Reference values for standardized tests of walking speed and distance: a systematic review

Natural History of Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay: a 4-Year Longitudinal Study

Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a neurologic disorder with generally well-known clinical manifestations. However, few studies assessed their progression rate using a longitudinal design. This study aimed to document the natural history of ARSACS over a 4-year period in terms of upper and lower limb functions, balance, walking capacity, performance in daily living activities, and disease severity. Forty participants were assessed on three occasions over 4 years. Participant performance was reported in raw data as well as in percentage from reference values to consider the normal aging process. Severe balance and walking capacity impairments were found, with a significant performance decrease over the 4 years. Balance reached a floor score of around 6 points on the Berg Balance Scale for participants aged >40 years, while other participants lost about 1.5 points per year. The mean loss in walking speed was 0.044 m/s per year and the mean decrease in the distance walked in 6 min was 20.8 m per year for the whole cohort. Pinch strength, balance, walking speed, and walking distance decreased over time even when reported in percentage from reference values. Major impairments and rapid progression rates were documented in the present study for upper limb coordination, pinch strength, balance, and walking capacity in the ARSACS population. A progression rate beyond the normal aging process was observed. These results provide fundamental insights regarding the disease prognosis that will help to better inform patients, develop specific rehabilitation programs, and improve trial readiness.

Normative values in healthy adults for the 6-minute and 2-minute walk tests in Belgium and Vietnam: implications for clinical practice

OBJECTIVE

To establish reference values for the 6-minute walk test (6MWT) and 2-minute walk test (2MWT) distances, to investigate the correlation between these 2 tests, and to establish prediction equations for these distances in healthy populations of Belgium and Vietnam.

DESIGN

Cross-sectional study.

SUBJECTS AND METHODS

The 6MWT and 2MWT were administered to a convenience sample of 239 Belgian and 303 Vietnamese participants between the ages of 18 and 80 years.

RESULTS

The mean (standard deviation; SD) 2MWT distances were 215 (32.8) m for Belgian participants and 156 (25.5) m for Vietnamese participants. The mean (SD) 6MWT distances were 625 (90.7) m for Belgian participants and 449 (70.4) m for Vietnamese participants. The Pearson correlation coefficient between the 2 tests was 0.901 (p < 0.001) for Belgian participants and 0.871 (p < 0.001) for Vietnamese participants. Age and sex were the 2 most important predictors of walking distance, followed by body mass index for Belgium and height for Vietnam. The adjusted R² ranged from 0.31 to 0.49 across 4 predictive equations.

CONCLUSION

These results can be used to determine the presence of walking performance deficits and to guide future studies. The 2MWT is suggested as a useful and convenient alternative to the 6MWT for assessing walking performance in clinical practice.

Assessing a GPS-Based 6-Minute Walk Test for People With Persistent Pain: Validation Study

BACKGROUND

The 6-minute walk test (6MWT) is a commonly used method to assess the exercise capacity of people with many health conditions, including persistent pain. However, it is conventionally performed with in-person supervision in a hospital or clinic, therefore requiring staff resources. It may also be difficult when in-person supervision is unavailable, such as during the COVID-19 pandemic, or when the person is geographically remote. A potential solution to these issues could be to use GPS to measure walking distance.

OBJECTIVE

The primary aim of this study was to assess the validity of a GPS-based smartphone app to measure walking distance as an alternative to the conventional 6MWT in a population with persistent pain. The secondary aim of this study was to estimate the difference between the pain evoked by the 2 test methods.

METHODS

People with persistent pain (N=36) were recruited to complete a conventional 6MWT on a 30-m shuttle track and a 6MWT assessed by a smartphone app using GPS, performed on outdoor walking circuits. Tests were performed in random order, separated by a 15-minute rest. The 95% limits of agreement were calculated using the Bland-Altman method, with a specified maximum allowable difference of 100 m. Pain was assessed using an 11-point numerical rating scale before and after each walk test.

RESULTS

The mean 6-minute walk distance measured by the GPS-based smartphone app was 13.2 (SD 46; 95% CI -2.7 to 29.1) m higher than that assessed in the conventional manner. The 95% limits of agreement were 103.9 (95% CI 87.4-134.1) m and -77.6 (95% CI -107.7 to -61) m, which exceeded the maximum allowable difference. Pain increased in the conventional walk test by 1.1 (SD 1.0) points, whereas pain increased in the app test by 0.8 (SD 1.4) points.

CONCLUSIONS

In individuals with persistent pain, the 2 methods of assessing the 6MWT may not be interchangeable due to limited validity. Potential reasons for the differences between the 2 methods might be attributed to the variation in track layout (shuttle track vs continuous circuit); poor GPS accuracy; deviations from the 30-m shuttle track; human variability in walking speed; and the potential impact of a first test on the second test due to fatigue, pain provocation, or a learning effect. Future research is needed to improve the accuracy of the GPS-based approach. Despite its limitations, the GPS-based 6MWT may still have value as a tool for remote monitoring that could allow individuals with persistent pain to self-administer frequent assessments of their functional capacity in their home environment.

Norms for Usual and Fast Walking Speed in Adults 45-69 Years Old From the French General Population: Constances Study

OBJECTIVES

Walking speed (WS) represents an objective measure of motor function and health. We aimed to develop usual (UWS) and fast WS (FWS) norms for the general population using a regression-based approach, while considering age, sex, height, and education.

DESIGN

Cross-sectional analysis of a population-based study.

SETTING AND PARTICIPANTS

French Constances study (45-69 years).

METHODS

UWS/FWS were measured over 3 m (dynamic start) using photoelectric cells. We addressed selection effects (related to survey sampling and nonresponse) and missing data using a combination of inverse probability weighting (IPW) and multiple imputation (MI). Norms by sex, age, height, and education (

RESULTS

Analyses are based on 44,772 participants (51.2% women) with a mean age of 56.8 years (SE = 0.2) for women and 57.3 years (SE = 0.2) for men, and a mean height of 161.4 cm (SE = 0.1) for women and 174.2 cm (SE = 0.1) for men after IPW/MI. WS estimates decreased after IPW/MI. The mean UWS was 116.9 cm/s (SE = 0.8) in women and 120.7 cm/s (SE = 0.8) in men, and the mean FWS was 168.7 cm/s (SE = 1.0) in women and 182.8 cm/s (SE = 1.2) in men. In the multiadjusted model, UWS/FWS decreased with age and increased with height and education. Men had faster FWS than women; they had slightly slower UWS than women in the low-education group, but there were no sex differences in the high-education group.

CONCLUSIONS AND IMPLICATIONS

We developed UWS/FWS norms by age, sex, height, and education for the French general population (45-69 years) that are available through a web app (https://cesp-proxy2.vjf.inserm.fr/NORMES-VM-EN/). These norms can be used to identify in midlife persons with lower motor performances than the general population, given their age, sex, height, and education, who are at higher risk of adverse outcomes.

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Key Words

• Walking speed
• aging
• population
• reference values
• selection bias

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MESH Headings

• Male
• Adult
• Humans
• Female
• Middle Aged
• Aged
• Walking Speed
• Cross-Sectional Studies
• Linear Models
• Walking/physiology

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Affiliation(s)

Félicia Santos Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
Adeline Renuy Inserm, Université Paris Cité, Université Paris Saclay, Université de Versailles-Saint-Quentin-en-Yvelines (UVSQ), UMS 011 « Population-based cohorts unit », Villejuif, France
Anna Ozguler Inserm, Université Paris Cité, Université Paris Saclay, Université de Versailles-Saint-Quentin-en-Yvelines (UVSQ), UMS 011 « Population-based cohorts unit », Villejuif, France
Céline Ribet Inserm, Université Paris Cité, Université Paris Saclay, Université de Versailles-Saint-Quentin-en-Yvelines (UVSQ), UMS 011 « Population-based cohorts unit », Villejuif, France
Marcel Goldberg Inserm, Université Paris Cité, Université Paris Saclay, Université de Versailles-Saint-Quentin-en-Yvelines (UVSQ), UMS 011 « Population-based cohorts unit », Villejuif, France
Marie Zins Inserm, Université Paris Cité, Université Paris Saclay, Université de Versailles-Saint-Quentin-en-Yvelines (UVSQ), UMS 011 « Population-based cohorts unit », Villejuif, France
Fanny Artaud Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
Alexis Elbaz Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France.

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Development of a systematic social observation tool for monitoring use of harm reduction supplies

BACKGROUND

Harm reduction services such as safer injection supply distribution are essential to reducing morbidity and mortality among people who use drugs (PWUD); however, local use of harm reduction supplies (e.g., tourniquets, saline solution) is difficult to routinely and systematically monitor. The purpose of this study was to develop and validate a systematic social observation tool designed to assess use of harm reduction supplies at the street block level.

METHODS

Data collection took place on a random sample of 150 blocks located throughout the Kensington neighborhood of North Philadelphia from November 2021 to January 2022. We measured inter-rater reliability by two-way mixed-effects intra-class correlation coefficients (ICC) with the consistency agreement definition and internal consistency reliability using Cronbach's alpha and McDonald's omega. Exploratory factor analysis with principal component extraction and promax rotation assessed internal consistency. We validated scales against locations of public syringe disposal boxes, a proxy measure for areas of concentrated drug use, using logistic regression.

RESULTS

Naloxone canisters, syringe caps, saline and sterile water solution bottles showed the highest reliability (ICC≥0.7). Items also showed high internal consistency (alpha, omega>0.7). Exploratory factor analysis identified one, three-item scale with high internal consistency: syringe caps, vials, and baggies (alpha = 0.85; omega = 0.85)-all supplies used concurrently with drug injection but not discarded in syringe disposal boxes. Drug use (OR = 1.78, 95 % CI = (1.48, 2.23)), harm reduction (OR = 3.53, 95 % CI = (2.20, 6.12)), and EFA scales (OR = 1.85, 95 %CI = (1.51, 2.34)) were significantly and positively associated with being within walking distance (≤0.25 miles or 0.4 km) of a syringe disposal box.

CONCLUSION

This study provides an efficient tool with high reliability and validity metrics to assess community uptake of harm reduction supplies designed for use by community organizations, policy makers, or other groups providing resources to PWUD.

Early detection and assessment of intensive care unit-acquired weakness: a comprehensive review

Intensive care unit-acquired weakness (ICU-AW) is a serious complication in critically ill patients. Therefore, timely and accurate diagnosis and monitoring of ICU-AW are crucial for effectively preventing its associated morbidity and mortality. This article provides a comprehensive review of ICU-AW, focusing on the different methods used for its diagnosis and monitoring. Additionally, it highlights the role of bedside ultrasound in muscle assessment and early detection of ICU-AW. Furthermore, the article explores potential strategies for preventing ICU-AW. Healthcare providers who manage critically ill patients utilize diagnostic approaches such as physical exams, imaging, and assessment tools to identify ICU-AW. However, each method has its own limitations. The diagnosis of ICU-AW needs improvement due to the lack of a consensus on the appropriate approach for its detection. Nevertheless, bedside ultrasound has proven to be the most reliable and cost-effective tool for muscle assessment in the ICU. Combining the Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE) II score assessment, and ultrasound can be a convenient approach for the early detection of ICU-AW. This approach can facilitate timely intervention and prevent catastrophic consequences. However, further studies are needed to strengthen the evidence.

The correlates and reference values for the 6-minute walk distance in Taiwanese adults with schizophrenia

PURPOSE

The study aimed to identify the factors associated with the 6-min walk distance (6MWD) and to provide reference values for the 6MWD in individuals with schizophrenia (SCZ) in Taiwan.

METHODS

A proportional stratified sampling method was utilized based on distribution of gender, age and body mass index (BMI) at the study hospital. The 6-minute walk test was conducted according to the American Thoracic Society protocol.

RESULTS

A total of 237 patients with SCZ completed the 6-minute walk test. The 6MWD was significantly associated with age, height, weight, and length of the onset of SCZ. Stepwise linear regression revealed that height and age were significant determinants of 6MWD. The reference values for males and females at different age groups were determined. Notably, females over 60 walked substantially shorter than the age younger than 60.

CONCLUSIONS

Height and age were the main predictors for 6MWD among people with SCZ in Taiwan. The established reference values can be used to identify those at risk of poor cardiorespiratory fitness and as a target outcome during exercise programs in psychiatric rehabilitation. Our results highlight that older females with SCZ may be a priority group to target with exercise interventions to mitigate the faster decline in cardiorespiratory fitness.IMPLICATIONS FOR REHABILITATIONHeight and age were predictors of 6-min walk distance (6MWD) in schizophrenia (SCZ).The established age- and gender reference values for the 6MWD can be used to identify those at risk of poor cardiorespiratory fitness.Females with SCZ over age 60 may be a priority group to target with exercise interventions to mitigate the faster decline in cardiorespiratory fitness.

The effects of gastrocnemius muscle spasticity on gait symmetry and trunk control in chronic stroke patients

BACKGROUND

Although reduced gait asymmetry and trunk control are generally accepted outcomes in stroke patients after having a stroke, the number of studies examining the factors affecting gait symmetry and trunk control is limited in the literature.

RESEARCH QUESTION

What are the effects of gastrocnemius muscle spasticity on trunk control and gait symmetry in chronic stroke patients?

METHOD

The sample of the study included 29 individuals aged 40-70 who were diagnosed with stroke at least six months ago. The sociodemographic information of the patients was collected using a descriptive information form. Their gastrocnemius muscle spasticity levels were assessed using the Modified Ashworth Scale (MAS), their trunk control was assessed using the Trunk Impairment Scale (TIS), and their gait symmetry was assessed using software developed for the Kinect V2 camera.

RESULTS

There was a numerical difference between the gait symmetry results of the patients who had a MAS score lower than 2 and those who had a MAS score of 2 or higher, where MAS scores corresponded to gastrocnemius muscle spasticity levels, but this difference was not statistically significant (p > 0.05). There was a statistically significant difference between the total TIS scores and TIS coordination subscale scores of the patients who had a MAS score lower than 2 and those who had a MAS score of 2 or higher (p < 0.05). A negative significant relationship was determined between total TIS and TIS coordination subscale scores and the severity of gastrocnemius muscle spasticity.

SIGNIFICANCE

According to the results of our study, to improve trunk control and gait in stroke survivors, the management of gastrocnemius muscle spasticity should be included in rehabilitation programs. We believe that our study will be guiding for future interventional studies aiming to improve trunk control and gait in stroke patients.

Normal gait speed varies by age and sex but not by geographical region: a systematic review

QUESTIONS

What are comfortable gait speed values for apparently healthy adults? How do these differ by age group, sex and geographical region?

DESIGN

Systematic review of observational studies with meta-analysis.

PARTICIPANTS

Apparently healthy, community-dwelling adults who have undergone measurement of comfortable gait speed.

SEARCH METHOD

Potentially relevant studies were identified in four databases. Extracted data from studies that satisfied the eligibility criteria were added to a database containing the same information from a meta-analysis published a decade ago.

OUTCOME MEASURES

The weighted mean comfortable gait speed was calculated along with the 95% confidence interval for each stratum of age/sex using a random-effects model. Mean gait speeds were further stratified by the continent where the study took place. Tests of homogeneity included I² and prediction intervals.

RESULTS

Meta-analysis of data from 51,248 apparently healthy adults was stratified by age (in decades) and sex. Male gait speed slowed beyond age 50 years whereas female gait speed slowed beyond age 30 years. The weighted mean gait speed ranged from 97 cm/s (females aged ≥ 80 years) to 140 cm/s (males aged 40 to 49 years). The I² values ranged from 0 to 34.07; prediction interval ranges varied from a low of 30 (125 to 155 cm/s; males aged 40 to 49 years) to a high of 77 (83 to 160 cm/s; females aged 60 to 69 years). There was considerable overlap in confidence intervals between continents for each sex/age group.

CONCLUSIONS

Comfortable gait speed slowed through the adult years, but males maintained a faster walking speed than females. Further stratification of comfortable gait speed by geographical region is not warranted.

Reference Values and Cutoff Scores of the Spinal Cord Independence Measure III to Determine Independence for Wheelchair Users and Ambulatory Individuals With Spinal Cord Injury

OBJECTIVE

To establish the reference values and optimal cutoff scores of the Spinal Cord Independence Measure Version III (SCIM III) to indicate independence of wheelchair users (WU) and ambulatory (AM) individuals with spinal cord injury (SCI).

DESIGN

A cross-sectional study.

SETTING

Tertiary rehabilitation center and communities.

PARTICIPANTS

A total of 309 (168 WU and 141 AM) participants with SCI.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE(S)

SCIM III scores.

RESULTS

Participants with greater levels of independence had significantly higher SCIM III scores, both total and subitem scores (P<.05). The SCIM III scores of ≥55 and ≥75 were optimal indicators of modified independence in WU and AM individuals, respectively (sensitivity and specificity >93%, AUC>.95). In addition, scores of 90 were proved to be excellent indicators for independence of AM individuals (sensitivity 94%, specificity 100%, AUC=.99).

CONCLUSIONS

The present findings provide the reference values of SCIM III scores covering WU and AM individuals with SCI at various levels of independence as well as optimal cutoff scores to indicate independence of these individuals. These data can be used as standard criteria for data comparison with patients' ability, and target functional values for individuals with SCI in clinical-, community-, and home-based settings.

Assessment of Walking Speed and Distance Post-Stroke Increases After Providing a Theory-Based Toolkit

BACKGROUND AND PURPOSE

While underutilized, poststroke administration of the 10-m walk test (10mWT) and 6-minute walk test (6MWT) can improve care and is considered best practice. We aimed to evaluate provision of a toolkit designed to increase use of these tests by physical therapists (PTs).

METHODS

In a before-and-after study, 54 PTs and professional leaders in 9 hospitals were provided a toolkit and access to a clinical expert over a 5-month period. The toolkit comprised a guide, smartphone app, and video, and described how to set up walkways, implement learning sessions, administer walk tests, and interpret and apply test results clinically. The proportion of hospital visits for which each walk test score was documented at least once (based on abstracted health records of ambulatory patients) were compared over 8-month periods pre- and post-intervention using generalized mixed models.

RESULTS

Data from 347 and 375 pre- and postintervention hospital visits, respectively, were analyzed. Compared with preintervention, the odds of implementing the 10mWT were 12 times greater (odds ratio [OR] = 12.4, 95% confidence interval [CI] 5.8, 26.3), and of implementing the 6MWT were approximately 4 times greater (OR = 3.9, 95% CI 2.3, 6.7), post-intervention, after adjusting for hospital setting, ambulation ability, presence of aphasia and cognitive impairment, and provider-level clustering. Unadjusted change in the percentage of visits for which the 10mWT/6MWT was documented at least once was smallest in acute care settings (2.0/3.8%), and largest in inpatient and outpatient rehabilitation settings (28.0/19.9% and 29.4/23.4%, respectively).

DISCUSSION AND CONCLUSIONS

Providing a comprehensive toolkit to hospitals with professional leaders likely contributed to increasing 10mWT and 6MWT administration during inpatient and outpatient stroke rehabilitation.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A390 ).

Association between heart failure severity and mobility in geriatric patients: an in-clinic study with wearable sensors

BACKGROUND

Individuals with heart failure (HF) frequently experience limitations in mobility, but specific aspects of these limitations are not well understood. This study investigated the association of HF severity, based on the New York Heart Association (NYHA) classes, with digital mobility outcomes (DMOs) and handgrip strength in older inpatients with HF.

METHODS

For this explorative analysis, hospital admission and discharge data from an ongoing, prospective cohort study were used. The sample included older participants with HF and a sub-sample of heart-healthy individuals. Participants were equipped with a wearable inertial measurement unit (IMU) system during mobility performance (balancing, sit-to-stand transfer, walking). We analyzed the association between 17 DMOs and HF severity with multiple linear regression models.

RESULTS

The total sample included 61 older participants (65-97 years of age, 55.7% female). Of all DMOs, only sway path in a semi-tandem stance position (m/s²) showed a relevant association with NYHA classes (admission: β = -0.28, P = 0.09; discharge: β = -0.39, P = 0.02). Handgrip strength showed a trend towards a significant association (admission: β = -0.15, P = 0.10; discharge: β = -0.15, P = 0.19).

CONCLUSIONS

This is to our best knowledge the first analysis on the association of HF severity and IMU-based DMOs. Sway path and handgrip strength may be the most promising parameters for monitoring mobility aspects in treatment of HF.

Factors associated with the 6-minute walk test performance in older adults with hyperkyphosis

Age-related hyperkyphosis is associated with adverse health outcomes, such as falls, fractures, and mortality. However, few studies investigated the relationship between the severity of hyperkyphosis and physical endurance in older adults. This study examined whether a degree of hyperkyphosis curvature was independently associated with the 6-minute walk test (6MWT) distance. We analyzed the baseline data of 112 older adults aged 60-92 enrolled in the Specialized Center of Research (SCOR) Kyphosis trial. The majority of the sample had at least a college degree and were white. On average, participants walked 503.9 (SD 82.3) meters in 6 minutes. Multivariate regression results showed that the degree of hyperkyphosis curvature was not independently associated with the 6MWT distance, but taller height, lighter weight, and less prescription medication were significant predictors of better performance on the 6MWT distance. Validation of the study findings in a large, diverse older adult population is warranted.

Slower upper extremity function in older adults with hyperkyphosis negatively impacts the 6-min walk test

BACKGROUND

Approximately 30% to 40% of older adults have hyperkyphosis, defined as excessive curvature of the thoracic spine. Hyperkyphosis is associated with increased morbidity and mortality. This study aimed to determine whether hyperkyphosis (Cobb's angle) and upper extremity tasks were independently associated with the 6-min walk test (6MWT) in community-dwelling older adults with hyperkyphosis.

METHODS

In this cross-sectional study, we studied 71 women and 28 men aged 60-87 from the study of hyperkyphosis, exercise, and function trial (SHEAF) who had kyphosis, 3 timed upper extremity tasks and the 6MWT assessed at their baseline visit. We used standing lateral spine radiographs and a standardized protocol for thoracic kyphosis (T4-T12) to measure Cobb angle of kyphosis. In addition, 3 activity of daily living (ADL) extremity tests (putting on and removing a laboratory coat, picking up a penny from the floor, and lifting a 7-lb. book to a shelf) were used.

RESULTS

The mean ± SD age was 70.1 ± 6.1 years. The mean ± SD Cobb angle of kyphosis was 57.4 ± 12.5 degrees. On average ± SD, the participants walked 504.8 ± 84.2 m in 6 min and took 2.4 ± 2.2 prescription medications. The mean ± SD height was 164.7 ± 8.5 cm, weight was 68.7 ± 13.1 kg, and BMI was 25.2 ± 4.0 kg/m2. Multivariate regression revealed that age, height, upper extremity book lift task, and the number of prescribed medications were significant predictors of performance on the 6MWT (p < 0.05).

CONCLUSIONS

While kyphosis was not associated with the 6MWT, timed tests of upper extremity function indicated that upper body dynamics can affect walking performance. In addition, sociodemographic factors and the number of prescribed medications were significant contributing factors to the 6MWT in older adults with mild to moderate hyperkyphosis. These results illustrate multifactorial influences on physical performance and the need for an integrated and targeted approach in helping older hyperkyphotic adults maintain healthy physical functioning as they age.

Intra-Articular Injections of Autologous Adipose Tissue or Platelet-Rich Plasma Comparably Improve Clinical and Functional Outcomes in Patients with Knee Osteoarthritis

The use of biologic therapies for the management of knee osteoarthritis (OA) has largely increased in recent years. The purpose of this study was to evaluate the efficiency and the therapeutic potential of platelet-rich plasma (PRP) and autologous adipose tissue (AAT) injections as a treatment for knee OA. Sixty participants were enrolled in the study: 20 healthy ones and 40 with minimal to moderate knee OA (KL I-III). The OA patients were randomly assigned either to the PRP or to the AAT group. The PRP samples showed a low expression level of NF-κB-responsive gene CCL5 and high expression levels of classic inflammatory and TNF-l INF responses. The AAT injection product was prepared using a Lipogems device, and its regenerative potential as well as the ability for expansion of mesenchymal stem cells were tested in the cell culture conditions. The patient assessments were carried out five times. Significant improvement was observed regardless of the treatment method in the VAS, KOOS, WOMAC and IKDC 2000 subjective evaluations as well as in the functional parameters. Intra-articular injections of AAT or PRP improved pain, symptoms, quality of life and functional capacity with a comparable effectiveness in the patients with mild to moderate knee osteoarthritis.

Validity and Reliability of the Insole3 Instrumented Shoe Insole for Ground Reaction Force Measurement during Walking and Running

Pressure-detecting insoles such as the Insole3 have potential as a portable alternative for assessing vertical ground reaction force (vGRF) outside of specialized laboratories. This study evaluated whether the Insole3 is a valid and reliable alternative to force plates for measuring vGRF. Eleven healthy participants walked overground at slow and moderately paced speeds and ran at a moderate pace while collecting vGRF simultaneously from a force plate (3000 Hz) and Insole3 (100 Hz). Intraclass correlation coefficients (ICC) demonstrated excellent vGRF agreement between systems during both walking speeds for Peak 1, Peak 2, the valley between peaks, and the vGRF impulse (ICC > 0.941). There was excellent agreement during running for the single vGRF peak (ICC = 0.942) and impulse (ICC = 0.940). The insoles slightly underestimated vGRF peaks (−3.7% to 0.9% bias) and valleys (−2.2% to −1.8% bias), and slightly overestimated impulses (4.2% to 5.6% bias). Reliability between visits for all three activities was excellent (ICC > 0.970). The Insole3 is a valid and reliable alternative to traditional force plates for assessing vGRF during walking and running in healthy adults. The excellent ICC values during slow walking suggests that the Insole3 may be particularly suitable for older adults in clinical and home settings.

A modified six-minute walk test (6MWT) for low-resource settings-a cross-sectional study

BACKGROUND

The 6 min walk test (6MWT) is a validated tool used to assess functional capacity in a variety of patient populations. Space constraints often limit the practicality of the 6MWT according to the standard (2002) American Thoracic Society protocol, and therefore, adaptations to this protocol are common with potential implications for research and clinical practice. Furthermore, such implications for research and clinical practice may be augmented in low-resourced settings.

OBJECTIVES

To determine the agreement between the 6 min walk distance (6MWD) achieved on the standard 30 m (6MWT₃₀), and a straight 10 m (6MWT₁₀), or 10 m figure-of-eight (6MWT_F8) configuration, respectively.

METHODS

A cross-sectional study was conducted in a socioeconomic challenged community. A heterogeneous sample of adults (n = 27) with non-communicable disease were randomized into performing the 6MWT₁₀ (n = 15) or 6MWT_F8 (n = 12), in addition to the standard 6MWT₃₀. Pairwise comparison and concordance correlation coefficients were used to assess agreement.

RESULTS

The mean (SD) 6MWD₃₀ was 437(42) meters, while the mean 6MWD₁₀ was 371(57). The mean difference (SE; p-value) between the 6MWD₃₀ and 6MWD₁₀ was 67 m (8.6; p .01). The mean 6MWD₃₀ was 424(67) meters, while the mean 6MWD_F8 was 347(58). The mean difference between the 6MWD₃₀ and 6MWD_F8 was 77 m (6.0; p .01). Moderate concordance was found between the 6MWT₃₀ and 6MWT_F8 or 6MWD₁₀, respectively.

CONCLUSIONS

The present data suggest that, independent of configuration, using a shorter pathway significantly reduced the 6MWD. Low-resource settings may benefit from contemporary measures of functional capacity more conducive to resource constraints, or standardization of the test when used in such settings.

Gait speed reference values in community-dwelling older adults - Cross-sectional analysis from the Rotterdam Study

BACKGROUND

Gait speed is a simple, inexpensive and clinically useful marker of physical function in older adults. We aimed to establish gait speed reference values for community-dwelling older adults. To this end, we further explored the association of age, sex and height with gait speed.

METHODS

This study included community-dwelling participants aged 50 years and over enrolled in the Rotterdam Study. Participants completed the gait protocol between 2009 and 2016. The mean gait speed was calculated for age and height groups, stratified by sex. Reference values for gait speed were calculated using a quantile regression model adjusted for sex, the non-linear effects of age and height, as well as the interaction between age and sex plus the interaction between age and height.

RESULTS

The study population included 4656 Dutch participants with a mean (standard deviation) age of 67.7 (9.5) years, comprising 2569 (55.2%) women. The mean height of the participants was 1.69 (0.10) meters and the mean gait speed was 1.20 (0.20) m/s. Gait speed was lower with older age and greater with taller stature, but the effect of height disappeared above the age of 80 years. Sex did not affect gait speed after accounting for age and height. Age-, sex-, and height-specific reference values for gait speed are available for use at https://emcbiostatistics.shinyapps.io/GaitSpeedReferenceValues/.

CONCLUSIONS

We found that height explains the commonly noted difference in usual gait speed between sexes and that neither height nor sex impacts gait speed in the very oldest adults. We developed reference values for usual gait speed in Western European community-dwelling older adults.

Anthropometric Measurements, Metabolic Profile and Physical Fitness in a Sample of Spanish Women with Type 2 Diabetes

Background: Exercise training has proven to be effective for treatment of metabolic diseases, such as type 2 diabetes mellitus. The aims of this study were to compare anthropometric measurements, metabolic profile and physical fitness between active and sedentary women with type 2 diabetes, and to analyse relationships between anthropometry and metabolic profile and components of physical fitness (balance, flexibility, strength and endurance). Methods: Cross-sectional research on 28 women with type 2 diabetes. Amount of daily physical activity, BMI, waist circumference, HbA1c, fibrinogen, hs-CRP, tiptoe dynamic balance, static balance, finger floor distance, abdominal, upper and lower limb strength and walking cardiovascular endurance were recorded. Results: Age: 58.5 ± 7.8. Overall, 16 subjects were physically active and 12 were sedentary. Active subjects had lower BMI (p = 0.033) and better cardiovascular endurance (p = 0.025). BMI and waist circumference were not influenced by any physical fitness component. HbA1c, fibrinogen and hs-CRP were related with worse dynamic balance (p = 0.036, 0.006 and 0.031, respectively). Conclusions: Active women had lower BMI and showed a better performance in cardiovascular endurance. Tiptoe dynamic balance impairments were related to worse glycaemic control, hypercoagulation and inflammatory state.

Clinically Important Reductions in Physical Function and Quality of Life in Adults with Tumor Prostheses in the Hip and Knee: A Cross-sectional Study

BACKGROUND

Patients with a bone sarcoma who undergo limb-sparing surgery and reconstruction with a tumor prosthesis in the lower extremity have been shown to have reduced self-reported physical function and quality of life (QoL). To provide patients facing these operations with better expectations of future physical function and to better evaluate and improve upon postoperative interventions, data from objectively measured physical function have been suggested.

QUESTIONS/PURPOSES

We sought to explore different aspects of physical function, using the International Classification of Functioning, Disability, and Health (ICF) as a framework, by asking: (1) What are the differences between patients 2 to 12 years after a bone resection and reconstruction surgery of the hip and knee following resection of a bone sarcoma or giant cell tumor of bone and age-matched controls without walking limitations in ICF body functions (ROM, muscle strength, pain), ICF activity and participation (walking, getting up from a chair, daily tasks), and QoL? (2) Within the patient group, do ICF body functions and ICF activity and participation outcome scores correlate with QoL?

METHODS

Between 2006 and 2016, we treated 72 patients for bone sarcoma or giant cell tumor of bone resulting in bone resection and reconstruction with a tumor prosthesis of the hip or knee. At the timepoint for inclusion, 47 patients were alive. Of those, 6% (3 of 47) had undergone amputation in the lower limb and were excluded. A further 32% (14 of 44) were excluded because of being younger than 18 years of age, pregnant, having long transportation, palliative care, or declining participation, leaving 68% (30 of 44) for analysis. Thus, 30 patients and 30 controls with a mean age of 51 ± 18 years and 52 ± 17 years, respectively, were included in this cross-sectional study. Included patients had been treated with either a proximal femoral (40% [12 of 30]), distal femoral (47% [14 of 30]), or proximal tibia (13% [4 of 30]) reconstruction. The patients were assessed 2 to 12 years (mean 7 ± 3 years) after the resection-reconstruction. The controls were matched on gender and age (± 4 years) and included if they considered their walking capacity to be normal and had no pain in the lower extremity. Included outcome measures were: passive ROM of hip flexion, extension, and abduction and knee flexion and extension; isometric muscle strength of knee flexion, knee extension and hip abduction using a hand-held dynamometer; pain intensity (numeric rating scale; NRS) and distribution (pain drawing); the 6-minute walk test (6MWT); the 30-second chair-stand test (CST); the Toronto Extremity Salvage Score (TESS), and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). The TESS and the EORTC QLQ-C30 were normalized to 0 to 100 points. Higher scoring represents better status for TESS and EORTC global health and physical functioning scales. Minimum clinically important difference for muscle strength is 20% to 25%, NRS 2 points, 6MWT 14 to 31 meters, CST 2 repetitions, TESS 12 to 15 points, and EORTC QLQ-C30 5 to 20 points.

RESULTS

Compared with controls, the patients had less knee extension and hip abduction strength in both the surgical and nonsurgical limbs and regardless of reconstruction site. Mean knee extension strength in patients versus controls were: surgical limb 0.9 ± 0.5 Nm/kg versus 2.1 ± 0.6 Nm/kg (mean difference -1.3 Nm/kg [95% CI -1.5 to -1.0]; p < 0.001) and nonsurgical limb 1.7 ± 0.6 Nm/kg versus 2.2 ± 0.6 Nm/kg (mean difference -0.5 Nm/kg [95% CI -0.8 to -0.2]; p = 0.003). Mean hip abduction strength in patients versus controls were: surgical limb 1.1 ± 0.4 Nm/kg versus 1.9 ± 0.5 Nm/kg (mean difference -0.7 Nm/kg [95% CI -1.0 to -0.5]; p < 0.001) and nonsurgical limb 1.5 ± 0.4 Nm/kg versus 1.9 ± 0.5 Nm/kg (-0.4 Nm/kg [95% CI -0.6 to -0.2]; p = 0.001). Mean hip flexion ROM in patients with proximal femoral reconstructions was 113° ± 18° compared with controls 130° ± 11° (mean difference -17°; p = 0.006). Mean knee flexion ROM in patients with distal femoral reconstructions was 113° ± 29° compared with patients in the control group 146° ± 9° (mean difference -34°; p = 0.002). Eighty-seven percent (26 of 30) of the patients reported pain, predominantly in the knee, anterior thigh, and gluteal area. The patients showed poorer walking and chair-stand capacity and had lower TESS scores than patients in the control group. Mean 6MWT was 499 ± 100 meters versus 607 ± 68 meters (mean difference -108 meters; p < 0.001), mean CST was 12 ± 5 repetitions versus 18 ± 5 repetitions (mean difference -7 repetitions; p < 0.001), and median (interquartile range) TESS score was 78 (21) points versus 100 (10) points (p < 0.001) in patients and controls, respectively. Higher pain scores correlated to lower physical functioning of the EORTC QLQ-C30 (Rho -0.40 to -0.54; all p values < 0.05). Less muscle strength in knee extension, knee flexion, and hip abduction correlated to lower physical functioning of the EORTC QLQ-C30 (Rho 0.40 to 0.51; all p values < 0.05).

CONCLUSION

This patient group demonstrated clinically important muscle weaknesses not only in resected muscles but also in the contralateral limb. Many patients reported pain, and they showed reductions in walking and chair-stand capacity comparable to elderly people. The results are relevant for information before surgery, and assessments of objective physical function are advisable in postoperative monitoring. Prospective studies evaluating the course of physical function and which include assessments of objectively measured physical function are warranted. Studies following this patient group with repetitive measures over about 5 years could provide information about the course of physical function, enable comparisons with population norms, and lead to better-designed, targeted, and timely postoperative interventions.

LEVEL OF EVIDENCE

Level III, therapeutic study.

Effects of various walking intensities on leg muscle fatigue and plantar pressure distributions

Background

Physical activity may benefit health and reduce risk for chronic complications in normal and people with diabetes and peripheral vascular diseases. However, it is unclear whether leg muscle fatigue after weight-bearing physical activities, such as brisk walking, may increase risk for plantar tissue injury. In the literature, there is no evidence on the effect of muscle fatigue on plantar pressure after various walking intensities. The objectives of this study were to investigate the effects of various walking intensities on leg muscle fatigue and plantar pressure patterns.

Methods

A 3 × 2 factorial design, including 3 walking speeds (1.8 (slow and normal walking), 3.6 (brisk walking), and 5.4 (slow running) mph) and 2 walking durations (10 and 20 min) for a total of 6 walking intensities, was tested in 12 healthy participants in 3 consecutive weeks. The median frequency and complexity of electromyographic (EMG) signals of tibialis anterior (TA) and gastrocnemius medialis (GM) were used to quantify muscle fatigue. Fourier transform was used to compute the median frequency and multiscale entropy was used to calculate complexity of EMG signals. Peak plantar pressure (PPP) values at the 4 plantar regions (big toe, first metatarsal head, second metatarsal head, and heel) were calculated.

Results

Two-way ANOVA showed that the walking speed (at 1.8, 3.6, 5.4 mph) significantly affected leg muscle fatigue, and the duration factor (at 10 and 20 min) did not. The one-way ANOVA showed that there were four significant pairwise differences of the median frequency of TA, including walking speed of 1.8 and 3.6 mph (185.7 ± 6.1 vs. 164.9 ± 3.0 Hz, P = 0.006) and 1.8 and 5.4 mph (185.7 ± 6.1 vs. 164.5 ± 5.5 Hz, P = 0.006) for the 10-min duration; and walking speed of 1.8 and 3.6 mph (180.0 ± 5.9 vs. 163.1 ± 4.4 Hz, P = 0.024) and 1.8 and 5.4 mph (180.0 ± 5.9 vs. 162.8 ± 4.9 Hz, P = 0.023) for the 20-min duration. The complexity of TA showed a similar trend with the median frequency of TA. The median frequency of TA has a significant negative correlation with PPP on the big toe ( r = -0.954, P = 0.003) and the first metatarsal head ( r = -0.896, P = 0.016).

Conclusions

This study demonstrated that brisk walking and slow running speeds (3.6 and 5.4 mph) cause an increase in muscle fatigue of TA compared to slow walking speed (1.8 mph); and the increased muscle fatigue is significantly related to a higher PPP.

Reference Values for 7 Different Protocols of Simple Functional Tests: A Multicenter Study

OBJECTIVES

To establish reference values and equations (ages 20-80y) for 7 simple functional tests based on a multicenter study.

DESIGN

Cross-sectional data collection in 4 research centers across different regions of a continental dimension country.

SETTING

Healthy subjects from general community were assessed in different research laboratories.

PARTICIPANTS

Data collection of 296 volunteer subjects (N=296; 45% men; aged 50±18y, forced expiratory volume in the first second 95±13% pred, body mass index 26.9±4.5 kg/m²) aged 20-80 years; representing both sexes; with the ability to understand and perform all proposed assessments; and with no severe and/or unstable condition that could limit functional assessments occurred simultaneously in all centers.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

All participants randomly performed the following 7 functional tests twice: (1) the 4-meter gait speed test at usual walking speed; (2) the 4-meter gait speed test at maximal walking speed; (3) the Sit-to-Stand test performed with 5 repetitions; (4) the Sit-to-Stand test performed in 30 seconds; (5) the Sit-to-Stand test performed in 1 minute; (6) the Timed Up and Go test at usual speed; and (7) the Timed Up and Go test at maximal speed. Spirometry, quality of life, depression, anxiety, physical activity, and comorbidities were also assessed to better characterize the sample. The best performance of each test was used to propose reference values for men and women and reference equations for all.

RESULTS

Participants similarly distributed by age groups from the 4 centers were included. All tests were correlated with age (0.34<r<0.53) and body mass index (0.24<r< 0.31; P<.05 for all). Reference values with limits of normality were provided by each 10-year age group and regression models identified reference equations for all tests. Reliability of the reference equations were confirmed in an independent sample.

CONCLUSIONS

Reference values and equations for 7 widely used simple functional tests were provided in this study and might help researchers and clinicians to identify and quantify functional impairments using easy-to-perform assessments.

Clinical Walking Tests and Gait Pattern Characterization During 6-Minute Walk Test Using Inertial Sensors: Follow-Up in Individuals With Lower Limb Amputation

Inertial measurement units and normative values enable clinicians to quantify clinical walking tests and set rehabilitation goals. Objectives of this study were (1) to compare time- and distance-based walking tests in individuals with lower limb amputation (iLLA) and normative values following rehabilitation discharge (T1) and 6 weeks after discharge (T2) and (2) to investigate spatiotemporal and foot kinematic parameters over a 6-minute walk test using inertial measurement units. Twelve iLLA participated in this study. Distance, cadence, stance ratio, loading rate ratio, push-up ratio, path length, and minimum toe clearance were analyzed during 6-minute walk test. Nonparametric repeated-measures analysis of variance tests, Bonferroni corrections, were performed. Time of distance-based walking tests diminished at T2 (P < .02). Compared with normative values, walking performance in iLLA was reduced. Cadence at T2 increased significantly (P = .026). Stance ratio increased in both legs at T2 (P < .05). Push-up ratio tended to decrease at T2 in the amputated leg (P = .0003). Variability of path length and minimum toe clearance at T2 were less than at T1 in the nonamputated leg (P < .05). Spatiotemporal improvement at T2 could be due to prosthesis adaptation in iLLA. The lower performance of the functional walk test compared with normative values could be due to amputation and pain-related fatigue.

Nature benefits revisited: Differences in gait kinematics between nature and urban images disappear when image types are controlled for likeability

Exposure to urban environments requires more cognitive processing than exposure to nature; an effect that can even be measured analysing gait kinematics whilst people walk towards photographic images. Here, we investigated whether differences in cognitive load between nature and urban scenes are still present when scenes are matched for their liking scores. Participants were exposed to images of nature and urban scenes that had been matched a priori for their liking scores by an independent participant sample (n = 300). Participants (N = 44) were either asked to memorise each image during walking or to rate each image for its visual discomfort after each walk. Irrespective of experimental task, liking score but not environment type predicted gait velocity. Moreover, subjective visual discomfort was predictive of gait velocity. The positive impact of nature described in the literature thus might, at least in part, be due to people's aesthetic preferences for nature images.

Mobility in Older Adults Receiving Maintenance Hemodialysis: A Qualitative Study

RATIONALE & OBJECTIVE

For older adults, maintaining mobility is a major priority, especially for those with advanced chronic diseases like kidney failure. However, our understanding of the factors affecting mobility in older adults receiving maintenance hemodialysis is limited.

STUDY DESIGN

Descriptive qualitative study.

SETTING AND PARTICIPANTS

Using purposive sampling, we recruited 1) persons aged ≥ 60 years receiving maintenance hemodialysis and 2) care partners (≥ 18 years) providing regular support to an older adult receiving hemodialysis. During a single in-person home visit, we assessed mobility using the Short Physical Performance Battery (SPPB) and conducted individual one-on-one interviews regarding important personal factors related to mobility.

ANALYTIC APPROACH

Descriptive statistics were used for demographic and SPPB data. Transcripts underwent thematic coding, informed by the International Classification of Function framework of mobility. We used conceptual content analysis to inductively extract themes and subthemes.

RESULTS

We enrolled 31 older adults receiving hemodialysis (42% female, 68% Black) with mean age of 73±8 years and mean dialysis duration of 4.6±3.5 years; mean SPPB was 3.6±2.8 points. Among 12 care partners (75% female, 33% Black), mean age was 54±16 years and mean SPPB was 10.1±2.4 points. Major themes extracted were: 1) mobility represents independence; 2) mobility is precarious; 3) limitations in mobility cause distress; 4) sources of encouragement and motivation are critical; and 5) adaptability is key.

LIMITATIONS

Modest sample from single geographic area.

CONCLUSIONS

For older adults receiving hemodialysis, mobility is severely limited and is often precarious in nature, causing distress. Older adults receiving hemodialysis and their care partners have identified sources of encouragement and motivation for mobility, and cite an adaptable mindset as important. Future studies should conceptualize mobility as a variable condition, and build upon this outlook of adaptability in the development of interventions.

Distinctions Between Self-Report and Performance-Based Measures of Physical Function in Older Patients Prior to Chemotherapy

BACKGROUND

The maintenance of physical function (PF) is an extremely important outcome for elderly people.

OBJECTIVE

The aims of this study were to identify differences in the subjective and objective measures of PF between younger older adults (YOAs, 60-69 years of age) and older adults (OA, ≥70 years of age), to compare the PF scores with age-matched samples from the general population, and to evaluate for associations between the subjective and objective measures of PF.

METHODS

Patients (n = 139) were assessed using subjective (ie, European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire) and objective (ie, Short Physical Performance Battery [SPPB]) measures prior to chemotherapy (CTX). Data were analyzed using parametric and nonparametric tests.

RESULTS

No differences were found between the 2 age groups in any of the subjective or objective measures of PF. Compared with the age-matched general population, both YOAs and OAs had significantly lower scores in both measures of PF. Large effect sizes were found for differences in European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire role function, SPPB balance, and SPPB total scores between the YOA group and the age-matched general population samples. Correlations between the subjective and objective measures were low.

CONCLUSIONS

Older patients with cancer have lower PF than their age-matched general population prior to CTX. Longitudinal studies are warranted to evaluate for changes in PF during and following CTX.

IMPLICATIONS FOR PRACTICE

Nurses need to perform routine assessments of PF in older oncology patients prior to CTX. Our findings suggest that SPPB gait speed may be a useful screening measure for PF in older patients.

The relationship between height of vertical jumps, functionality and fall episodes in patients with chronic obstructive pulmonary disease: A case-control study

This study aimed to compare the height of jumps and functional parameters in patients with chronic obstructive pulmonary disease (COPD) to those in healthy people, in addition to assessing the relationship among variables in patients with COPD. Twenty patients with COPD (forced expiratory volume [FEV1] % of predicted: 39.98 ± 11.69%; age: 62.95 ± 8.06 years) and 16 healthy people (FEV1% of predicted: 97.44 ± 14.45%; age: 59.94 ± 6.43 years) were evaluated, and all participants performed the Squat Jump (SJ) and Counter Movement Jump (CMJ) tests to assess rapid force considering the jumping height. Functional capacity was assessed using the self-selected walking speed tests, walking speed in 10 m, walking test in 6 min, balance on one leg, sitting and standing, timed up and go, and a stair-climbing test. In addition, the questionnaires on recall of falls, Falls Efficacy Scale-International (concern with falling), International Physical Activity Questionnaires, and Saint George Respiratory Questionnaire were administered. The height of the jumps showed no difference between the groups, but the COPD group performed worse in most functional tests and was more afraid of falling. The number of falls was correlated with height in the SJ (r = -0.51) and CMJ (r = -0.62) jumps (p < 0.05), and with the performance in different functional tests. We suggest that interventions targeting rapid force may bring improvements in functional mobility and physical fitness as well as reducing fall episodes in patients with COPD.

Identifying unmet needs and limitations in physical health in survivors of Head and Neck Cancer

Objective

To gain insight into the level of unmet needs and limitations in physical health experienced by survivors of head and neck cancer, and to evaluate whether unmet needs in physical health and limitations in physical performance are associated.

Materials and methods

In this cross‐sectional study, unmet needs were measured with Supportive Care Needs Surveys (SCNS‐SF34, SCNS‐HNC). Limitations in physical health were measured for maximal mouth opening, neck and shoulder function, hand grip strength and lower body strength, level of mobility and walking ability.

Results

The SCNSs showed that 48% had a cancer generic unmet need and 46% had at least one HNC‐specific unmet need. In total, 76% of sHNC had a cancer generic limitation in physical health and that 58% had an HNC‐specific limitation in the mobility of neck and shoulders or maximum mouth opening. The domain of physical and daily living needs showed a weak association with lateral flexion of the neck to the left (R = −0.319; p = 0.024).

Conclusion

Survivors of HNC might benefit from the use of both SCNSs and physical performance measurements during usual care follow‐up for early and optimal identification of unmet needs and limitations in physical health.

Development of stratified normative data and reference equations for the timed up and down stairs test for healthy children 6-14 years of age

OBJECTIVES

To generate normative data on healthy children aged 6-14 years for the timed up and down stairs (TUDS) test, and to provide reference equations.

DESIGN AND SETTING

Cross-sectional study at two primary schools.

PARTICIPANTS

Healthy children 6-14 years of age.

MAIN OUTCOMES MEASURES

Anthropometric data and Minnesota Leisure-Time Physical Activity Questionnaire from children were collected before the start of the TUDS test. Heart rate, blood pressure and perceived exertion were measured at the beginning and at the end of the test. Two trials of the TUDS test were performed with 15-minute of rest on the same day and the better of the two trials was used in the analyses. The reference equations were established using the anthropometric variables as possible predictors of the TUDS test.

RESULTS

Two hundred fifty eight children (125 boys and 133 girls) were assessed. The mean TUDS test score decreased significantly from 6 to 14 years of age in boys and girls alike, with statistically significant differences between the three age range groups. A significant difference was found between girls and boys in TUDS test score. The 56% of the variation in TUDS test score could be explained by age, height, and weight in boys [TUDS_sec score=(9.967-(0.182×Age_years)+(0.025×Weight_kg)-(2.546×Height_m)], while 50% could be explained in girls [TUDS_sec score=10.553-(0.194×Age_years)+(0.019×Weight_kg)-(2.406×Height_m)]. The inclusion of physical level activity increased the variability explained (boys: 59%; girls: 51%).

CONCLUSIONS

TUDS score improved as the age of the children increased, with boys achieving better values than girls within each age group. TUDS test score can be easily predicted from age, height, and weight. The inclusion of the child's physical activity level increased the variance explained by the equation.

Cultural bias in motor function patterns: Potential relevance for predictive, preventive, and personalized medicine

Background

Quantification of motor performance has a promising role in personalized medicine by diagnosing and monitoring, e.g. neurodegenerative diseases or health problems related to aging. New motion assessment technologies can evolve into patient-centered eHealth applications on a global scale to support personalized healthcare as well as treatment of disease. However, uncertainty remains on the limits of generalizability of such data, which is relevant specifically for preventive or predictive applications, using normative datasets to screen for incipient disease manifestations or indicators of individual risks.

Objective

This study explored differences between healthy German and Japanese adults in the performance of a short set of six motor tests.

Methods

Six motor tasks related to gait and balance were recorded with a validated 3D camera system. Twenty-five healthy adults from Chiba, Japan, participated in this study and were matched for age, sex, and BMI to a sample of 25 healthy adults from Berlin, Germany. Recordings used the same technical setup and standard instructions and were supervised by the same experienced operator. Differences in motor performance were analyzed using multiple linear regressions models, adjusted for differences in body stature.

Results

From 23 presented parameters, five showed group-related differences after adjustment for height and weight (R ² between .19 and .46, p<.05). Japanese adults transitioned faster between sitting and standing and used a smaller range of hand motion. In stepping-in-place, cadence was similar in both groups, but Japanese adults showed higher knee movement amplitudes. Body height was identified as relevant confounder (standardized beta >.5) for performance of short comfortable and maximum speed walks. For results of posturography, regression models did not reveal effects of group or body stature.

Conclusions

Our results support the existence of a population-specific bias in motor function patterns in young healthy adults. This needs to be considered when motor function is assessed and used for clinical decisions, especially for personalized predictive and preventive medical purposes. The bias affected only the performance of specific items and parameters and is not fully explained by population-specific ethnic differences in body stature. It may be partially explained as cultural bias related to motor habits. Observed effects were small but are expected to be larger in a non-controlled cross-cultural application of motion assessment technologies with relevance for related algorithms that are being developed and used for data processing. In sum, the interpretation of individual data should be related to appropriate population-specific or even better personalized normative values to yield its full potential and avoid misinterpretation.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13167-021-00236-3.

The role of theory to develop and evaluate a toolkit to increase clinical measurement and interpretation of walking speed and distance in adults post-stroke

PURPOSE

The iWalk study showed that 10-meter walk test (10mWT) and 6-minute walk test (6MWT) administration post-stroke increased among physical therapists (PTs) following introduction of a toolkit comprising an educational guide, mobile app, and video. We describe the use of theory guiding toolkit development and a process evaluation.

MATERIALS AND METHODS

We used the knowledge-to-action framework to identify research steps; and a guideline implementability framework, self-efficacy theory, and the transtheoretical model to design and evaluate the toolkit and implementation process (three learning sessions). In a before-and-after study, 37 of the 49 participating PTs completed online questionnaires to evaluate engagement with learning sessions, and rate self-efficacy to perform recommended practices pre- and post-intervention. Thirty-three PTs and 7 professional leaders participated in post-intervention focus groups and interviews, respectively.

RESULTS

All sites conducted learning sessions; attendance was 50-78%. Self-efficacy ratings for recommended practices increased and were significant for the 10mWT (p ≤ 0.004). Qualitative findings highlighted that theory-based toolkit features and implementation strategies likely facilitated engagement with toolkit components, contributing to observed improvements in PTs' knowledge, attitudes, skill, self-efficacy, and clinical practice.

CONCLUSIONS

The approach may help to inform toolkit development to advance other rehabilitation practices of similar complexity.Implications for RehabilitationToolkits are an emerging knowledge translation intervention used to support widespread implementation of clinical practice guideline recommendations.Although experts recommend using theory to inform the development of knowledge translation interventions, there is little guidance on a suitable approach.This study describes an approach to using theories, models and frameworks to design a toolkit and implementation strategy, and a process evaluation of toolkit implementation.Theory-based features of the toolkit and implementation strategy may have facilitated toolkit implementation and practice change to increase clinical measurement and interpretation of walking speed and distance in adults post-stroke.

Six-minute walk test in cardiac rehabilitation

Six-minute walk test (6MWT) is a simple and safe tool for assessing exercise tolerance in  various  categories  of  patients.  Currently,  6MWT  is  used to assess the functional status of a patient and determine the strategy of increasing physical activity, primarily in patients with reduced exercise tolerance and contraindications for cardiopulmonary exercise  test. The basic requirements for the 6MWT are presented, taking into account the factors affecting its  informativeness  and  accuracy,  as  well  as the interpretation of results. The diagnostic and prognostic value of 6MWT in different categories of patients are discussed. The prospects for 6MWT use in cardiac rehabilitation for planning rehabilitation program, prescribing exercises,  determining  the  risk   of   complications,   and   evaluating the effectiveness  are  considered.  The  limitations  of  6MWT  and  ways to overcome it, as well as directions for further research are presented.

Investigating the Relationship of the Functional Gait Assessment to Spatiotemporal Parameters of Gait and Quality of Life in Individuals With Stroke

BACKGROUND AND PURPOSE

Walking in the community is an important aspect of independence and quality of life (QOL) that poses challenges for individuals with stroke. This study investigated whether performance on the Functional Gait Assessment (FGA) differentiated spatiotemporal gait parameters, QOL, and fall history of community-ambulating individuals with stroke. We hypothesized that those scoring higher on the FGA would present with better gait speed and cadence, stride width and length, and improved load time on the paretic limb, report a higher QOL, and be less likely to have a fall history than those who scored lower on the FGA.

METHODS

Participants were screened for cognitive impairment and the ability to walk independently. Participant demographics and stroke characteristics were recorded. The Falls Risk for Older People in the Community (FROP-Com) screening tool determined whether the participant had incurred 1 or more falls within the preceding 12 months. The FGA provided a composite measure of gait with varied walking tasks challenging different aspects of walking. The total score was recorded. The GAITRite instrumented-walkway was used to acquire high-resolution footfall data during performance of the first 9 FGA walking tasks. The Assessment of Quality of Life-6D (AQoL-6D) was used to measure health-related QOL across the domains of independent living, mental health, coping, relationships, pain, and senses. Pearson and Spearman correlations were used to check for correlations between FGA score and the demographic characteristics, AQoL-6D scores, and 12-month fall history. Pearson correlations were used to check for correlations between FGA score and multiple spatiotemporal gait parameters for each FGA item.

RESULTS AND DISCUSSION

A sample of 29 volunteers who were community-ambulating individuals with stroke was recruited. Participants had a mean age of 62.31 (10.89) years, mean time since stroke of 3.78 (4.10) years, and included both males and females (52% male). Individuals presented with both left- and right-sided strokes. FGA score correlated positively with velocity, cadence, and step length, and negatively with stride width, double-support percent, and single-support variability (P = .001 to P = .031). FGA score correlated positively with the AQoL-6D dimension of independent living. FGA score correlated significantly with the FROP-Com screening tool predicted fall risk, but not with fall history.

CONCLUSIONS

The FGA is a clinical measure of functional gait performance that reflected spatiotemporal gait parameters and ability of individuals with chronic stroke to live independently. The FGA could be used to target interventions to improve functional gait performance of individuals with chronic stroke.

Can reminders improve adherence to regular physical activity and exercise recommendations in people over 60 years old? : A randomized controlled study

Purpose

The purpose of the study was to investigate whether additional reminders could enhance adherence to a 12-week program consisting of regular physical activity.

Methods

The study collective consisted of pensioners insured with the Austrian Insurance Fund for Civil or Public Servants. They were made aware of our program through the public service union. The subjects were randomized to an intervention group (group A) that received reminders and to a control group (group B) that did not receive such notifications. Adherence to physical activity was assessed by the use of diaries.

Results

Group A performed 96 min more moderate intensity regular physical activity per week than group B (group A median 269 min, r = 0–1560 min; group B median 173 min, r = 0–2700 min). The Mann–Whitney U-test showed no significant differences (p = 0.080) between the study groups.

There was no difference in muscle strengthening activity (group A: median: 2, r = 0–13 sessions; group B: median: 2, r = 0–20 sessions).

Conclusion

The major positive observation was that both the experimental and control group participants exceeded the recommended level of physical activity. Nevertheless, there were some differences concerning the minutes of physical activity performed in favor of the intervention group.

Patient-specific reference values for objective physical function tests: data from the Osteoarthritis Initiative

INTRODUCTION/OBJECTIVE

We aimed to establish sex-specific reference values of objective physical function tests among individuals with or at risk for knee osteoarthritis (KOA) across subsets of age, radiographic KOA severity, and body mass index (BMI).

METHOD

We included Osteoarthritis Initiative participants with data for objective physical function tests, sex, age, BMI, and radiographic KOA severity (Kellgren-Lawrence [KL] grade) at baseline. Objective physical function was quantified with 20-m walk speed, chair-stand speed, 400-m walk time, and knee extension and flexion strength. We created participant characteristic subsets for sex, age, KL grade, and BMI. Reference values were created as percentiles from minimum to maximum in 10% increments for each combination of participant characteristic subsets. Previously established clinically important differences for 20-m walk speed and knee extension strength were used to highlight clinically relevant differences.

RESULTS

Objective physical function reference values tables and an interactive reference value table were created across all combinations of sex, age, KL grade, and BMI among 3860 individuals with or at risk for KOA. Clinically relevant differences exist for 20-m walk speed and knee extension strength between males and females across age groups, KL grades, and BMI categories.

CONCLUSIONS

Establishing an individual's relative level of objective physical function by comparing their performance to individuals with similar sex, age, KL grade, or BMI may help improve interpretation of physical function performance. The interactive reference value table will provide clinicians and researchers a clinically accessible avenue to use these reference values.Key Points• Since greater age, radiographic knee osteoarthritis severity, and body mass index are all associated with worse objective physical function, reference values should consider the complex inter-play among these patient characteristics.• This study provides objective physical function reference values among subsets of individuals across the spectrum of sex, age groups, radiographic knee osteoarthritis severity, and body mass index categories.• These reference values offer a more patient-centered approach for interpreting an individual's relative level of objective physical function by comparing them to a more homogeneous group of individuals with similar participant characteristics.• We have provided a clinically accessible interactive table that will enable clinicians and researchers to input their patient's data to quickly and efficiently determine a patient's relative objective physical function compared to individual's with similar characteristics.

The importance of physical fitness for the relationship of BDNF with obesity measures in young normal-weight adults

Aims

Brain derived neurotrophic factor (BDNF) is essential for cognitive function. It is also found in non-neuronal tissues with various regulatory actions, including metabolic. Physical fitness (PF) is associated with improved synthesis and secretion of BDNF and reduced obesity. However, the importance of PF for the relationship of BDNF with obesity has not been investigated. This study aims at examining the relationship of PF with BDNF and obesity in 174 young (age = 25.30 ± 9.2 years) healthy adults.

Main methods

Serum BDNF was evaluated using ELISA while obesity was determined using body weight (BW), BMI, and waist circumference (WC). Six minute walk distance (6MWD) test was used to estimate PF.

Key findings

Serum BDNF was greater (p = 0.000) in the participants with high (Hi6MWD) versus low (Lw6MWD) PF group. Additionally, 6MWD explained 6.8% of serum BDNF. Obesity measures were greater (p < 0.05) in the participants with low versus high BDNF. In regression analyses, serum BDNF explained 4.7% of BW (p = 0.004), 3.8% of BMI (p = 0.011), and 6.2% of WC (p = 0.001). However, when the participants were divided into Hi6MWD and Lw6MWD, BDNF explained 8.2% of BW (p = 0.009), 6.0% of BMI (p = 0.03), and 7.0% of WC (p = 0.013), only in the Hi6MWD, but not in the Lw6MWD (p > 0.05) groups.

Significance

The finding confirms the relationship of BDNF with obesity. Additionally, it further suggests the importance of PF level to this relationship among young adults. Future studies are needed to confirm these findings.

Alcohol Advertising and Violence

INTRODUCTION

Numerous studies have found associations between alcohol outlet density and violence, but it is unknown whether alcohol advertisements visible outside outlets are also associated with violent crime. Baltimore City, MD enacted restrictions on retail alcohol establishment advertising practices as of June 5, 2017. This study examines the association between alcohol advertisements visible outside off-premise alcohol outlets and violent crime before this restriction.

METHODS

Outlet observations (n=683) were conducted in summer 2015, and violent crime data (n=24,085) were from June 5, 2015, through June 4, 2017. The number of violent crimes per square mile within 1,000 feet of outlets was summed using kernel density estimation. In 2018-2019, authors used mixed models with a Simes-Benjamini-Hochberg correction for multiple testing.

RESULTS

Roughly half (47%, n=267) of the outlets with complete data (n=572) had alcohol advertisements visible from the exterior. Outlets with alcohol advertisements had 15% more violent crimes per square mile within 1,000 feet (e^β=1.15, 95% CI=1.07, 1.25, q<0.001) after adjusting for neighborhood context. All associations between alcohol advertisements and specific types of violent crime were significant, with the association strongest for homicides (e^β=1.28, 95% CI=1.13, 1.46, q<0.001). There was no association between cigarette advertisements and violent crime (e^B=1.08, 95% CI=0.92, 1.26, q=0.43).

CONCLUSIONS

Alcohol advertisements visible outside off-premise outlets were associated with increased violent crime over and above the association between the outlets themselves and violent crime. Reducing alcohol advertising visible from the street may decrease risk of violent crime that is associated with alcohol outlets.

Comparison of measurement protocols to estimate preferred walking speed between sites

BACKGROUND

Walking speed influences a variety of typical outcome measures in gait analysis. Many researchers use a participant's preferred walking speed (PWS) during gait analysis with a goal of trying to capture how a participant would typically walk. However, the best practices for estimating PWS and the impact of laboratory size and walk distance are still unclear.

RESEARCH QUESTION

Is measured PWS consistent across different distances and between two laboratory sites?

METHODS

Participants walked overground at a "comfortable speed" for six different conditions with either dynamic (4, 6, 10, and 400 m) or static (4 and 10 m) starts and stops at two different data collection sites. Repeated measures ANOVA with Bonferroni corrections were used to test for differences between conditions and sites.

RESULTS

Participants walked significantly faster in the 4, 6, and 10 m dynamic conditions than in the 400 m condition. On average, participants walked slower in the static trials than the dynamic trials of the same distance. There was a significant interaction of lab and condition and so results were examined within each lab. Across both labs, we found that the 4 and 10 m dynamic conditions were not different than the 6 m dynamic condition at both sites, while other tests did not provide consistent results at both sites.

SIGNIFICANCE

We recommend researchers use a 6 m distance with acceleration and deceleration zones to reliably test for PWS across different laboratories. Given some of the differences found between conditions that varied by site, we also emphasize the need to report the test environment and methods used to estimate PWS in all future studies so that the methods can be replicated between studies.

Limitations of 6-minute walk test reference values for spinal muscular atrophy

INTRODUCTION

The 6-minute walk test (6MWT) is a well-established clinical assessment of functional endurance, validated as a measure of walking ability in spinal muscular atrophy (SMA). The current availability of disease-modifying therapies for SMA indicates a growing need for normative reference data to compare SMA patients with healthy controls.

METHODS

The literature was searched in two scientific databases. Studies were evaluated and selected based on adherence to American Thoracic Society guidelines for administering the 6MWT. Reference equations from the selected studies were applied to 6MWT data collected from SMA patients to calculate and compare % predicted values.

RESULTS

Three pediatric and six adult studies were selected for comparison. The % predicted values using the pediatric and adult equations ranged from 47.7 ± 18.2% to 67.6 ± 26.2% and 43.0 ± 17.9% to 59.5 ± 26.2%, respectively, and were significantly different (P < 0.001).

DISCUSSION

Results suggest significant variability between % predicted values derived from published reference equations in children and adults, despite adherence to 6MWT standardization.

Effect of 4 Weeks of Foot Orthosis Intervention on Ambulatory Capacities and Posture in Normal-Weight and Obese Patients

BACKGROUND

Several works have shown the benefits of foot orthosis intervention on postural stability in healthy individuals and patients with foot malalignment. However, the effects of foot orthoses on the daily ambulatory activities explored by the Six-Minute Walk Test (6MWT) were never examined. We hypothesized that foot orthoses could increase the gait distance and attenuate the post-6MWT posture alterations already reported in healthy individuals.

METHODS

In ten normal-weight (NW) and ten obese patients with foot malalignment and/or abnormal foot arch, we examined the benefits of 4 weeks of custom-molded orthosis intervention (D30) on 6MWT gait distance, fatigue sensation scores, ankle plantarflexion force, and post-6MWT sway of the center of pressure (COP) measured by a pedobarographic platform. Data were compared with those measured in two control-matched groups of ten NW and ten obese individuals, explored at study inclusion and at D30.

RESULTS

At study inclusion, the post-6MWT changes in COP surface and the medial and lateral COP deviations were significantly higher in obese participants who needed to wear the foot orthoses compared with obese control subjects. The foot orthosis intervention significantly improved the ambulatory performances of NW and obese individuals during the 6MWT, attenuated the bodily fatigue sensation after the 6MWT, and reduced the post-6MWT COP deviations, with the benefits of insoles being significantly accentuated in obese participants.

CONCLUSIONS

Four weeks of foot orthosis intervention significantly increases gait distance and is an effective means to reduce postural sway after walking.

Serious game for locomotor rehabilitation of hemiparetic stroke patients

Abstract Introduction: Hemiparesis post-stroke usually results in locomotor limitations. As conventional rehabilitation is monotonous, the Serious Games (SG) represents an excellent treatment strategy, allowing to perform physical training in an interesting and enjoyable way. Objective: To evaluate the effects of an exercise program using the SG developed for hemiparetic stroke patients’ locomotor rehabilitation. Method: Non-Randomized Controlled Clinical Trial. Twenty-four hemiparetic stroke patients with subacute or chronic stroke (twelve men), mean age of 57.8 ± 10.4 years (injury time of 16.8 ± 19.6 months) participated in the study. The experimental group (n = 16) participated in an exercise program with the SG for lower limb rehabilitation. The control group (n = 8) received conventional treatment (kinesiotherapy). The intervention consisted of sessions twice a week for ten weeks. The following parameters were assessed: muscle strength (dynamometry), spasticity (Modified Ashworth Scale), functional mobility (Timed Up and Go Test - TUGT), and the gait speed (GS). Results: Both groups showed improvements, but the experimental group was better in all the studied variables, the muscular strength of the lower limb paresis and of the quadriceps femoris (p = 0.002; d = 0.7); and for the hamstrings (p < 0.001; d = 1.3), TUGT (p < 0.001; d = 0.4), and GS (p = 0.001; d = 0.4). Conclusion: The exercise program with the SG was useful for the patients treated in this study. The results showed a superiority of the SG regarding the conventional treatment in all the controlled variables. This was probably because of the greater repeatability of the exercises and the increased attention and motivation.

The higher they go the harder they could fall: The impact of risk-glorifying commercials on risk behavior

Previous research on risk-glorifying media has provided encompassing evidence for a positive connection between risk-glorifying contents and (a) risk-positive emotions, (b) risk-positive cognitions and attitudes, and (c) risk-positive behavioral inclinations. Nevertheless, little evidence shows whether risk-glorifying content increases actual risk behavior. We conducted three experimental studies to assess whether risk-glorifying commercials increase risk behavior. In all studies, participants were randomly assigned to a risk-glorifying or a neutral commercial. Additionally, in Study 2 participants were randomly assigned to an arousal or a non-arousal condition to test the mediating effect of arousal. In Study 3, we tested the mediating effect of the accessibility to risk-positive cognitions. We measured participants’ risk behavior via the risk assessment ramp (RAR). Our results revealed that participants who watched the risk-glorifying commercial walked faster to the jumping-off point (Studies 1, 2, & 3) and would have jumped from a higher level (Studies 2 & 3), thus, indicating the exposure to risk-glorifying media content increases people’s risk behavior. Neither arousal nor the accessibility to risk-positive cognitions mediated the effect of risk-glorifying media content. Beyond our findings, we offer a new tool to assess risk behavior that is effective and easy to apply.

Development and validation of a Bayesian survival model for inclusion body myositis

BACKGROUND

Associations between disease characteristics and payer-relevant outcomes can be difficult to establish for rare and progressive chronic diseases with sparse available data. We developed an exploratory bridging model to predict premature mortality from disease characteristics, and using inclusion body myositis (IBM) as a representative case study.

METHODS

Candidate variables that may be potentially associated with premature mortality were identified by disease experts and from the IBM literature. Interdependency between candidate variables in IBM patients were assessed using existing patient-level data. A Bayesian survival model for the IBM population was developed with identified variables as predictors for premature mortality in the model. For model selection and external validation, model predictions were compared to published mortality data in IBM patient cohorts. After validation, the final model was used to simulate the increased risk of premature death in IBM patients. Baseline survival was based on age- and gender-specific survival curves for the general population in Western countries as reported by the World Health Organisation.

RESULTS

Presence of dysphagia, aspiration pneumonia, falls, being wheelchair-bound and 6-min walking distance (6MWD in meters) were identified as candidate variables to be used as predictors for premature mortality based on inputs received from disease experts and literature. There was limited correlation between these functional performance measures, which were therefore treated as independent variables in the model. Based on the Bayesian survival model, among all candidate variables, presence of dysphagia and decrease in 6MWD [m] were associated with poorer survival with contributing hazard ratios (HR) 1.61 (95% credible interval [CrI]: 0.84-3.50) and 2.48 (95% CrI: 1.27-5.00) respectively. Excess mortality simulated in an IBM cohort vs. an age- and gender matched general-population cohort was 4.03 (95% prediction interval 1.37-10.61).

CONCLUSIONS

For IBM patients, results suggest an increased risk of premature death compared with the general population of the same age and gender. In the absence of hard data, bridging modelling generated survival predictions by combining relevant information. The methodological principle would be applicable to the analysis of associations between disease characteristics and payer-relevant outcomes in progressive chronic and rare diseases. Studies with lifetime follow-up would be needed to confirm the modelling results.

The Effectiveness of Telerehabilitation as a Supplement to Rehabilitation in Patients After Total Knee or Hip Replacement: Randomized Controlled Trial

Background

Telerehabilitation can contribute to the maintenance of successful rehabilitation regardless of location and time. The aim of this study was to investigate a specific three-month interactive telerehabilitation routine regarding its effectiveness in assisting patients with physical functionality and with returning to work compared to typical aftercare.

Objective

The aim of the study was to investigate a specific three-month interactive telerehabilitation with regard to effectiveness in functioning and return to work compared to usual aftercare.

Methods

From August 2016 to December 2017, 111 patients (mean 54.9 years old; SD 6.8; 54.3% female) with hip or knee replacement were enrolled in the randomized controlled trial. At discharge from inpatient rehabilitation and after three months, their distance in the 6-minute walk test was assessed as the primary endpoint. Other functional parameters, including health related quality of life, pain, and time to return to work, were secondary endpoints.

Results

Patients in the intervention group performed telerehabilitation for an average of 55.0 minutes (SD 9.2) per week. Adherence was high, at over 75%, until the 7th week of the three-month intervention phase. Almost all the patients and therapists used the communication options. Both the intervention group (average difference 88.3 m; SD 57.7; P=.95) and the control group (average difference 79.6 m; SD 48.7; P=.95) increased their distance in the 6-minute-walk-test. Improvements in other functional parameters, as well as in quality of life and pain, were achieved in both groups. The higher proportion of working patients in the intervention group (64.6%; P=.01) versus the control group (46.2%) is of note.

Conclusions

The effect of the investigated telerehabilitation therapy in patients following knee or hip replacement was equivalent to the usual aftercare in terms of functional testing, quality of life, and pain. Since a significantly higher return-to-work rate could be achieved, this therapy might be a promising supplement to established aftercare.

Trial Registration

German Clinical Trials Register DRKS00010009; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00010009

Expanding Tools for Investigating Neighborhood Indicators of Drug Use and Violence: Validation of the NIfETy for Virtual Street Observation

A growing body of evidence suggests that characteristics of the neighborhood environment in urban areas significantly impact risk for drug use behavior and exposure to violent crime. Identifying areas of community need, prioritizing planning projects, and developing strategies for community improvement require inexpensive, easy to use, evidence-based tools to assess neighborhood disorder that can be used for a variety of research, urban planning, and community needs with an environmental justice frame. This study describes validation of the Neighborhood Inventory for Environmental Typology (NIfETy), a neighborhood environmental observational assessment tool designed to assess characteristics of the neighborhood environment related to violence, alcohol, and other drugs, for use with Google Street View (GSV). GSV data collection took place on a random sample of 350 blocks located throughout Baltimore City, Maryland, which had previously been assessed through in-person data collection. Inter-rater reliability metrics were strong for the majority of items (ICC ≥ 0.7), and items were highly correlated with in-person observations (r ≥ 0.6). Exploratory factor analysis and constrained factor analysis resulted in one, 14-item disorder scale with high internal consistency (alpha = 0.825) and acceptable fit indices (CFI = 0.982; RMSEA = 0.051). We further validated this disorder scale against locations of violent crimes, and we found that disorder score was significantly and positively associated with neighborhood crime (IRR = 1.221, 95% CI = (1.157, 1.288), p < 0.001). The NIfETy provides a valid, economical, and efficient tool for assessing modifiable neighborhood risk factors for drug use and violence prevention that can be employed for a variety of research, urban planning, and community needs.

Tester and testing procedure influence clinically determined gait speed

BACKGROUND

There is a clinical need to be able to reliably detect meaningful changes (0.1 to 0.2 m/s) in usual gait speed (UGS) considering reduced gait speed is associated with morbidity and mortality.

RESEARCH QUESTION

What is the impact of tester on UGS assessment, and the influence of test repetition (trial 1 vs. 2), timing method (manual stopwatch vs. automated timing), and starting condition (stationary vs. dynamic start) on the ability to detect changes in UGS and fast gait speed (FGS)?

METHODS

UGS and FGS was assessed in 725 participants on a 8-m course with infrared timing gates positioned at 0, 2, 4 and 6 m. Testing was performed by one of 13 testers trained by a single researcher. Time to walk 4-m from a stationary start (i.e. from 0-m to 4-m) was measured manually using a stopwatch and automatically via the timing gates at 0-m and 4-m. Time taken to walk 4-m with a dynamic start was measured during the same trial by recording the time to walk between the timing gates at 2-m and 6-m (i.e. after 2-m acceleration).

RESULTS

Testers differed for UGS measured using manual vs. automated timing (p = 0.02), with five and two testers recording slower and faster UGS using manual timing, respectively. 95% limits of agreement for trial 1 vs. 2, manual vs. automated timing, and dynamic vs. stationary start ranged from ±0.15 m/s to ±0.20 m/s, coinciding with the range for a clinically meaningful change. Limits of agreement for FGS were larger ranging from ±0.26 m/s to ±0.35 m/s.

SIGNIFICANCE

Repeat testing of UGS should performed by the same tester or using an automated timing method to control for tester effects. Test protocol should remain constant both between and within participants as protocol deviations may result in detection of an artificial clinically meaningful change.

Adaptive empirical pattern transformation (ADEPT) with application to walking stride segmentation

Quantifying gait parameters and ambulatory monitoring of changes in these parameters have become increasingly important in epidemiological and clinical studies. Using high-density accelerometry measurements, we propose adaptive empirical pattern transformation (ADEPT), a fast, scalable, and accurate method for segmentation of individual walking strides. ADEPT computes the covariance between a scaled and translated pattern function and the data, an idea similar to the continuous wavelet transform. The difference is that ADEPT uses a data-based pattern function, allows multiple pattern functions, can use other distances instead of the covariance, and the pattern function is not required to satisfy the wavelet admissibility condition. Compared to many existing approaches, ADEPT is designed to work with data collected at various body locations and is invariant to the direction of accelerometer axes relative to body orientation. The method is applied to and validated on accelerometry data collected during a $450$-m outdoor walk of $32$ study participants wearing accelerometers on the wrist, hip, and both ankles. Additionally, all scripts and data needed to reproduce presented results are included in supplementary material available at Biostatistics online.