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Caronni A, Picardi M, Scarano S, Rota V, Guidali G, Bolognini N, Corbo M. Minimal detectable change of gait and balance measures in older neurological patients: estimating the standard error of the measurement from before-after rehabilitation data thanks to the linear mixed-effects models. J Neuroeng Rehabil 2024; 21:44. [PMID: 38566189 PMCID: PMC10986034 DOI: 10.1186/s12984-024-01339-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/11/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Tracking gait and balance impairment in time is paramount in the care of older neurological patients. The Minimal Detectable Change (MDC), built upon the Standard Error of the Measurement (SEM), is the smallest modification of a measure exceeding the measurement error. Here, a novel method based on linear mixed-effects models (LMMs) is applied to estimate the standard error of the measurement from data collected before and after rehabilitation and calculate the MDC of gait and balance measures. METHODS One hundred nine older adults with a gait impairment due to neurological disease (66 stroke patients) completed two assessment sessions before and after inpatient rehabilitation. In each session, two trials of the 10-meter walking test and the Timed Up and Go (TUG) test, instrumented with inertial sensors, have been collected. The 95% MDC was calculated for the gait speed, TUG test duration (TTD) and other measures from the TUG test, including the angular velocity peak (ωpeak) in the TUG test's turning phase. Random intercepts and slopes LMMs with sessions as fixed effects were used to estimate SEM. LMMs assumptions (residuals normality and homoscedasticity) were checked, and the predictor variable ln-transformed if needed. RESULTS The MDC of gait speed was 0.13 m/s. The TTD MDC, ln-transformed and then expressed as a percentage of the baseline value to meet LMMs' assumptions, was 15%, i.e. TTD should be < 85% of the baseline value to conclude the patient's improvement. ωpeak MDC, also ln-transformed and expressed as the baseline percentage change, was 25%. CONCLUSIONS LMMs allowed calculating the MDC of gait and balance measures even if the test-retest steady-state assumption did not hold. The MDC of gait speed, TTD and ωpeak from the TUG test with an inertial sensor have been provided. These indices allow monitoring of the gait and balance impairment, which is central for patients with an increased falling risk, such as neurological old persons. TRIAL REGISTRATION NA.
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Affiliation(s)
- Antonio Caronni
- Department of Neurorehabilitation Sciences, Ospedale San Luca, IRCCS, Istituto Auxologico Italiano, Milan, 20149, Italy.
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, 20133, Italy.
- IRCCS Istituto Auxologico Italiano, Via Giuseppe Mercalli, 28, Milano, 20122, MI, Italia.
| | - Michela Picardi
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milano, 20144, Italy
| | - Stefano Scarano
- Department of Neurorehabilitation Sciences, Ospedale San Luca, IRCCS, Istituto Auxologico Italiano, Milan, 20149, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, 20133, Italy
| | - Viviana Rota
- Department of Neurorehabilitation Sciences, Ospedale San Luca, IRCCS, Istituto Auxologico Italiano, Milan, 20149, Italy
| | - Giacomo Guidali
- Department of Neurorehabilitation Sciences, Ospedale San Luca, IRCCS, Istituto Auxologico Italiano, Milan, 20149, Italy
- Department of Psychology and NeuroMI, University of Milano-Bicocca, Milano, 20126, Italy
| | - Nadia Bolognini
- Department of Neurorehabilitation Sciences, Ospedale San Luca, IRCCS, Istituto Auxologico Italiano, Milan, 20149, Italy
- Department of Psychology and NeuroMI, University of Milano-Bicocca, Milano, 20126, Italy
| | - Massimo Corbo
- Department of Neurorehabilitation Sciences, Casa di Cura Igea, Milano, 20144, Italy
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Jorgensen A, McManigal M, Post A, Werner D, Wichman C, Tao M, Wellsandt E. Reliability of an Instrumented Pressure Walkway for Measuring Walking and Running Characteristics in Young, Athletic Individuals. Int J Sports Phys Ther 2024; 19:429-439. [PMID: 38576831 PMCID: PMC10987304 DOI: 10.26603/001c.94606] [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: 07/31/2023] [Accepted: 02/07/2024] [Indexed: 04/06/2024] Open
Abstract
Background Spatiotemporal parameters of gait are useful for identifying pathological gait patterns and presence of impairments. Reliability of the pressure-sensitive ZenoTM Walkway has not been established in young, active individuals without impairments, and no studies to this point have included running. Purpose The purposes of this study were to 1) determine if up to two additional trials of walking and running on the ZenoTM Walkway are needed to produce consistent measurements of spatiotemporal variables, and 2) establish test-retest reliability and minimal detectable change (MDC) values for common spatiotemporal variables measured during walking and running. Study Design Cross-Sectional Laboratory Study. Methods Individuals (n=38) in this cross-sectional study walked and ran at self-selected comfortable speed on a pressure-sensitive ZenoTM Walkway. Twenty-one participants returned for follow-up testing between one and 14 days later. Intraclass correlation coefficients (ICCs) were used to assess reliability of spatiotemporal variable means using three, four, or five passes over the ZenoTM Walkway and to assess test-retest reliability of spatiotemporal variables across sessions. Results All variables showed excellent reliability (ICC > 0.995) for walking and running when measured using three, four, or five passes. Additionally, all variables demonstrated moderate to excellent test-retest reliability during walking (ICC: 0.732-0.982) and running (ICC: 0.679-0.985). Conclusion This study establishes a reliable measurement protocol of three one-way passes when using the ZenoTM Walkway for walking or running analysis. This is the first study to establish reliability of the ZenoTM Walkway during running and in young, active individuals without neuromusculoskeletal pathology. Level of Evidence 3b.
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Affiliation(s)
- Alyx Jorgensen
- Department of Health and Rehabilitation Sciences; Medical Sciences Interdepartmental Area Program University of Nebraska Medical Center
| | - Matthew McManigal
- Department of Health and Rehabilitation Sciences University of Nebraska Medical Center
| | - Austin Post
- College of Medicine University of Nebraska Medical Center
| | - David Werner
- Medical Sciences Interdepartmental Area Program; Department of Health and Rehabilitation Sciences University of Nebraska Medical Center
| | | | - Matthew Tao
- Department of Orthopaedic Surgery and Rehabilitation; Department of Health and Rehabilitation Sciences University of Nebraska Medical Center
| | - Elizabeth Wellsandt
- Department of Health and Rehabilitation Sciences; Department of Orthopaedic Surgery and Rehabilitation University of Nebraska Medical Center
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Mason R, Barry G, Robinson H, O'Callaghan B, Lennon O, Godfrey A, Stuart S. Validity and reliability of the DANU sports system for walking and running gait assessment. Physiol Meas 2023; 44:115001. [PMID: 37852268 DOI: 10.1088/1361-6579/ad04b4] [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: 07/04/2023] [Accepted: 10/18/2023] [Indexed: 10/20/2023]
Abstract
Objective. Gait assessments have traditionally been analysed in laboratory settings, but this may not reflect natural gait. Wearable technology may offer an alternative due to its versatility. The purpose of the study was to establish the validity and reliability of temporal gait outcomes calculated by the DANU sports system, against a 3D motion capture reference system.Approach. Forty-one healthy adults (26 M, 15 F, age 36.4 ± 11.8 years) completed a series of overground walking and jogging trials and 60 s treadmill walking and running trials at various speeds (8-14 km hr-1), participants returned for a second testing session to repeat the same testing.Main results. For validity, 1406 steps and 613 trials during overground and across all treadmill trials were analysed respectively. Temporal outcomes generated by the DANU sports system included ground contact time, swing time and stride time all demonstrated excellent agreement compared to the laboratory reference (intraclass correlation coefficient (ICC) > 0.900), aside from ground contact time during overground jogging which had good agreement (ICC = 0.778). For reliability, 666 overground and 511 treadmill trials across all speeds were examined. Test re-test agreement was excellent for all outcomes across treadmill trials (ICC > 0.900), except for swing time during treadmill walking which had good agreement (ICC = 0.886). Overground trials demonstrated moderate to good test re-test agreement (ICC = 0.672-0.750), which may be due to inherent variability of self-selected (rather than treadmill set) pacing between sessions.Significance. Overall, this study showed that temporal gait outcomes from the DANU Sports System had good to excellent validity and moderate to excellent reliability in healthy adults compared to an established laboratory reference.
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Affiliation(s)
- Rachel Mason
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Gillian Barry
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
| | | | | | | | - Alan Godfrey
- Department of Computer and Information Sciences, Northumbria University, Newcasle upon Tyne, United Kingdom
| | - Samuel Stuart
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, United Kingdom
- Department of Neurology, Oregon Health and Science University, Portland, OR, United States of America
- Northumbria Healthcare NHS Foundation Trust, North Shields, United Kingdom
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Ivaniski-Mello A, Müller VT, de Liz Alves L, Casal MZ, Haas AN, Correale L, Kanitz AC, Martins VF, Gonçalves AK, Martinez FG, Peyré-Tartaruga LA. Determinants of Dual-task Gait Speed in Older Adults with and without Parkinson's Disease. Int J Sports Med 2023; 44:744-750. [PMID: 37130568 DOI: 10.1055/a-2085-1429] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Mobility difficulties for people with Parkinson's disease (PwPD) are more pronounced when they perform a simultaneous cognitive task while walking. Although it is known that neurodegeneration results in widespread motor and brain impairments, few studies have comprehensively examined possible physical and mental determinants of dual task walking in PwPD. In this cross-sectional study, we aimed to investigate if and how muscle strength (sit-to-stand 30-sec test), cognition (mini-mental state examination) and functionality (timed up and go test) affect walking performance (10-meter walking test) with and without arithmetic dual task from older adults with and without Parkinson's disease. Walking speed was reduced by 16% and 11% with arithmetic dual task for PwPD (from 1.07±0.28 to 0.91±0.29 m.s-1, p<0.001) and older adults (from 1.32±0.28 to 1.16±0.26 m.s-1, p=0.002) compared to essential walking. The cognitive state was similar among the groups, but it was only associated with the dual-task walking speed in PwPD. In PwPD, lower limb strength was the better predictor of speed, whereas mobility was more related to it in older adults. Therefore, future exercise interventions aiming to improve walking in PwPD should consider these findings to maximize their effectiveness.
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Affiliation(s)
- André Ivaniski-Mello
- LaBiodin Biodynamics Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Vivian Torres Müller
- LaBiodin Biodynamics Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lucas de Liz Alves
- LaBiodin Biodynamics Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcela Zimmermann Casal
- LaBiodin Biodynamics Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Aline Nogueira Haas
- LaBiodin Biodynamics Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- Atlantic Fellow for Equity in Brain Health, Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Luca Correale
- Department of Public Health, Experimental Medicine and Forensic Sciences, University of Pavia, Pavia, Italy
| | - Ana Carolina Kanitz
- LaBiodin Biodynamics Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Valéria Feijó Martins
- LaBiodin Biodynamics Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Andréa Kruger Gonçalves
- LaBiodin Biodynamics Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Flávia Gomes Martinez
- LaBiodin Biodynamics Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Leonardo Alexandre Peyré-Tartaruga
- LaBiodin Biodynamics Laboratory, School of Physical Education, Physiotherapy and Dance, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Parati M, Gallotta M, De Maria B, Pirola A, Morini M, Longoni L, Ambrosini E, Ferriero G, Ferrante S. Video-based Goniometer Applications for Measuring Knee Joint Angles during Walking in Neurological Patients: A Validity, Reliability and Usability Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:2232. [PMID: 36850828 PMCID: PMC9960424 DOI: 10.3390/s23042232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/07/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
Easy-to-use evaluation of Range Of Motion (ROM) during walking is necessary to make decisions during neurological rehabilitation programs and during follow-up visits in clinical and remote settings. This study discussed goniometer applications (DrGoniometer and Angles - Video Goniometer) that measure knee joint ROM during walking through smartphone cameras. The primary aim of the study is to test the inter-rater and intra-rater reliability of the collected measurements as well as their concurrent validity with an electro-goniometer. The secondary aim is to evaluate the usability of the two mobile applications. A total of 22 patients with Parkinson's disease (18 males, age 72 (8) years), 22 post-stroke patients (17 males, age 61 (13) years), and as many healthy volunteers (8 males, age 45 (5) years) underwent knee joint ROM evaluations during walking. Clinicians and inexperienced examiners used the two mobile applications to calculate the ROM, and then rated their perceived usability through the System Usability Scale (SUS). Intraclass correlation coefficients (ICC) and correlation coefficients (corr) were calculated. Both applications showed good reliability (ICC > 0.69) and validity (corr > 0.61), and acceptable usability (SUS > 68). Smartphone-based video goniometers could be used to assess the knee ROM during walking in neurological patients, because of their acceptable degree of reliability, validity and usability.
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Affiliation(s)
- Monica Parati
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Milan, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Milan, Italy
| | - Matteo Gallotta
- Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Milan, Italy
| | - Beatrice De Maria
- Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Milan, Italy
| | - Annalisa Pirola
- Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Milan, Italy
| | - Matteo Morini
- Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Milan, Italy
| | - Luca Longoni
- Istituti Clinici Scientifici Maugeri, 20851 Lissone, Monza Brianza, Italy
| | - Emilia Ambrosini
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Milan, Italy
| | - Giorgio Ferriero
- Istituti Clinici Scientifici Maugeri IRCCS Tradate, 21049 Tradate, Varese, Italy
- Department of Biotechnology and Life Sciences, University of Insubria, 21110 Varese, Varese, Italy
| | - Simona Ferrante
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Milan, Italy
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Parati M, Gallotta M, Muletti M, Pirola A, Bellafà A, De Maria B, Ferrante S. Validation of Pressure-Sensing Insoles in Patients with Parkinson's Disease during Overground Walking in Single and Cognitive Dual-Task Conditions. SENSORS (BASEL, SWITZERLAND) 2022; 22:6392. [PMID: 36080851 PMCID: PMC9460700 DOI: 10.3390/s22176392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/23/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
There is a need for unobtrusive and valid tools to collect gait parameters in patients with Parkinson's disease (PD). The novel promising tools are pressure-sensing insoles connected to a smartphone app; however, few studies investigated their measurement properties during simple or challenging conditions in PD patients. This study aimed to examine the validity and reliability of gait parameters computed by pressure-sensing insoles (FeetMe® insoles, Paris, France). Twenty-five PD patients (21 males, mean age: 69 (7) years) completed two walking assessment sessions. In each session, participants walked on an electronic pressure-sensitive walkway (GaitRite®, CIR System Inc., Franklin, NJ, USA) without other additional instructions (i.e., single-task condition) and while performing a concurrent cognitive task (i.e., dual-task condition). Spatiotemporal gait parameters were measured simultaneously using the pressure-sensing insoles and the electronic walkway. Concurrent validity was assessed by correlation coefficients and Bland-Altman methodology. Test-retest reliability was examined by intraclass correlation coefficients (ICC) and minimal detectable changes (MDC). The validity results showed moderate to excellent correlations and good agreement between the two systems. Concerning test-retest reliability, moderate-to-excellent ICC values and acceptable MDC demonstrated the repeatability of the measured gait parameters. Our findings support the use of these insoles as complementary instruments to conventional tools during single and dual-task conditions.
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Affiliation(s)
- Monica Parati
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Italy
| | - Matteo Gallotta
- Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Italy
| | - Manuel Muletti
- Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Italy
| | - Annalisa Pirola
- Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Italy
| | - Alice Bellafà
- Istituti Clinici Scientifici Maugeri IRCCS, 20138 Milan, Italy
| | | | - Simona Ferrante
- Neuroengineering and Medical Robotics Laboratory, Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy
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