The reliability and validity of the Figure of 8 Walk test in older people with knee replacement: does the setting have an impact?

Reliability and validity of the single- and dual-task Figure-of-8 Walk tests in stroke patients

OBJECTIVES

To assess the validity and reliability of the single- and dual-task Figure-of-8 Walk (F8W) tests in stroke patients.

METHODS

Thirty-two patients aged 61.09   ±   9.27 years (mean) were enrolled. The general cognitive function and stroke severity were assessed using the Standardized Mini Mental Test and National Institutes of Health Stroke Scale, respectively. The single- and dual-task F8W tests were performed in the study. The F8W test with a cognitive task of counting backward by threes (F8W  +  cog), and the F8W test with a motor task of carrying a glass of water on a tray (F8W  +  mot) consisted dual-task F8W. Relative and absolute reliability was assessed using the test-retest method and Bland-Altman plots. Intraclass correlation coefficients (ICC) and standard error of measurement (SEM) values were calculated. To assess convergent validity, the Timed Up and Go Test (TUGT), the 10-Meter Walk Test (10mWT), the Modified Four-Square Step Test (mFSST), and the Six-Spot Step Test (SSST) were administered.

RESULTS

The test-retest reliability of the F8W, F8W  +  cog, and F8W  +  mot tests demonstrated excellent results, with ICC values of 0.938, 0.929, and 0.935, respectively, and SEM values of 4.57, 5.52, and 5.01. Bland-Altman plots demonstrated that the F8W, F8W  +  cog, and F8W  +  mot were quite compatible with all tests (p > 0.99). All F8W tests were moderate to very strong correlation with the TUGT, 10mWT, mFSST, and SSST (p < 0.01).

CONCLUSION

The single- and dual-task F8W tests are useful reliable and valid tests in stroke patients.

Digital assessment of walking ability: Validity and reliability of the automated figure-of-eight walk test in older adults

BACKGROUND

The Figure-of-Eight Walk Test (F8WT) can assess straight- and curved-path walking ability, but the validity and reliability of automated measurement of the F8WT using digital device has not yet been studied. The aim of this study was to verify the validity (method comparison) and test-retest reliability of the automated FW8T (aFW8T) using a digital device based on image analysis by comparing the results of the aF8WT with those of the manual F8WT (mF8WT).

METHODS

Community-dwelling older adults underwent the mF8WT performed by a physiotherapist and the aF8WT using the Digital Senior Fitness Test system. To verify the test-retest reliability, the aF8WT was administered again to a randomly selected group of participants one week after the baseline test. The intraclass correlation coefficient (ICC) and Pearson's correlation analysis were used to verify the degree of agreement between the results of and correlation between the mF8WT and aF8WT, respectively. The 95% confidence interval (CI) of the limits of agreement (LoA) was obtained using Bland-Altman analysis.

RESULTS

The analysis included 83 participants (mean age 71.6 ± 4.7 years). The participants' mF8WT and aF8WT results were 29.1 ± 4.9 and 29.8 ± 4.9 seconds, respectively. Pearson's correlation analysis showed a very strong correlation between the mF8WT and aF8WT results with r = 0.91 (p < 0.001), and the ICC between the mF8WT and aF8WT results was 0.95 (0.91-0.97), showing excellent agreement. The 95% CI of the LoA was -0.7 (-4.8 to 3.3) seconds in the Bland-Altman analysis. In an analysis of the test-retest reliability of the aF8WT, participants' aF8WT results were 30.9 ± 4.7 seconds (baseline) and 29.6 ± 4.9 seconds (retest), with an ICC of 0.94 (0.81-0.98, p < 0.001), indicating excellent reliability.

CONCLUSION

Automated measurement of the F8WT using a digital device showed excellent validity and reliability. The aF8WT can be used to assess and monitor the walking ability of community-dwelling older adults.

Impact of step width on trunk motion and gait adaptation in elderly women with knee osteoarthritis

BACKGROUND

Step width during walking can provide important information about aging and pathology. Although knee osteoarthritis (OA) is a common disease in elderly women, little is known about how different step widths influence gait parameters in patients with knee OA.

OBJECTIVE

To address this, we investigated the differences between narrower and wider step width on the center of mass (CoM) and gait biomechanics of elderly women with knee OA.

METHODS

Gait and CoM data were measured using a three-dimensional motion capture system and anthropometric data were acquired via standing full-limb radiography. Thirty elderly women with knee OA were divided into two groups depending on the average step width value (0.16 m). Specifically, the narrower step width group included those with a below average step width (n= 15) and the wider step width group included those with an above average step width (n= 15). The differences between the two groups were analyzed using an independentt-test.

RESULTS

Walking speed, step length, knee and ankle sagittal excursion, and medial-lateral CoM range were significantly greater in the narrower group. In contrast, the medial-lateral CoM velocity, medial-lateral ground reaction force (GRF), and foot progression angle were significantly higher in wider group. The external knee adduction moment, vertical GRF, and vertical CoM did not differ between the groups.

CONCLUSIONS

Our data indicate that step width in women with knee OA is associated with trunk motion and gait patterns. People with a narrower step might improve their gait function by increasing trunk frontal control to maintain gait stability. In contrast, in those with a wider step, greater toe out angle and shorter step length might be a compensatory adaptation to reduce knee loading.

Investigation of Reaction Time, Proprioception, and Shaped Pathway Walking Performance in Older Patients with Total Knee Arthroplasty

OBJECTIVES

The existing literature on total knee arthroplasty (TKA) does not provide clear data on step reaction time and proprioception and gait in shaped pathways. This study investigated the relationship between proprioception and reaction time with walking performance in shaped pathways in older patients undergoing TKA.

DESIGN

A cross-sectional observational study.

SETTING AND PARTICIPANTS

An orthopedic outpatient clinic with 103 older patients with TKA after a minimum of 6 months after surgery.

METHODS

Participants were evaluated with Figure-of-8 Walk Test (F8WT), L Test, Tinnetti Gait Test (TGT), proprioception measurement with an app-based inclinometer, and step reaction time (SRT) test. The same assessor carried out all evaluations.

RESULTS

F8WT showed a strong correlation with SRT-right, SRT-left, and Tinetti Gait Test (TGT), respectively (r1 = 0.628, r2 = 0.619, r3 = -0.615, P < .01). In addition, F8WT was moderately correlated with Right Leg Proprioception Test (RLPT) and Left Leg Proprioception Test (LLPT), respectively (r1 = 0.487, r2 = 0.439, P < .01). There was a moderate correlation between L Test with RLRT, LLRT, and TGT, respectively (r1 = 0.597, r2 = 0.584, r3 = -0.542, P < .01). Besides, there was a weak positive correlation between L Test with RLPT and LLPT, respectively (r1 = 0.394, r2 = 0.335, P < .01). A regression model showed that the L test was related to RLRT, LLRT, and TGT (R2 = 0.432, P < .001). The higher ability of the L test was weakly associated with higher levels of TGT (standardized β = -0.28, P = .0012). Besides, regression analysis also proved that F8WT was related to RLRT, LLRT, and TGT (R2 = 0.522, P < .001). The most highly associated parameter was LLRT (standardized β = 0.958, P = .003).

CONCLUSIONS AND IMPLICATIONS

Gait in shaped pathways is associated with proprioception, reaction time, and balance ability in older patients with TKA. Therefore, proprioception, reaction time, and balance should be considered to improve the shaped pathway walking performance of patients after bilateral, right, or left TKA surgery.

Feasibility of a theoretically grounded, multicomponent, physiotherapy intervention aiming to promote autonomous motivation to adopt and maintain physical activity in patients with lower-limb osteoarthritis: protocol for a single-arm trial

BACKGROUND

Lower-limb osteoarthritis (OA) causes high levels of pain and disability in adults over 45 years of age. Adopting and maintaining appropriate levels of physical activity (PA) can help patients with lower-limb OA self-manage their symptoms and reduce the likelihood of developing secondary noncommunicable diseases. However, patients with lower-limb OA are less active than people without musculoskeletal pain. This single-arm feasibility trial seeks to determine the feasibility and acceptability of a complex multicomponent physiotherapy behaviour change intervention that aims to aid patients with lower-limb OA to adopt and maintain optimal levels of PA.

METHODS

This trial will be conducted at one site in a National Health Service physiotherapy outpatient setting in the West Midlands of England. Up to thirty-five participants with lower-limb OA will be recruited to receive a physiotherapy intervention of six sessions that aims to optimise their PA levels during phases of behavioural change: adoption, routine formation and maintenance. The intervention is underpinned by self-determination theory (and other motivational frameworks) and seeks to foster a motivationally optimal (empowering) treatment environment and implement behaviour change techniques (BCTs) that target PA behaviours across the three phases of the intervention. Physiotherapists (n = 5-6) will receive training in the why and how of developing a more empowering motivational environment and the delivery of the intervention BCTs. Participants will complete patient-reported and performance-based outcome measures at baseline and 3-month (to reflect behavioural adoption) and 6-month (maintenance) post-baseline. Feasibility and acceptability will be primarily assessed through semi-structured interviews (purposively recruiting participants) and focus groups (inviting all physiotherapists and research staff). Further evaluation will include descriptive analysis of recruitment rates, loss of follow-up and intervention fidelity.

DISCUSSION

A novel complex, multicomponent theoretical physiotherapy behaviour change intervention that aims to create a more empowering motivational treatment environment to assist patients with lower-limb OA to adopt and maintain optimal PA levels has been developed. Testing the feasibility and acceptability of the intervention and its associated physiotherapist training and related trial procedures is required to determine whether a full-scale parallel group (1:1) randomised controlled trial to evaluate the interventions effectiveness in clinical practice is indicated.

TRIAL REGISTRATION

Trial register: International Standard Randomised Controlled Trial identification number: ISRCTN12002764 . Date of registration: 15 February 2022.

The psychometric properties of the figure-of-eight walk test in people with Parkinson's disease

PURPOSE

To investigate: (1) the interrater, and test-retest reliability of the figure-of-eight walk test (F8WT) in people with Parkinson's disease (PwPD); (2) the minimum detectable change in the F8WT times; (3) the concurrent and known-groups validity of the F8WT times; and (4) the cut-off times that best discriminate PwPD from healthy people and fallers from non-fallers with PD.

METHODS

This was a cross-sectional study. Forty-three PwPD and 34 healthy people were recruited. The F8WT was performed along with the timed up and go test, 10 m walk test, Berg Balance Scale, Activities-Specific Balance Confidence Scale, Unified Parkinson's disease Rating Scale, and Hoehn and Yahr Scale.

RESULTS

The F8WT showed good interrater and test-retest reliability (ICC = 0.964-0.978 and ICC = 0.905-0.920, respectively). The MDC was 2.77 s. The F8WT was correlated with other outcome measures. Significant differences in the F8WT times were found between PwPD and healthy people and between fallers and non-fallers with PD (p < 0.001 and p < 0.001, respectively). The cut-off times of 8.43 s best discriminated PwPD from healthy people, while 11.19 s best discriminated fallers from non-fallers with PD.

CONCLUSIONS

The F8WT is a reliable, valid, and easy-to-administer tool in assessing the walking skill of PwPD.Implications for rehabilitationThe figure-of-eight walk test (F8WT) is a reliable, valid, and clinically available tool for assessing walking skill in Parkinson's disease (PD).The minimal detectable change of the F8WT is 2.77 s, which may help to determine any real change in walking skill after any intervention.The F8WT correlated with functional mobility, gait speed, balance, balance confidence, and severity and stage of PD.The F8WT times may detect impaired walking skill between people with PD and healthy people, and between fallers and non-fallers with PD.

The reliability and validity of the Figure of 8 walk test in mildly disabled persons with multiple sclerosis

BACKGROUND

Figure of 8 Walk Test (F8WT) assesses the multidirectional and adaptive requirements of both straight and curved path walking. The study aimed to examine the reliability, validity, and minimal detectable change (MDC) of the F8WT in patients with Multiple Sclerosis (pwMS).

METHODS

45 mildly disabled pwMS (10 male, 35 female) were included in the study. Reliability of F8WT test was evaluated with Intraclass Correlation Coefficient (ICC). MDC estimates were calculated using baseline data. The correlation between the F8WT and Berg Balance Scale (BBS), The Timed Up and Go test (TUG), The Timed 25-Foot Walk Test (T25FW), The Four Square Step Test (FSST) was used for the validity.

RESULTS

The intra-rater (ICC 0.980-0.983) and inter-rater (ICC 0.976-0.985) reliability of the F8WT was determined to be excellent. MDC values for intra-rater were 1.04-1.08 s, and MDC values for inter-rater were 1.16-0.99 s. The correlation with F8WT and BBS (p = 0.000, r = -0.702), TUG (p = 0.000, r = 0.854), T25FW (p = 0.000, r = 0.784), FSST (p = 0.000, r = 0.748) was found to be statistically significant.

CONCLUSION

The F8WT has good reliability and validity in mildly disabled pwMS. According to the MDC results, small differences in pwMS can be adequately detected with F8WT. Therefore, it may be a clinically suitable test for detecting balance and walking.

Test–retest reliability for performance-based outcome measures among individuals with arthrogryposis multiplex congenita

Background

Most individuals with arthrogryposis multiplex congenita, a rare condition characterized by joint contractures in ≥ 2 body regions, have foot and ankle involvement leading to compromised gait and balance. The purpose of this study was to establish between-days, test–retest reliability for performance-based outcome measures evaluating gait and balance, i.e., the 10-m Walk Test, Figure-of-8 Walk Test, 360-degree Turn Test, and modified Four Square Step Test, among adolescents and adults with arthrogryposis multiplex congenita.

Methods

This reliability study included ambulatory participants, aged 10 to 50 years, with a medical diagnosis of arthrogryposis multiplex congenita. Participants completed performance-based measures, in a randomized order, on two separate occasions. Intraclass correlation coefficients with 95% confidence intervals and minimal detectable changes at the 90% and 95% confidence level were calculated.

Results

Participants included 38 community-ambulators with a median of 13 out of 14 upper and lower joint regions affected. Intraclass correlation coefficient point estimates and 95% confidence intervals ranged from .85-.97 and .70-.98, respectively. Minimal detectable changes were 10 to 39% of sample means and were largest for the modified Four Square Step Test.

Conclusions

Among individuals with arthrogryposis, gait speed per the 10-m Walk Test, as well as non-linear walking and dynamic balance assessment per the Figure-of-8 Walk and 360 Degree Turn Tests, have adequate test–retest reliability enabling evaluation of individual patient changes. Changes in groups of ambulatory individuals with arthrogryposis multiplex congenita may be reliably evaluated with all of the studied outcome measures.

The test-retest reliability, concurrent validity, and minimal detectable change of the L test in patients with total hip arthroplasty

Background

The L test is a modified version of the timed up and go test (TUG) with an L-shaped walking path. The L test is more extensive than other performance tests, especially in turn direction and specific tasks. The study aimed to evaluate the test-retest reliability, concurrent validity, and minimal detectable change of the L test in patients with total hip arthroplasty (THA). A cross-sectional study was conducted with 33 unilateral and primary THA patients. The L test was performed twice with an interval of an hour on the same day for the test-retest reliability. Timed up and go test (TUG), five times sit to stand test (FTST), and Harris hip score (HHS) were carried out for the analysis of the concurrent validity of the L test.

Results

The mean age of the participants was 74.6 ± 10.3 years. The ICC score of the L test was 0.992. Test-retest reliability was excellent. SEM95 and MDC95 values were 3.39 and 9.39, respectively. Both TUG and HHS were strongly correlated with the L test (r1 = 0.889, r2 = −0.568, p < 0.001). However, there was no significant correlation between FTST and L test (r = 0.024, p > 0.05).

Conclusions

The L test is valid and reliable performance measurement in patients with primary unilateral THA. MDC95 of the L test is an essential reference for clinicians in the rehabilitation follow-up process of THA patients.

The test-retest reliability and concurrent validity of the 3-m backward walk test and 50-ft walk test in community-dwelling older adults

BACKGROUND

Three-meter backward walk test (3MBWT) and 50-ft walk test (50FWT) are frequent physical performance tests in clinical practice.

AIMS

The aim of the study was to determine the test-retest reliability and concurrent validity of the 3MBWT and 50FWT in community-dwelling older adults.

METHODS

A cross-sectional study was carried out with 65 participants. 3MBWT, 50FWT, Timed Up and Go Test (TUG), and Five Times Sit to Stand Test (FTST) were evaluated in the first assessment. The test-retest reliability was evaluated by performing two repetitions of the 3MBWT and 50FWT with 1-h interval. The test-retest reliability and validity were assessed by the intraclass correlation coefficient (ICC) and the Spearman correlation coefficient, respectively.

RESULTS

The mean age of the participants was 68.9±3.7 years. The ICC score of 3MBWT and 50FWT were 0.940 and 0.820, respectively. The test-retest reliability of both tests was excellent (> 0.80). Both the test and retest assessment of the 3MBWT were strongly correlated with TUG (r_test = 0.649, r_retest = 0.645, p < 0.01). 50FWT (test) was not significantly correlated with FTST (r = 0.215, p > 0.05). 50FWT (retest) were weakly correlated with FTST (r = 0.260, p < 0.05). Both the test and retest assessments of the 50FWT was strongly correlated with TUG (r_test = 0.550, r_retest = 0.596, p < 0.01).

CONCLUSIONS

The 3MBWT and 50FWT are valid and reliable performance tests in community-dwelling older adults. MDC value of both tests provides an essential contribution to clinical practice.

The test-retest reliability and concurrent validity of the five times sit to stand test and step test in older adults with total hip arthroplasty

PURPOSE

The aim of the study was to determine the test-retest reliability and concurrent validity of the five times sit to stand test (FTST) and step test (ST) in older adults with total hip arthroplasty (THA).

METHODS

A cross-sectional and prospective study was carried out with 32 unilateral total hip arthroplasty patients. FTST, ST, and Timed Up & Go Test were evaluated at the first evaluation session. The test-retest reliability was evaluated by performing two repetitions of the FTST and ST. Besides, the functional status of the patients was evaluated with the Harris Hip Score (HHS). The test-retest reliability of the FTST and ST were assessed by the intraclass correlation coefficient (ICC). In the concurrent validity analysis, the Pearson correlation coefficient was analyzed. In addition, the standard error of measurement (SEM₉₅) and minimal detectable change (MDC₉₅) values of the FTST and ST were also calculated.

RESULTS

The mean age of the participants was 75.4 ± 10.3 years. The ICC score of FTST, ST (right) and ST (left) were 0.987, 0.908 and 0.846, respectively. SEM₉₅ and MDC₉₅ values of the FTST were 1.05 and 2.91, respectively. FTST was correlated with both the HHS and TUG (r₁ = -0.522, r₂ = 0.730, p < 0.01). SEM₉₅ and MDC₉₅ values of the ST (right) were 0.37 and 1.02, respectively. SEM₉₅ and MDC₉₅ values of the ST (left) were 0.55 and 1.52, respectively. Also, ST (right) was only correlated with TUG (r = -0.654, p < 0.01). ST (right) were correlated with both the HHS and TUG (r₁ = 0.503, r₂ = -0.806, p < 0.01). The degree of correlations was strong.

CONCLUSION

The FTST and ST are valid and reliable performance tests in older adults with primary unilateral THA.

Performance-based outcome measures are associated with cadence variability during community ambulation among individuals with a transtibial amputation

BACKGROUND

In the United States, Medicare Functional Classification Level (K-level) guidelines require demonstration of cadence variability to justify higher-level prosthetic componentry prescription; however, clinical assessment of cadence variability is subjective. Currently, no clinical outcome measures are associated with cadence variability during community ambulation.

OBJECTIVES

Evaluate whether physical performance, i.e. 10-meter Walk Test (10mWT)-based walking speeds, L-Test, and Figure-of-8 Walk Test scores, is associated with community-based cadence variability among individuals with a transtibial amputation.

STUDY DESIGN

Cross-sectional.

METHODS

Forty-nine participants, aged 18-85 years, with a unilateral transtibial amputation were included. Linear regression models were conducted to determine whether physical performance was associated with cadence variability (a unitless calculation from FitBit® One^TM minute-by-minute step counts), while controlling for sex, age, and time since amputation (p ⩽ .013).

RESULTS

Beyond covariates, self-selected gait speed explained the greatest amount of variance in cadence variability (19.2%, p < .001). Other outcome measures explained smaller, but significant, amounts of the variance (11.1-17.1%, p = .001-.008). For each 0.1 m/s-increase in self-selected and fast gait speeds, or each 1-s decrease in L-Test and F8WT time, community-based cadence variability increased by 1.76, 1.07, 0.39, and 0.79, respectively (p < .013).

CONCLUSIONS

In clinical settings, faster self-selected gait speed best predicted increased cadence variability during community ambulation.

CLINICAL RELEVANCE

The 10-meter Walk Test may be prioritized during prosthetic evaluations to provide objective self-selected walking speed data, which informs the assessment of cadence variability potential outside of clinical settings.

The Figure-of-8 Walk Test used to detect the loss of motor skill in walking among persons with Parkinson's disease

BACKGROUND

The Figure-of-8 Walk Test (F8W) is a valid measure of walking skill in older adults with a mobility disability. Use of the F8W in assessing walking skill in persons with Parkinson's disease (PWP) is unknown.

PURPOSE

We examined the validity of the F8W by associations with mobility, and cognitive and physical function, and determined the ability of the F8W to discriminate the motor skill of walking in PWP from that of older adults (OA).

METHODS

Participants, PWP (n = 60) and OA (n = 34) performed the F8W, usual straight path walking, the Montreal Cognitive Assessment (MoCA), and the Late-Life Function and Disability Instrument (LLFDI).

RESULTS

Among PWP, F8W time and steps related to: usual gait speed (r = -0.660, -0.650); stride time variability (r = 0.377, 0.438); cognition (r = -0.293, time only); and physical function (r = -0.532, - 0.619), all p < .05. Area under the curve (AUC) analyses demonstrated greater sensitivity and specificity of F8W performance (0.811, 0.790) compared to usual gait speed (0.729) to recognize the motor skill of walking in PWP from that of OA.

CONCLUSION

The F8W is a valid indicator of the motor skill of walking in PWP. Use of the F8W may uncover walking difficulties not identified by usual gait speed.

The maximal gait speed is a simple and useful prognostic indicator for functional recovery after total hip arthroplasty

PURPOSE

The present study aimed to compare the capabilities of preoperative usual and maximal gait speeds in predicting functional recovery in patients who have undergone total hip arthroplasty (THA).

METHODS

Primary and unilateral THAs were performed in 317 patients, and the proportion of patients who achieved unassisted walking (functional recovery) 5 days postoperatively was recorded as an outcome measure. Preoperative functional assessment included hip pain, leg muscle strength, range of motion (ROM), and gait speed evaluations. The capabilities of preoperative usual and maximal gait speeds in predicting functional recovery were compared based on the areas under the curves (AUCs) of receiver operating characteristic (ROC) curves. Further, ROC curves were constructed using two models: 1. a model of gait speed only and 2. a clinical model including age, sex, leg muscle strength, and ROM.

RESULTS

On the AUCs for predictive ability of functional recovery, maximal gait speed was greater than usual gait speed (0.66 and 0.70, respectively). The AUC for maximal gait speed was as large as that of the clinical model (0.70 and 0.70, respectively).

CONCLUSION

Our results suggest that maximal gait speed is a simple and useful prognostic indicator of functional recovery in patients who have undergone THA.