 0.03), but there was not a significant difference between the two groups in improvements in walking speed. However, a greater improvement was observed for the participants who underwent robotic training than those who underwent treadmill-only training (i.e., 15% vs. 2%). CONCLUSIONS Applying a pelvis assistance force for facilitating weight shifting during treadmill training may improve locomotor function in humans with spinal cord injury.
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Affiliation(s)
- Ming Wu
- Leg and walking lab, Shirley Ryan Abilitylab, Chicago, IL, 60611, USA
- Department of Physical Medicine and Rehabilitation, Northwestern University Medical School, Chicago, IL, 60611, USA
| | - Janis Kim
- Leg and walking lab, Shirley Ryan Abilitylab, Chicago, IL, 60611, USA
| | - Feng Wei
- Leg and walking lab, Shirley Ryan Abilitylab, Chicago, IL, 60611, USA
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