Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA 15260, USA.
Phys Ther. 2011 Dec;91(12):1857-64. doi: 10.2522/ptj.20100387. Epub 2011 Oct 14.
Mobility often is tested under a low challenge condition (ie, over a straight, uncluttered path), which often fails to identify early mobility difficulty. Tests of walking during challenging conditions may uncover mobility difficulty that is not identified with usual gait testing.
The purpose of this study was to determine whether gait during challenging conditions predicts decline in gait speed over 1 year in older people with apparently normal gait (ie, gait speed of ≥1.0 m/s).
This was a prospective cohort study.
/b> Seventy-one older adults (mean age=75.9 years) with a usual gait speed of ≥1.0 m/s participated. Gait was tested at baseline under 4 challenging conditions: (1) narrow walk (15 cm wide), (2) stepping over obstacles (15.24 cm [6 in] and 30.48 cm [12 in]), (3) simple walking while talking (WWT), and (4) complex WWT. Usual gait speed was recorded over a 4-m course at baseline and 1 year later. A 1-year change in gait speed was calculated, and participants were classified as declined (decreased ≥0.10 m/s, n=18), stable (changed <0.10 m/s, n=43), or improved (increased ≥0.10 m/s, n=10). Analysis of variance was used to compare challenging condition cost (usual--challenging condition gait speed difference) among the 3 groups.
Participants who declined in the ensuing year had a greater narrow walk and obstacle walk cost than those who were stable or who improved in gait speed (narrow walk cost=0.43 versus 0.33 versus 0.22 m/s and obstacle walk cost=0.35 versus 0.26 versus 0.13 m/s). Simple and complex WWT cost did not differ among the groups.
The participants who declined in gait speed over time walked the fastest, and those who improved walked the slowest at baseline; thus, the potential contribution of regression to the mean to the findings should not be overlooked.
In older adults with apparently normal gait, the assessment of gait during challenging conditions appears to uncover mobility difficulty that is not identified by usual gait testing.
通常在低挑战条件下测试移动能力（即在直的、无障碍的路径上），这往往无法识别早期的移动困难。在具有挑战性的条件下进行行走测试可能会发现通常步态测试无法识别的移动困难。
本研究的目的是确定在步态看似正常（即，行走速度≥1.0m/s）的老年人中，在具有挑战性的条件下行走是否能预测其在 1 年内行走速度的下降。
这是一项前瞻性队列研究。
71 名年龄较大的成年人（平均年龄=75.9 岁），行走速度≥1.0m/s，参与了研究。在基线时，在 4 种具有挑战性的条件下测试了步态：（1）狭窄的行走（15cm 宽），（2）跨越障碍物（15.24cm[6 英寸]和 30.48cm[12 英寸]），（3）简单行走时说话（WWT），和（4）复杂 WWT。在基线和 1 年后，在 4 米的跑道上记录了通常的行走速度。计算了行走速度的 1 年变化，并将参与者分为下降（下降≥0.10m/s，n=18）、稳定（变化<0.10m/s，n=43）或改善（增加≥0.10m/s，n=10）。使用方差分析比较了 3 组之间的挑战性条件成本（通常情况下-挑战性条件下的行走速度差异）。
在接下来的一年中，步态下降的参与者的狭窄行走和障碍物行走成本大于步态稳定或改善的参与者（狭窄行走成本=0.43 比 0.33 比 0.22m/s 和障碍物行走成本=0.35 比 0.26 比 0.13m/s）。简单和复杂的 WWT 成本在各组之间没有差异。
随着时间的推移，步态下降的参与者行走速度最快，而步态改善的参与者行走速度最慢；因此，应注意回归平均值对研究结果的潜在影响。
在步态看似正常的老年人中，在具有挑战性的条件下评估步态似乎可以发现通常步态测试无法识别的移动困难。
