title: Responsiveness and predictability of gait speed and other disability measures in acute stroke. Frailty Intervention Trial (FIT) Prognostic value of usual gait speed in well-functioning older people--results from the Health, Aging and Body Composition Study. Rollator use adversely impacts on assessment of gait and mobility during geriatric rehabilitation. Temporal and spatial features of gait in older adults transitioning to frailty. Physical performance measures in the clinical setting.
abstract: OBJECTIVES To identify the most responsive method of measuring gait speed , to estimate the responsiveness of other outcome measures , and to determine whether gait speed predicts discharge destination in acute stroke . DESIGN A prospect i ve cohort study . SETTING Five acute-care hospitals . PATIENTS Fifty subjects with residual gait deficits after a first-time stroke . INTERVENTIONS Five- ( 5mWT ) and 10-meter walk tests ( 10mWT ) at comfortable and maximum speeds , with 2 evaluations conducted an average + /- st and ard deviation ( SD ) of 8 + /- 3 and 38 + /- 5 days poststroke . MAIN OUTCOME MEASURE St and ardized response mean ( SRM = mean change/SD of change ) was used to estimate responsiveness for each walk test , the Berg Balance Scale , the Barthel Index , the Stroke Rehabilitation Assessment of Movement ( STREAM ) , and the Timed Up and Go ( TUG ) . RESULTS The SRMs were 1.22 and 1.00 for the 5mWT , and .92 and .83 for the 10mWT performed at a comfortable and maximum pace , respectively . The SRMs for the Berg Balance Scale , the Barthel Index , the STREAM , and the TUG were 1.04,.99,.89 , and .73 , respectively . The probability of discharge to a rehabilitation center for persons walking at < or = 0.3 m/s or > 0.6 m/s at the first evaluation was.95 and .22 , respectively . CONCLUSIONS The 5mWT at a comfortable pace is recommended as the measure of choice for clinicians and research ers who need to detect longitudinal change in walking disability in the first 5 weeks poststroke Background Frailty is a term commonly used to describe the condition of an older person who has chronic health problems , has lost functional abilities and is likely to deteriorate further . However , despite its common use , only a small number of studies have attempted to define the syndrome of frailty and measure its prevalence . The criteria Fried and colleagues used to define the frailty syndrome will be used in this study ( i.e. weight loss , fatigue , decreased grip strength , slow gait speed , and low physical activity ) . Previous studies have shown that clinical outcomes for frail older people can be improved using multi-factorial interventions such as comprehensive geriatric assessment , and single interventions such as exercise programs or nutritional supplementation , but no interventions have been developed to specifically reverse the syndrome of frailty . We have developed a multidisciplinary intervention that specifically targets frailty as defined by Fried et al. We aim to establish the effects of this intervention on frailty , mobility , hospitalisation and institutionalisation in frail older people . Methods and Design A single centre r and omised controlled trial comparing a multidisciplinary intervention with usual care . The intervention will target identified characteristics of frailty , functional limitations , nutritional status , falls risk , psychological issues and management of chronic health conditions .  Two hundred and thirty people aged 70 and over who meet the Fried definition of frailty will be recruited from clients of the aged care service of a metropolitan hospital . Participants will be followed for a 12-month period . Discussion This research is an important step in the examination of specifically targeted frailty interventions . This project will assess whether an intervention specifically targeting frailty can be implemented , and whether it is effective when compared to usual care . If successful , the study will establish a new approach to the treatment of older people at risk of further functional decline and institutionalisation . The strategies to be examined are readily transferable to routine clinical practice and are applicable broadly in the setting of aged care health services . Trial Registration Australian New Zeal and Clinical Trails Registry : ACTRN12608000250336 OBJECTIVES To define clinical ly relevant cutpoints for usual gait speed and to investigate their predictive value for health-related events in older persons . DESIGN Prospect i ve cohort study . SETTING Health , Aging and Body Composition Study . PARTICIPANTS Three thous and forty-seven well-functioning older persons ( mean age 74.2 ) . MEASUREMENTS Usual gait speed on a 6-m course was assessed at baseline . Participants were r and omly divided into two groups to identify ( Sample A ; n=2,031 ) and then vali date ( 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 . RESULTS A grade d 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 . CONCLUSION 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 clinical ly meaningful cutpoint for usual gait speed may facilitate its use in clinical and research setting OBJECTIVE To investigate the influence of the use of a rollator walking aid on assessment of gait and mobility . DESIGN Prospect i ve , longitudinal study . SUBJECTS Geriatric patients during inpatient rehabilitation ( n=109 ; mean age 83.1 years ) . METHODS Assessment at the beginning and prior to discharge from rehabilitation using : gait- analysis ( GAITRite ® , speed , cadence , stride-time , stride-length , base-of-support , double-support ) , Performance-Oriented-Mobility- Assessment ( POMA ) , and Timed-Up- and -Go ( TUG ) . Differences between outcomes obtained without and with rollator use were calculated for baseline assessment and for changes over time for the total group and subgroups according to diagnosis ( hip fracture vs. other ) . Responsiveness was calculated using st and ardized response means . RESULTS Baseline performances were significantly ( p ≤ 0.05 ) higher when assessed with vs. without rollator in the total group and in hip fracture ( except cadence ) and other ( except cadence , stride-time , TUG ) patients . Changes over time were significantly greater when assessed without vs. with rollator in the total group and hip fracture ( except cadence , POMA ) and other patients ( except base-of-support , double-support ) . Tests without rollator showed superior responsiveness ( except TUG ) . CONCLUSION The use of rollator walking aids limits the detection of initial gait and mobility deficits , adversely affects the assessment of changes over time in gait and mobility performance , and reduces the responsiveness of tests . When full weight-bearing is permitted , assessment without a walking aid is recommended Examining gait characteristics in older adults who are transitioning to frailty enhances our underst and ing of movement control in this fall-prone population and helps to better target preventive interventions . This work presents data on temporal and spatial gait parameters  of a group of older adults who have been operationally defined as " transitionally frail " .  Gait speed , cadence , stride length , stance , swing , double-support , and horizontal heel velocity at heel contact were measured in 50 transitionally frail older adults while walking at a self-selected pace . These data suggest that the temporal and spatial gait features of these older adults differ substantially from published results from other older adults OBJECTIVES To assess the ability of gait speed alone and a three-item lower extremity performance battery to predict 12-month rates of hospitalization , decline in health , and decline in function in primary care setting s serving older adults . DESIGN Prospect i ve cohort study . SETTING Primary care programs of a Medicare health maintenance organization ( HMO ) and Veterans Affairs ( VA ) system . PARTICIPANTS Four hundred eighty-seven persons aged 65 and older . MEASUREMENTS  Lower extremity performance Established Population for Epidemiologic Studies of the Elderly ( EPESE ) battery including  gait speed , chair st and s , and t and em balance tests ; demographics ; health care use ; health status ; functional status ; probability of repeated admission scale ( Pra ) ; and primary physician 's hospitalization risk estimate . RESULTS Veterans had poorer health and higher use than HMO members . Gait speed alone and the EPESE battery predicted hospitalization ; 41 % ( 21/51 ) of slow walkers ( gait speed < 0.6 m/s ) were hospitalized at least once , compared with 26 % ( 70/266 ) of intermediate walkers ( 0.6 - 1.0 m/s ) and 11 % ( 15/136 ) of fast walkers ( > 1.0 m/s ) ( P < .0001 ) . The relationship was stronger in the HMO than in the VA . Both performance measures remained independent predictors after accounting for Pra . The EPESE battery was superior to gait speed when both Pra and primary physician 's risk estimate were included . Both performance measures predicted decline in function and health status in both health systems . Performance measures , alone or in combination with self-report measures , were more able to predict outcomes than self-report alone . CONCLUSION Gait speed and a physical performance battery are brief , quantitative estimates of future risk for hospitalization and decline in health and function in clinical population s of older adults . Physical performance measures might serve as easily accessible " vital signs " to screen older adults in clinical setting
target: Gait speed at usual pace in acute care setting s was 0.46 m/s ( 95 % CI : 0.34 - 0.57 ) , which was significantly slower than the gait speed of 0.74 m/s ( 95 % CI : 0.65 - 0.83 ) recorded in outpatient setting s. CONCLUSIONS Gait speed is an important measure in comprehensive geriatric assessment .
  The consolidation of data from multiple studies reported in this meta- analysis highlights the mobility limitations experienced by older people in clinical setting s and the need for ongoing rehabilitation to attain levels sufficient for reintegration in the community
background: BACKGROUND  Gait speed  is a quick , inexpensive , reliable measure of functional capacity with well-documented predictive value for major health-related outcomes .
  Numerous epidemiological studies have documented gait speed in healthy , community-dwelling older people .