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Mehdipour A, Malouka S, Beauchamp M, Richardson J, Kuspinar A. Measurement properties of the usual and fast gait speed tests in community-dwelling older adults: a COSMIN-based systematic review. Age Ageing 2024; 53:afae055. [PMID: 38517125 PMCID: PMC10958613 DOI: 10.1093/ageing/afae055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVE The gait speed test is one of the most widely used mobility assessments for older adults. We conducted a systematic review to evaluate and compare the measurement properties of the usual and fast gait speed tests in community-dwelling older adults. METHODS Three databases were searched: MEDLINE, EMBASE and CINAHL. Peer-reviewed articles evaluating the gait speed test's measurement properties or interpretability in community-dwelling older adults were included. The Consensus-based Standards for the selection of health Measurement Instruments guidelines were followed for data synthesis and quality assessment. RESULTS Ninety-five articles met our inclusion criteria, with 79 evaluating a measurement property and 16 reporting on interpretability. There was sufficient reliability for both tests, with intraclass correlation coefficients (ICC) generally ranging from 0.72 to 0.98, but overall quality of evidence was low. For convergent/discriminant validity, an overall sufficient rating with moderate quality of evidence was found for both tests. Concurrent validity of the usual gait speed test was sufficient (ICCs = 0.79-0.93 with longer distances) with moderate quality of evidence; however, there were insufficient results for the fast gait speed test (e.g. low agreement with longer distances) supported by high-quality studies. Responsiveness was only evaluated in three articles, with low quality of evidence. CONCLUSION Findings from this review demonstrated evidence in support of the reliability and validity of the usual and fast gait speed tests in community-dwelling older adults. However, future validation studies should employ rigorous methodology and evaluate the tests' responsiveness.
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Affiliation(s)
- Ava Mehdipour
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Selina Malouka
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Marla Beauchamp
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
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Sipilä S, Tirkkonen A, Savikangas T, Hänninen T, Laukkanen P, Alen M, Fielding RA, Kivipelto M, Kulmala J, Rantanen T, Sihvonen SE, Sillanpää E, Stigsdotter Neely A, Törmäkangas T. Effects of physical and cognitive training on gait speed and cognition in older adults: A randomized controlled trial. Scand J Med Sci Sports 2021; 31:1518-1533. [PMID: 33772877 DOI: 10.1111/sms.13960] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/12/2021] [Accepted: 03/23/2021] [Indexed: 01/14/2023]
Abstract
Gait speed is a measure of health and functioning. Physical and cognitive determinants of gait are amenable to interventions, but best practices remain unclear. We investigated the effects of a 12-month physical and cognitive training (PTCT) on gait speed, dual-task cost in gait speed, and executive functions (EFs) compared with physical training (PT) (ISRCTN52388040). Community-dwelling older adults, who did not meet physical activity recommendations, were recruited (n = 314). PT included supervised walking/balance (once weekly) and resistance/balance training (once weekly), home exercises (2-3 times weekly), and moderate aerobic activity 150 min/week in bouts of >10 min. PTCT included the PT and computer training (CT) on EFs 15-20 min, 3-4 times weekly. The primary outcome was gait speed. Secondary outcomes were 6-min walking distance, dual-task cost in gait speed, and EF (Stroop and Trail Making B-A). The trial was completed by 93% of the participants (age 74.5 [SD3.8] years; 60% women). Mean adherence to supervised sessions was 59%-72% in PT and 62%-77% in PTCT. Home exercises and CT were performed on average 1.9 times/week. Weekly minutes spent in aerobic activities were 188 (median 169) in PT and 207 (median 180) in PTCT. No significant interactions were observed for gait speed (PTCT-PT, 0.02; 95%CI -0.03, 0.08), walking distance (-3.8; -16.9, 9.3) or dual-task cost (-0.22; -1.74, 1.30). Stroop improvement was greater after PTCT than PT (-6.9; -13.0, -0.8). Complementing physical training with EFs training is not essential for promotion of gait speed. For EF's, complementing physical training with targeted cognitive training provides additional benefit.
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Affiliation(s)
- Sarianna Sipilä
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Anna Tirkkonen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Tiina Savikangas
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Tuomo Hänninen
- NeuroCenter, Neurology, Kuopio University Hospital, Kuopio, Finland
| | - Pia Laukkanen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Markku Alen
- Department of Medical Rehabilitation, Oulu University Hospital, Oulu, Finland
| | - Roger A Fielding
- Nutrition, Exercise Physiology, and Sarcopenia Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Miia Kivipelto
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden.,Institute of Clinical Medicine/Neurology, University of Eastern Finland, Kuopio, Finland.,Neuroepidemiology and Ageing Research Unit, School of Public Health, Imperial College London, London, UK
| | - Jenni Kulmala
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.,Division of Clinical Geriatrics, Center for Alzheimer Research, NVS, Karolinska Institutet, Stockholm, Sweden.,Faculty of Social Sciences (Health Sciences) and Gerontology Research Centre (GEREC), Tampere University, Tampere, Finland
| | - Taina Rantanen
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Sanna E Sihvonen
- School of Health and Social Studies, Jyväskylä University of Applied Sciences, Jyväskylä, Finland
| | - Elina Sillanpää
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Anna Stigsdotter Neely
- Department of Social and Psychological Studies, Karlstad University, Karlstad, Sweden.,Engineering Psychology, Luleå University of Technology, Luleå, Sweden
| | - Timo Törmäkangas
- Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
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Timmermans EJ, Reinhard E, Ruijsbroek A, Huisman M, Avendano M. Regeneration of deprived neighbourhoods and indicators of functioning in older adults: A quasi-experimental evaluation of the Dutch District Approach. Health Place 2020; 64:102359. [PMID: 32838884 DOI: 10.1016/j.healthplace.2020.102359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 05/07/2020] [Accepted: 05/20/2020] [Indexed: 12/21/2022]
Abstract
This study examines the impact of the Dutch District Approach, a major urban regeneration programme that was started in 2008 in the Netherlands, on social, physical and mental functioning of older adults. Data from 1092 participants (58-93 years at baseline) across two waves (2005/06 and 2011/12) of the Longitudinal Aging Study Amsterdam were linked to detailed data on exposure to the programme. Using a difference-in-difference approach, we assessed differences from pre-intervention to the intervention period between the target and control districts in loneliness, social engagement, social isolation, physical activity, and anxiety and depressive symptoms. Regardless of programme intensity, the results indicate that the Dutch District Approach did not benefit or harm these aspects of functioning in older adults.
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Affiliation(s)
- Erik J Timmermans
- Department of Epidemiology and Biostatistics, Amsterdam UMC - location VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
| | - Erica Reinhard
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom; Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Annemarie Ruijsbroek
- Center for Nutrition, Prevention and Health Services, National Institute for Public Health and Environment, Bilthoven, the Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Biostatistics, Amsterdam UMC - location VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Department of Sociology, Faculty of Social Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Mauricio Avendano
- Department of Global Health and Social Medicine, King's College London, London, United Kingdom; Department of Social Behavioral Sciences, Harvard T. H. Chan School of Public Health, Cambridge, MA, USA
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Steinbichler T, Bender B, Blassnigg E, Riechelmann H. Evaluation of a German version of the tonsil and adenoid health status instrument. J Otolaryngol Head Neck Surg 2014; 43:41. [PMID: 25367415 PMCID: PMC4232686 DOI: 10.1186/s40463-014-0041-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 10/16/2014] [Indexed: 11/12/2022] Open
Abstract
Background To create and validate a German version of the Tonsil and Adenoid Health Status Instrument (TAHSI) for evaluation of tonsillectomy outcome in adult patients with chronic or recurrent tonsillitis. Subjects and methods 46 healthy volunteers were assessed twice in a 6 week interval with the TAHSI questionnaire. Their results were compared with 45 patients suffering from chronic tonsillitis before tonsillectomy and 6 months following surgery. For internal consistency, Cronbach’s alpha was calculated; to identify normal score values, the optimum cutoff between healthy and diseased individuals was identified with receiver operating characteristic analysis; and responsiveness was assessed using Guyatt’s Responsiveness Index (GRI). Results Cronbach’s alpha for all questions was 0.92. Test- retest intraclass correlation coefficient was 0.89 (95% confidence interval 0.80-0.94 p < 0.001). Mean score for the healthy individuals was 7.0 (95% confidence interval 4.2-9.7). The optimum cut off score between healthy and diseased was 20 with a sensitivity of 80% and a specificity of 90% to differentiate controls from tonsillectomy patients. Conclusion The TAHSI performed well in this validation tests and is considered a favorable instrument to evaluate the effectiveness of tonsillectomy in adults with chronic or recurrent tonsillitis.
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Affiliation(s)
- Teresa Steinbichler
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstr 35, A-6020 Innsbruck, Austria
| | - Birte Bender
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstr 35, A-6020 Innsbruck, Austria
| | - Elisabeth Blassnigg
- Department of Otorhinolaryngology, Community Hospital Kufstein, Endach 27, A-6330 Kufstein, Austria
| | - Herbert Riechelmann
- Department of Otorhinolaryngology, Medical University of Innsbruck, Anichstr 35, A-6020 Innsbruck, Austria
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Motor phenotype of decline in cognitive performance among community-dwellers without dementia: population-based study and meta-analysis. PLoS One 2014; 9:e99318. [PMID: 24911155 PMCID: PMC4049832 DOI: 10.1371/journal.pone.0099318] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 05/13/2014] [Indexed: 11/19/2022] Open
Abstract
Background Decline in cognitive performance is associated with gait deterioration. Our objectives were: 1) to determine, from an original study in older community-dwellers without diagnosis of dementia, which gait parameters, among slower gait speed, higher stride time variability (STV) and Timed Up & Go test (TUG) delta time, were most strongly associated with lower performance in two cognitive domains (i.e., episodic memory and executive function); and 2) to quantitatively synthesize, with a systematic review and meta-analysis, the association between gait performance and cognitive decline (i.e., mild cognitive impairment (MCI) and dementia). Methods Based on a cross-sectional design, 934 older community-dwellers without dementia (mean±standard deviation, 70.3±4.9years; 52.1% female) were recruited. A score at 5 on the Short Mini-Mental State Examination defined low episodic memory performance. Low executive performance was defined by clock-drawing test errors. STV and gait speed were measured using GAITRite system. TUG delta time was calculated as the difference between the times needed to perform and to imagine the TUG. Then, a systematic Medline search was conducted in November 2013 using the Medical Subject Heading terms “Delirium,” “Dementia,” “Amnestic,” “Cognitive disorders” combined with “Gait” OR “Gait disorders, Neurologic” and “Variability.” Findings A total of 294 (31.5%) participants presented decline in cognitive performance. Higher STV, higher TUG delta time, and slower gait speed were associated with decline in episodic memory and executive performances (all P-values <0.001). The highest magnitude of association was found for higher STV (effect size = −0.74 [95% Confidence Interval (CI): −1.05;−0.43], among participants combining of decline in episodic memory and in executive performances). Meta-analysis underscored that higher STV represented a gait biomarker in patients with MCI (effect size = 0.48 [95% CI: 0.30;0.65]) and dementia (effect size = 1.06 [95% CI: 0.40;1.72]). Conclusion Higher STV appears to be a motor phenotype of cognitive decline.
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Beauchet O, Launay CP, Allali G, Herrmann FR, Annweiler C. Gait Changes with Anti-Dementia Drugs: A Prospective, Open-Label Study Combining Single and Dual Task Assessments in Patients with Alzheimer’s Disease. Drugs Aging 2014; 31:363-72. [DOI: 10.1007/s40266-014-0175-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Linhares DVBR, da Fonseca JAL, Borrego LM, Matos A, Pereira AM, Sá-Sousa A, Gaspar A, Mendes C, Moreira C, Gomes E, Rebelo FF, Cidrais Rodrigues JC, Onofre JM, Azevedo LF, Alfaro M, Calix MJ, Amaral R, Rodrigues-Alves R, Correia de Sousa J, Morais-Almeida M. Validation of control of allergic rhinitis and asthma test for children (CARATKids)--a prospective multicenter study. Pediatr Allergy Immunol 2014; 25:173-9. [PMID: 24628568 DOI: 10.1111/pai.12218] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Control of Allergic Rhinitis and Asthma Test for Children (CARATKids) is the first questionnaire that assesses simultaneously allergic rhinitis and asthma control in children. It was recently developed, but redundancy of questions and its psychometric properties were not assessed. This study aimed to (i) establish the final version of the CARATKids questionnaire and (ii) evaluate its reliability, responsiveness, cross-sectional validity, and longitudinal validity. METHODS A prospective observational study was conducted in 11 Portuguese centers. During two visits separated by 6 wk, CARATKids, visual analog scale scales and childhood asthma control test were completed, and participant's asthma and rhinitis were evaluated by his/her physician without knowing the questionnaires' results. Data-driven item reduction was conducted, and internal consistency, responsiveness analysis, and associations with external measures of disease status were assessed. RESULTS Of the 113 children included, 101 completed both visits. After item reduction, the final version of the questionnaire has 13 items, eight to be answered by the child and five by the caregiver. Its Cronbach's alpha was 0.80, the Guyatt's responsiveness index was -1.51, and a significant (p < 0.001) within-patient change of CARATKids score in clinical unstable patients was observed. Regarding cross-sectional validity, correlation coefficients of CARATKids with the external measures of control were between 0.45 and -0.69 and met the a priori predictions. In the longitudinal validity assessment, the correlation coefficients between the score changes of CARATKids and those of external measures of control ranged from 0.34 to 0.46. CONCLUSION CARATKids showed adequate psychometric properties and is ready to be used in clinical practice.
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Litwin H, Stoeckel KJ. Social network and mobility improvement among older Europeans: the ambiguous role of family ties. Eur J Ageing 2013; 10:159-169. [PMID: 28804291 DOI: 10.1007/s10433-013-0269-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This study examined the social network correlates of improvement in lower extremity mobility among respondents aged 65 and older from the longitudinal sample of the Survey of Health, Ageing and Retirement in Europe. The study focused on those who self-reported having difficulties with four lower extremity functions: (1) walking 100 m; (2) rising from a seated position; (3) climbing flights of steps; and (4) stooping, kneeling, or crouching. Multivariate logistic regression analyses revealed that social networks were variously associated with improvement in lower extremity function at the two-year follow-up. The findings suggest that under certain circumstances, a lack of social support in late life may actually promote mobility improvement. The research also shows that family networks are not always facilitative of mobility improvement. This is in contrast to previously published social network research positing that supportive relationships help foster health and buffer stressors in late life. Family caregivers and social services should keep this in mind when devising treatment plans upon discharge from the hospital and implementing care management plans for frail older persons in the community.
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Affiliation(s)
- Howard Litwin
- Israel Gerontological Data Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Kimberly J Stoeckel
- Israel Gerontological Data Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Freiberger E, de Vreede P, Schoene D, Rydwik E, Mueller V, Frändin K, Hopman-Rock M. Performance-based physical function in older community-dwelling persons: a systematic review of instruments. Age Ageing 2012; 41:712-21. [PMID: 22885845 DOI: 10.1093/ageing/afs099] [Citation(s) in RCA: 238] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Identification of older persons at risk for the loss of independence, onset of (co)-morbidity or functional limitations through screening/assessment is of interest for the public health-care system. To date several different measurement instruments for overall physical function are frequently used in practice, but little information about their psychometric properties is available. Objectives and METHODS Our aim was to assess instruments with an overall score related to functional status and/or physical performance on content and psychometric properties. Electronic databases (Medline, EMBASE, AMED, Cochrane Library and CINAHL) were searched, using MeSH terms and relevant keywords. Studies, published in English, were included if their primary or secondary purpose was to evaluate the measurement properties of measurement instruments for overall physical function in community-dwelling older persons aged 60 years and older. Reliability, validity, responsiveness and practicability were evaluated, adhering to a specified protocol. RESULTS In total 78 articles describing 12 different functional assessment instruments were included and data extracted. Seven instruments, including their modified versions, were evaluated for reliability. Nine instruments, including their modified versions, were evaluated with regard to validity. CONCLUSION In conclusion, the Short Physical Performance Battery can be recommended most highly in terms of validity, reliability and responsiveness, followed by the Physical Performance Test and Continuous Scale Physical Functional Performance.
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Affiliation(s)
- Ellen Freiberger
- Institute of Sport Science and Sports, Friedrich-Alexander-Universität, Gebbertstr. 123b, Erlangen-Nürnberg, Erlangen 91058, Germany.
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Rydwik E, Bergland A, Forsén L, Frändin K. Investigation into the reliability and validity of the measurement of elderly people's clinical walking speed: A systematic review. Physiother Theory Pract 2011; 28:238-56. [DOI: 10.3109/09593985.2011.601804] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Annweiler C, Schott AM, Montero-Odasso M, Berrut G, Fantino B, Herrmann FR, Beauchet O. Cross-sectional association between serum vitamin D concentration and walking speed measured at usual and fast pace among older women: the EPIDOS study. J Bone Miner Res 2010; 25:1858-66. [PMID: 20205167 PMCID: PMC5005070 DOI: 10.1002/jbmr.80] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The purpose of this study was to determine whether there was an association between serum 25-hydroxyvitamin D [25(OH)D] concentration and walking speed measured at usual and fast pace among older women. Usual- and fast-pace walking speeds and 25(OH)D concentrations were assessed in 739 randomized older women (mean age 80.2 +/- 3.5 years) from the EPIDOS study. The following 25(OH)D thresholds were used: 10, 20, and 30 ng/mL. Walking speed was dichotomized on being in the worst quintile or not. Age, body mass index, number of chronic diseases, physical activity, quadriceps strength, cognition, use of psychoactive drugs, and serum parathyroid hormone were used as potential confounders. The results show that 90% of subjects had 25(OH)D insufficiency. Only fast-pace walking speed was significantly different between groups (p = .021) and decreased from normal serum 25(OH)D concentrations to severe insufficiency (trend p = .007). Serum 25(OH)D concentration was associated with walking speed at both usual and fast pace in the unadjusted linear regression (beta = 0.16, p = .027 and beta = 0.23, p = .009, respectively). This association remained significant only for fast-pace walking after adjustment (adjusted beta = 0.18, p = .033) and was strengthened from a lower 25(OH)D value compared with usual pace [25(OH)D = 27.15 ng/mL for fast pace and 38.65 ng/mL for usual pace). Lastly, logistic regression showed a stronger association of serum 25(OH)D insufficiency with fast-pace walking speed whatever the 25(OH)D thresholds used [30 to 20 ng/mL: adjusted odds ratio (adjOR) = 6.01, p = .003; 20 to 10 ng/mL: adjOR = 4.10, p = .014; <10 ng/mL: adjOR = 6.95, p = .001) compared with usual pace (30 to 20 ng/mL: adjOR = 3.79, p = .022; 20 to 10 ng/mL: adjOR = 3.76, p = .016; <10 ng/mL: adjOR = 5.44, p = .003). The findings show a stronger positive association between 25(OH)D concentrations and fast-pace walking speed that is a more sensitive marker of neuromuscular functioning compared with usual-pace walking.
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Affiliation(s)
- Cédric Annweiler
- Department of Internal Medicine and Geriatrics, Angers University Hospital, Angers, France.
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van Iersel MB, Munneke M, Esselink RAJ, Benraad CEM, Olde Rikkert MGM. Gait velocity and the Timed-Up-and-Go test were sensitive to changes in mobility in frail elderly patients. J Clin Epidemiol 2007; 61:186-91. [PMID: 18177792 DOI: 10.1016/j.jclinepi.2007.04.016] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Revised: 03/25/2007] [Accepted: 04/12/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To estimate clinically relevant changes in functional mobility tests and quantitative gait measures at group and individual level in frail elderly patients. STUDY DESIGN AND SETTING This study was a cohort study of consecutively admitted frail elderly patients. Gait velocity, Timed-Up-and-Go test (TUG), and other mobility tests were measured on admission and 2 weeks later. In between, patients received multidisciplinary treatment. Three experts decided from video recordings if patients had a clinically relevant change in gait, defined as change in the expected risk of falling. RESULTS A total of 85 patients (mean age 75.8 years, 46 female) participated. Of whom, 45% had dementia; 59 patients were stable and 26 showed a clinically relevant change in gait. Gait velocity and TUG were most sensitive to change at group level. In individual patients, a 5% change from baseline in gait velocity and 9% change in TUG had a sensitivity of 92% and 93% for detection of clinically relevant change, but specificity of 27% and 34%, respectively. CONCLUSION At group level, gait velocity and TUG were, from all investigated tests, most sensitive to change and in this perspective the best outcome variables. In individual patients, the high intraindividual variability makes these measures unsuitable as independent screening instruments for clinically relevant changes in gait.
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Affiliation(s)
- Marianne B van Iersel
- Department of Geriatrics, Radboud University Nijmegen Medical Centre, Internal code 925, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
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Wolf SL, O'Grady M, Easley KA, Guo Y, Kressig RW, Kutner M. The influence of intense Tai Chi training on physical performance and hemodynamic outcomes in transitionally frail, older adults. J Gerontol A Biol Sci Med Sci 2006; 61:184-9. [PMID: 16510864 DOI: 10.1093/gerona/61.2.184] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Few data exist to evaluate whether Tai Chi (TC) training improves physical performance and hemodynamic outcomes more than a wellness education (WE) program does among older fallers transitioning to frailty. METHODS This 48-week randomized clinical trial was provided at 10 matched pairs of congregate living facilities in the Atlanta metropolitan area to 291 women and 20 men, who were transitionally frail, >or=70 years old, and had fallen at least once within the past year. Pairs of facilities were randomized to either TC exercise (n = 158) or WE (control) interventions (n = 153) over 48 weeks. Physical performance (freely chosen gait speed, reach, chair-rises, 360 degrees turn, picking up an object from the floor, and single limb support) and hemodynamic outcomes (heart rate and blood pressure) were obtained at baseline and after 4, 8, and 12 months. RESULTS Mean percent change (baseline to 1 year) for gait speed increased similarly in both cohorts (TC: 9.1% and WE: 8.2%; p =.78). However, time to complete three chair-rises decreased 12.3% for TC and increased 13.7% for WE (p =.006). Baseline to 1 year mean percent change decreased among TC and increased within WE cohorts for: body mass index (-2.3% vs 1.8%; p <.0001), systolic blood pressure (-3.4% vs 1.7%; p =.02), and resting heart rate (-5.9% vs 4.6%; p <.0001). CONCLUSIONS TC significantly improved chair-rise and cardiovascular performance. Because TC training reduced fall occurrences in this cohort, factors influencing functional and cardiovascular improvements may also favorably impact fall events.
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Affiliation(s)
- Steven L Wolf
- Department of Rehabilitation Medicine, Emory University School of Medicine, 212 C Rehabilitation Center, 1441 Clifton Rd. NE, Atlanta, GA 30322, USA.
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Abstract
Abstract
Problems with ambulation and mobility are frequent problems in older adults. Each year, about one in 100 older adults develops new severe mobility disability. Assessment of abnormal gait constitutes a major component of clinical practice and may lead to fall reduction. Clinicians can benefit from simple gait and mobility assessment tools to be used in busy clinical settings. This review focuses on gait and stepping performance measures that can be used by the busy clinician to assess gait, mobility performance, balance, and falls risk in the older adult.
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Montero-Odasso M, Schapira M, Soriano ER, Varela M, Kaplan R, Camera LA, Mayorga LM. Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years and older. J Gerontol A Biol Sci Med Sci 2006; 60:1304-9. [PMID: 16282564 DOI: 10.1093/gerona/60.10.1304] [Citation(s) in RCA: 445] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE Although gait velocity (GV) measurement could predict poor outcomes, few studies regarding its usefulness as a single test in well functioning elderly persons have been pursued. The aim of this study was to asses whether GV could be sufficient to predict adverse events such as hospitalization for any cause, requirement for a caregiver, nursing home placement, falls, fractures, or death in healthy elderly persons. METHODS Ours was a cohort study comprising 102 well functioning participants aged 75 and older. Demographic features, health status, and functional capacity were assessed at baseline and followed for adverse outcomes. Measurements included evaluation of cognition, activities of daily living, and mobility. The time required to walk the middle 8 meters of 10 meters was defined as GV. Three GV groups were distinguished: high GV (>1.1 m/s), median GV (1-0.7 m/s), and low GV (<0.7 m/s). RESULTS At baseline, the three groups were comparable in their health status with an average age of 79.6 +/- 4 years. At 24 months, the low GV group had a significantly higher incidence of adverse events than did the other groups. Low GV was a predictor of hospitalization (relative risk [RR] = 5.9, 95% confidence interval [CI], 1.9-8.5), requirement of a caregiver (RR = 9.5, 95% CI, 1.3-2.5), and new falls (RR = 5.4, 95% CI, 2.0-4.3). These associations remained significant after a multiple logistic regression analysis. CONCLUSIONS GV measurement in the ambulatory setting may allow the detection of healthy elderly people at risk for adverse events. These data may suggest that simple assessment of GV is enough to predict adverse events in well functioning older persons.
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Melzer D, Lan TY, Tom BDM, Deeg DJH, Guralnik JM. Variation in Thresholds for Reporting Mobility Disability Between National Population Subgroups and Studies. J Gerontol A Biol Sci Med Sci 2004; 59:1295-303. [PMID: 15699529 DOI: 10.1093/gerona/59.12.1295] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Disability questions require older people to report difficulties with everyday activities, using broad categorical responses. Relatively little is known about population group differences in the thresholds for reporting difficulty or inability with medium-distance mobility against tested mobility-related performance. We aimed to estimate the thresholds on tested performance at which self-reports change from one category to another, across a range of sociodemographic subgroups. We also aimed to compare reported and tested performance across two national population studies. METHODS The samples were from the third U.S. National Health and Nutrition Examination Study (NHANES III) and the Longitudinal Aging Study Amsterdam (LASA). Measures of gait speed, chair stands, and peak expiratory flow rate in both studies yielded the validated index of mobility-related physical limitations (MOBLI). Latent probit models were used to estimate cutpoints (thresholds) on the index for reporting difficulty or inability to walk a medium distance. RESULTS Thresholds for reporting difficulty or inability were studied by age, sex, race, educational level, and income in NHANES III. In models adjusting for the other factors, performance thresholds for reporting disability categories varied by age and income. The younger elderly persons in NHANES III on average reported difficulties or inabilities only when they reached a more severe level of tested limitation compared with older old persons. A similar pattern exists for those on higher incomes. For race, differences in threshold were present only for reporting inability, but not difficulty. Significant differences in thresholds were not present between groups defined by sex or for years of education. Comparisons between the NHANES and LASA studies show that lower reported mobility difficulty or inability prevalence in the Dutch sample is attributable both to reporting at higher levels of limitation and to better functioning. CONCLUSIONS There is evidence of differences in thresholds for reporting mobility disability, especially across age and income groups in older Americans. Further work is needed to understand the perceptual, attitudinal, or environmental factors that cause these reporting differences.
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Affiliation(s)
- David Melzer
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 2SR, UK.
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