Prognostic value of usual gait speed in well-functioning older people--results from the Health, Aging and Body Composition Study.
ABSTRACT To define clinically relevant cutpoints for usual gait speed and to investigate their predictive value for health-related events in older persons.
Prospective cohort study.
Health, Aging and Body Composition Study.
Three thousand forty-seven well-functioning older persons (mean age 74.2).
Usual gait speed on a 6-m course was assessed at baseline. Participants were randomly divided into two groups to identify (Sample A; n=2,031) and then validate (Sample B; n=1,016) usual gait-speed cutpoints. Rates of persistent lower extremity limitation events (mean follow-up 4.9 years) were calculated according to gait speed in Sample A. A cutpoint (defining high- (< 1 m/s) and low risk (> or = 1 m/s) groups) was identified based on persistent lower extremity limitation events. The predictive value of the identified cutpoints for major health-related events (persistent severe lower extremity limitation, death, and hospitalization) was evaluated in Sample B using Cox regression analyses.
A graded response was seen between risk groups and health-related outcomes. Participants in the high-risk group had a higher risk of persistent lower extremity limitation (rate ratio (RR)=2.20, 95% confidence interval (CI)=1.76-2.74), persistent severe lower extremity limitation (RR=2.29, 95% CI=1.63-3.20), death (RR=1.64, 95% CI=1.14-2.37), and hospitalization (RR=1.48, 95% CI=1.02-2.13) than those in the low-risk group.
Usual gait speed of less than 1 m/s identifies persons at high risk of health-related outcomes in well-functioning older people. Provision of a clinically meaningful cutpoint for usual gait speed may facilitate its use in clinical and research settings.
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ABSTRACT: To identify, appraise and synthesize evidence regarding efficacy of conservative interventions (physiotherapeutic, pharmacological) to improve walking in ambulant adults with cerebral palsy (CP). Standard search and extraction methods were utilised. A descriptive synthesis was performed with additional limited meta-analysis where the same outcome measurements were used and clinical heterogeneity was low. Interventions were considered according to target domain (International Classification of Functioning, Disability and Health). From 1571 papers identified, 10 met inclusion criteria. Study exclusion was predominantly due to gait not being a target of the intervention, or non-adult age range. Five randomised controlled trials were identified. Interventions were diverse and included strength training, sensory cueing, neurodevelopmental training, whole body vibration and spasticity medication. A small between-group effect on gait speed was found, weighted mean difference 0.09 (95 % CI 0.03 to 0.16). Evidence to support efficacy of one physiotherapeutic or pharmacological intervention over another to improve gait in adults with CP is currently limited. Further research is required using standardised gait outcome measures, longer follow up periods and higher quality trial designs.Journal of Developmental and Physical Disabilities 10/2014; 26(5):633-654. DOI:10.1007/s10882-014-9385-1 · 0.89 Impact Factor
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