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Journal of Geriatric Physical Therapy Vol. 32;2:09
2
1
Clinical Assistant Professor, Physical erapy Program, De-
partment of Exercise Science, Arnold School of Public Health,
University of South Carolina, Columbia SC
2
Professor of Physical erapy & Geriatrics, Dept. of Physical
erapy & Human Movement Science, College of Education
& Health Professions, Sacred Heart University, Faireld, CT
Walking speed is almost the perfect measure.
1
A reliable,
valid,
2,3
sensitive
4
and specic
5
measure, self-selected walking
speed (WS), also termed gait velocity, correlates with functional
ability,
6
and balance condence.
7
It has the potential to pre-
dict future health status,
8,9
and functional decline
10
including
hospitalization,
11
discharge location,
12,13
and mortality.
14
Walk-
ing speed reects both functional and physiological changes,
6
is a discriminating factor in determining potential for rehabili-
tation,
15
and aids in prediction of falls
16
and fear of falling.
17
Furthermore, progression of WS has been linked to clinical
meaningful changes in quality of life
18
and in home and com-
munity walking behavior.
19
Due to its ease of use
20
and psycho-
metric properties, WS has been used as a predictor and outcome
measure across multiple diagnoses.
8,9,19,21-26
In addition, WS was
chosen by a panel of experts as the standardized assessment to
measure locomotion for the Motor Function Domain of the
NIH Toolbox.
27
Walking speed, like blood pres-
sure, may be a general indicator
that can predict future events and
reect various underlying physi-
ological processes.
8
While WS can-
not stand alone as the only predic-
tor of functional abilities, just at
blood pressure is not the only sign
of heart disease; WS can be used
as a functional “vital signto help
determine outcomes such as func-
tional status,
6,8
discharge location,
12
and the need for rehabilitation
11
(Figure 1).
Walking is a complex func-
tional activity; thus, many vari-
ables contribute to or inuence
WS. ese include, but are not
limited to, an individual’s health
status,
28
motor control,
29
muscle
performance and musculoskel-
etal condition,
30,31
sensory and
perceptual function,
32
endurance
and habitual activity level,
33
cog-
nitive status,
34
motivation and
mental health,
35,36
as well as the
characteristics of the environment
in which one walks.
37
While per-
formance measures used in conjunction with WS are often bet-
ter able to predict health status,
28
the use of WS alone can be
an excellent predictor.
11,20
For example, WS predicts the post
hospital discharge location 78% of the time, and the addition of
cognition or initial FIM scores does not signicantly strengthen
the ability of dening if a patient will be discharged to home or
to a skilled nursing facility.
12
Several standardized assessments and physical performance
tests reliably predict function and health related events. Yet the
consistent use of measures in physical therapy and other clinical
settings is not widely practiced.
38
Factors contributing to this
non-use of standardized assessments may include insucient
time, inadequate equipment or space, or lack of knowledge in
interpreting the assessment.
39
Walking speed is one standard-
ized measure that can be quickly and easily incorporated into
the PT examination/evaluation process.
Determining feasibility is the rst essential step in deciding
to use a test or measure in the clinic. e main questions clini-
cians should pose regarding a tests or measure’s feasibility are:
(1) Is the test safe?
(2) Is it cost effective?
(3) How easy is the test to administer? and
(4) How easily are the results of the test graded and interpreted?
White Paper: “Walking Speed: the Sixth Vital Sign
Stacy Fritz, PT, PhD;
1
Michelle Lusardi, PT, PhD
2
0 mph 0.4 mph 0.9 mph 1.3 mph 1.8 mph 2.2 mph 2.7 mph 3.1 mph
10 meter walk time 50 sec 25 sec 16.7 sec 12.5 sec 10 sec 8.3 sec 7.1 sec
10 foot walk time 15.2 sec 7.6 sec 5 sec 3.8 sec 3 sec 2.5 sec 2.2 sec
ADL: activities of daily living; IADL: instrumental ADLs; D/C: discharged; WS: walking speed; mph: miles per hour;
sec: seconds
Figure 1. A collection of walking speed times that are linked to dependence, hospitalization,
rehabilitation needs, discharge locations, and ambulation category.
Journal of Geriatric Physical Therapy Vol. 32;2:09
3
An armative answer to all these questions, as there is with
WS, lends to feasibility of use in a clinical setting. Walking
speed is safe, requires no special equipment, adds no signi-
cant cost to an assessment, requires little additional time (can
be administered in less than 2 minutes
8
), is easy to calculate
(distance/time), and is easy to interpret based on published
norms
3,40-42
(Figure 2).
Figure 2. Self selected walking speed categorized by gender
and age (6-12 and teens,
47
20s-50s,
42
& 60s-80s
48
).
Walking speed can be quickly and accurately assessed in the
majority of physical therapy practice settings, including home
care, subacute and acute rehabilitation facilities, long-term care
facilities, out-patient oces, and schools, as well as during com-
munity wellness/screening activities.
43
Measurements of walk-
ing speed are highly reliable, regardless of the method for mea-
surement, for different patient populations and for individuals
with known impairments affecting gait.
3,42
Examination of WS
requires a stopwatch and as little as a 20 foot space to walk
forward.
3
While most reported normative values are based on
measuring in the middle two-thirds of a longer walkway, al-
lowing walking speed to reach a steady state, others have used
shorter distances.
44,45
If possible, timing WS three times dur-
ing the examination (with a few minutes of rest between trials)
and developing a mean WS value will provide a more accurate
estimate of actual self-selected walking speed than a single trial
would.
3,41,43
Figure 3 displays a suggested reliable, inexpensive method
to collect WS by using the 10 meter (m) walk test.
25
It re-
quires a 20 m straight path, with 5 m for acceleration, 10 m
for steady-state walking, and 5 m for deceleration. Markers are
placed at the 5 and 15 m positions along the path. e patient
begins to walk “at a comfortable pace
at one end of the path, and continues
walking until he or she reaches the
other end. e Physical erapist uses
a stopwatch to determine how much
time it takes for the patient to traverse
the 10 m center of the path, starting
the stopwatch as soon as the patients
limb crosses the rst marker and stop-
ping the stopwatch as soon as the pa-
tient’s limb crosses the second marker.
If a full 20 m walkway is not available, shorter distances can
be used, as long as there is adequate room for acceleration and
deceleration (eg, 5 ft acceleration, 10 ft. steady state, 5 ft. de-
celeration).
While WS varies by age, gender, and anthropometrics, the
range for normal WS is 1.2-1.4m/sec.
46
is general guideline
can help in monitoring our patients, along with norms by age
42,47,48
(Figure 2), and other cited cutoff points
6,8,11,12,46
(Figure
1). Interpretation of WS also includes understating what con-
stitutes true change and what change may be due to measure-
ment error.
49
In a recent study, with a diverse group of older
participants with varying diagnoses, 0.05 m/s was calculated as
the needed change for a small but meaningful improvement in
WS.
25
In addition, for patients who do not have normal walk-
ing speed, an improvement in WS of at least 0.1 m/s is a useful
predictor for well-being,
9,14
while a decrease in the same amount
is linked with poorer health status, more disability, longer hos-
pital stays, and increased medical costs.
9
e MDC scores are
specic to the population and will vary according to your cli-
ent’s presentation.
26,50
Walking speed is an easily accessible screening tool
11
that
should be performed to offer insight into our patients function-
al capacity and safety. Physical therapists, as specialists in move-
ment and function, can use WS as a practical and informative
functional sixth vital signfor all patients; examining walking
speed in the same way that we routinely monitor blood pres-
sure, pulse, respiration, temperature, and pain.
51
is sixth “vi-
tal sign” provides a relevant functional perspective to the health
status provided by the system-level vital signs assessed on most
visits to physicians’ oces.
is review summarizes the strong psychometric properties
of WS and robust evidence for using this clinical measurement.
Walking speed is easily measurable, clinically interpretable,
14
and a potentially modiable risk factor.
52
For these reasons, us-
ing WS as the sixth vital sign is both pragmatic and essential.
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... Measuring gait parameters (e.g. speed, cadence, step duration) accurately is invaluable for evaluation and treatment of older adults who struggle with disability onset [1,2], disease progression [3], balance [2,4] and injurious falls [2,5]. Gait speed is especially indicative of these conditions as changes in 5 functional ability are directly related to a person's speed [4,6,7]. ...
... speed, cadence, step duration) accurately is invaluable for evaluation and treatment of older adults who struggle with disability onset [1,2], disease progression [3], balance [2,4] and injurious falls [2,5]. Gait speed is especially indicative of these conditions as changes in 5 functional ability are directly related to a person's speed [4,6,7]. Gait naturally changes with aging and walking speed becomes slower. ...
... Gait naturally changes with aging and walking speed becomes slower. This change in speed can be significant when there is also an underlying condition associated with balance uncertainty and indicate an oncoming adverse health change [2,8,4,9]. For example, speed can be used in fall risk assessment 10 of older adults as an indicator of an oncoming falls allowing caregivers to take early, preventative action. ...
Article
Measuring gait parameters (e.g. speed, cadence, step duration) accurately is invaluable for evaluation during treatment of older adults who struggle with disability onset, disease progression, balance, and injurious falls. Traditionally stopwatches or timing gates are used to measure gait speed in clinical settings, and these are limited to measuring gait speed. Other wearable and non-wearable technologies offer the ability to measure additional gait parameters though patients are known to walk differently with the devices and even tend to slow down before engaging with a non-wearable such as a floor mat. Floor vibrations are a promising option to measuring gait parameters while not being intrusive and not requiring line-of-sight to the patient for measurements. This paper presents methodology for extracting gait parameters using vibrations with comparisons to APDM Wearable Technologies Mobility Lab sensors and stopwatch measurements. Performance is examined across 97 participants for self-selected speed forward, full speed forward, and backwards walks at three different testing sites for a total of 1039 walks. Gait speed vibrations measurements demonstrated excellent reliability with APDM Mobility Lab (ICC: 0.98; 99% CI: 0.01 ± 0.01 m/s) and stopwatch (ICC: 0.97; 99% CI: −0.01 ± 0.01 m/s) measurements. Similar excellent results are reported for cadence, gait cycle duration, step duration, and stride length parameters.
... Son évaluation est primordiale car une dégradation de la marche est souvent liée à une diminution de la santé. Fritz et al. (2009) proposent que le test de vitesse de marche soit considéré comme le sixième signe clinique vital, après la pression artérielle, la fréquence cardiaque et respiratoire, la température et la saturation en oxygène [2]. Une vitesse de marche ralentie serait prédictive d'une dépendance fonctionnelle, de la fragilité, du déclin des capacités cognitives, de la dépression, du risque de chutes, des troubles cardiorespiratoires, de la sarcopénie et de la mortalité [3,4]. ...
... Son évaluation est primordiale car une dégradation de la marche est souvent liée à une diminution de la santé. Fritz et al. (2009) proposent que le test de vitesse de marche soit considéré comme le sixième signe clinique vital, après la pression artérielle, la fréquence cardiaque et respiratoire, la température et la saturation en oxygène [2]. Une vitesse de marche ralentie serait prédictive d'une dépendance fonctionnelle, de la fragilité, du déclin des capacités cognitives, de la dépression, du risque de chutes, des troubles cardiorespiratoires, de la sarcopénie et de la mortalité [3,4]. ...
... PwPD were excluded if they had 1) evidence of secondary or atypical parkinsonism, 2) significant cognitive impairment (MMSE score <24) or major psychiatric disorder, 3) presence of significant motor fluctuations (unpredictable "on" and "off" fluctuations), and 4) taking cognition-altering drugs. Exclusion criteria for older adult participants included: 1) having a diagnosed neurological condition, unstable or progressive cardiac or pulmonary disease, insulin-dependent diabetes, or any other condition affecting ambulation, 2) significant cognitive impairment (MMSE score ≤24), 3) a self-selected gait speed >1.15 m/s [14], and 4) inability to walk comfortably without assistance. As gait speed influences ILC [3,12], we recruited CON with mobility characteristics similar to those with early-stage Parkinson's disease, specifically targeting CON participants who walked slower than 1.15 m/s [14]. ...
... Exclusion criteria for older adult participants included: 1) having a diagnosed neurological condition, unstable or progressive cardiac or pulmonary disease, insulin-dependent diabetes, or any other condition affecting ambulation, 2) significant cognitive impairment (MMSE score ≤24), 3) a self-selected gait speed >1.15 m/s [14], and 4) inability to walk comfortably without assistance. As gait speed influences ILC [3,12], we recruited CON with mobility characteristics similar to those with early-stage Parkinson's disease, specifically targeting CON participants who walked slower than 1.15 m/s [14]. This criteria ensured any differences observed in ILC are not due to physical performance, but underlying pathology. ...
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Introduction Although there is growing literature supporting the implementation of backward walking as a potential rehabilitation tool, moving backwards may precipitate falls for persons with Parkinson's disease. We sought to better understand interlimb coordination during backward walking in comparison to forward walking in persons with Parkinson's disease and healthy controls. Methods We assessed coordination using point estimate of relative phase at each participant's preferred walking speed. Results Persons with Parkinson's disease demonstrated impaired interlimb coordination between the more affected arm and each leg compared to controls, which worsened during backward walking. Conclusion For those with Parkinson's disease, inability to output smooth coordinated movement of the more affected shoulder may impair coordination during forward and, especially, backward walking. Our findings provide new information about backward walking that can allow clinicians to make safer, more effective therapeutic recommendations for persons with Parkinson's disease.
... Walking speed is a great indicator for functional abilities and quality of life in different populations (Fritz & Lusardi 2009). Therefore, improving walking speed and diminishing the effect of other gait abnormalities should be one of the main focuses of training interventions in CP. ...
Thesis
Read more: http://urn.fi/URN:NBN:fi:jyu-201912185397 - Cerebral palsy (CP) affects individuals throughout their lifetime, usually introducing detrimental changes in ambulatory abilities. Various management strategies to support functional abilities and overall health in order to minimize the effects of the CP have been published. Several studies have shown positive results using different kinds of exercise therapy interventions to increase strength, motor activity or cardiovascular fitness. It is hypothesized that the intervention including both treadmill training and muscle strengthening will enhance walking speed, improve gait kinematics and ankle dorsiflexion. Also, evaluating lower limb functionality with gait analysis could improve the prescription of resistance training exercises for people with CP. The purpose of this study is to show does the three-month tailored exercise therapy intervention, consisting of two to three supervised sessions per week, provide benefits to lower-body gait kinematics, gait performance and lower limb function for three different CP case subjects. A convenience sample of three male (16-21 years old) with spastic CP (hemiplegic or diplegic, GMFCS I-III) participated in the study. The twelve-week exercise therapy intervention consisted of two to three supervised sessions per week. Each training session started with gait training on a non-motorized incline treadmill with hands supported, was followed by strength and flexibility training for main lower limb muscles. In the gait analysis session, participants performed six times one-minute walking trials with one-minute rest between trials. Lower limb 3D kinematics were acquired with an eight-camera motion capture system at 200 Hz, and in addition to calf muscle wireless EMG, forces were simultaneously measured with two mounted force plates at 1 kHz sampling frequency. Kinematics were analyzed in Visual3D software. Six-minute walk test (6MWT) was performed after the gait analysis. Plantar and dorsiflexor force production was measured in custom-built ankle dynamometer. Measurement results PRE and POST intervention were compared. Intervention may likely improve the gait performance and strength in adolescents and young adults with CP. However, improvements do not happen hand in hand with gait quality as mostly the same compensations and pathological gait patterns were present also after the intervention. The differences in spatiotemporal gait and isometric torque parameters between affected and non-affected limbs reduced after intervention in the hemiplegic participant. Toe lift of the more affected leg in the terminal swing was slightly improved in one diplegic case. While one diplegic participant had typical EMG onset pattern, triceps surae muscle activity started prematurely in terminal swing in the other two participants overlapping with TA activity. The distance walked in 6MWT improved in two participants (5.8 and 8.1%). This study provides more means and considerations to individualize the training or treatment for children with CP. The intervention period may not be long enough to induce changes on motor patterns and major gait deviations such as crouch gait but may improve gait performance. The underlying neuromechanical and cortical mechanisms should be studied to understand better the changes that are induced because of a training intervention
... • Timed Up and Go, a timed rise from a seated position followed by a short walk over 3 m [35]; • Gait Speed (GST) measures the speed at which participants walk over a marked distance of 4 m (measured twice and averaged). A threshold of ≤0.8 m/s signifies frailty [36][37][38]. ...
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Background Frailty is a highly prevalent clinical syndrome increasing older people’s vulnerability to risk of adverse outcomes. Better frailty identification through expanded screening implementation has been advocated within general practice settings, both internationally and within Australia. However, little is known about practitioner perceptions of the feasibility of specific instruments, and the underlying motivations behind those perceptions. Consequently, the purpose of this study was to explore the attitudes and perceptions of a convenience and volunteer sample of Australian general practitioners (GPs) and practice nurses (PNs) towards common frailty screening instruments. Methods The feasibility of several frailty screening instruments (PRISMA-7 [P7], Edmonton Frail Scale [EFS], FRAIL Questionnaire [FQ], Gait Speed Test [GST], Groningen Frailty Indicator [GFI], Kihon Checklist [KC] and Timed Up and Go [TUG]) to 43 Australian GPs and PNs was assessed. The study adopted a concurrent embedded mixed-methods design incorporating quantitative (ranking exercise) and qualitative (content analysis) data collection integrated during the analysis phase. Results Practitioners assessed multi-dimensional instruments (EFS, GFI, KC) as having relatively higher clinical utility, better integration into existing assessment processes and stronger links to intervention over uni-dimensional (GST, TUG) and simple (FQ, P7) instruments. Conclusions While existing frailty screening instruments show promise as an initial step in supporting better care for older people, all the included instruments were associated with perceived advantages and disadvantages. Ultimately, clinicians will need to weigh several factors in their selection of the optimal screening instrument. Further translational research, with a focus on contextual fit, is needed to support clinical decision-making on the selection of instruments for frailty screening.
... After controlling for potential confounders (i.e., sex, age, MMSE and years of education), for each increase in standard deviation (SD) of 0.1 m/s from fast GS, cognitive impairment was attenuated by up to 85%. One interpretation of this result is that having a preserved cognitive status (MMSE assessment) and longer years of education acts as a protective factor, increasing the individual's chance of not developing cognitive decline [9,29,56]. Moreover, it should be considered that GS is not an exclusive predictor of future cognitive impairment at an advanced age. ...
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We aimed to examine associations between cognitive vulnerability and gait speed (GS) in a large older sample. A cross-sectional study analyzed data from the “Health, Lifestyle and Fitness in Adults and Seniors in Amazonas” (SEVAAI) project. In total, 697 participants were included (mean age 70.35 ± 6.86 years). Usual and fast GS were evaluated, and cognitive performance was examined by the COGTEL test battery. There was a positive and large correlation between cognition (COGTEL score) and usual GS (r = 0.510; p < 0.001) and fast GS (r = 0.503; p < 0.001). The usual GS, as a continuous variable, indicated a chance of improved cognitive performance by up to 55%, and fast GS by up to 82%. After controlling for potential confounders (i.e., sex, age, MMSE and years of education), usual and fast GS indicated a chance of improving cognition, respectively, in 57% and 85%. Analysis of GS in quartiles (Q) showed high and significant associations between usual and fast GS and cognitive vulnerability. GS classified as Q1 (slower), Q2 and Q3 represented a greater chance of presenting cognitive deficits, respectively, than in participants with both GS classified as Q4 (highest). Cognitive vulnerability was associated with low GS. Usual and fast GS can be used as complementary measures for the evaluation of cognitively normal Brazilian older adults.
... Gait speed is an important measure of lower extremity physical performance in older adults and is widely used for the consensus definition of frailty and sarcopenia. Previous studies have indicated that walking speed can predict life span [48], and one study has even proposed that walking speed can be used as the sixth vital sign [49]. Toots, et al. have found lower walking speed was significantly associated with an increased risk of allcause mortality after adjustment for multiple confounders [50]. ...
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