Karpman Craig, Lebrasseur Nathan K, Depew Zachary S, Novotny Paul J, Benzo Roberto P
Division of Pulmonary and Critical Care Medicine.
Respir Care. 2014 Apr;59(4):531-7. doi: 10.4187/respcare.02688. Epub 2013 Aug 27.
Gait speed is a simple physical function measure associated with key outcomes in the elderly population. Gait speed measurements may improve clinical care in patients with COPD. However, there is a knowledge gap about the reliability and variability of gait speed testing protocols in COPD. We evaluated established techniques of measuring gait speed in patients with COPD and assessed feasibility of implementing gait speed as a routine vital sign in an out-patient clinic.
The usual 4-meter gait speed (4MGS) ("walk at a comfortable/natural pace"), maximal 4MGS ("walk as fast as you can safely"), usual 10-meter gait speed (10MGS), and maximal 10MGS of subjects with stable COPD were measured. Walks were measured using a stopwatch and automated timing system. For the feasibility/implementation phase, patients from the entire spectrum of respiratory diseases completed acceptability surveys, and clinical assistants administered gait speed measurements using an automated timing system. Time to train and to administer the test and acceptability by the staff were evaluated.
Seventy subjects enrolled; 60% were men, and the mean age ± SD was 69 ± 10 years. All methods showed excellent test-retest reliability (intraclass correlation coefficient of 0.95-0.97). The difference between the two timing systems did not exceed the suggested minimal clinically important difference of 0.1 m/s for the usual pace instructions but did exceed 0.1 m/s for maximal pace walks. The difference between 4MGS and 10MGS was 0.13 ± 0.10 m/s.
Most subjects reported that gait speed measurement prior to clinic appointment was very acceptable (66%) or acceptable (33%). Time added to clinic visit measuring 4MGS was 95 ± 20 seconds, and clinical assistants reported gait speed measurements as very acceptable (60%), acceptable (30%), and somewhat acceptable (10%).
Gait speed is a reliable measure in COPD, regardless of instructed pace, distance, or timing mechanism; however, adhering to one protocol is suggested. 4MGS was easily implemented into clinical practice with high acceptability by patients and clinic staff.
步速是一项简单的身体功能指标，与老年人群的关键预后相关。步速测量可能会改善慢性阻塞性肺疾病（COPD）患者的临床护理。然而，关于COPD患者步速测试方案的可靠性和变异性存在知识空白。我们评估了测量COPD患者步速的既定技术，并评估了在门诊将步速作为常规生命体征实施的可行性。
测量了稳定期COPD患者的常规4米步速（4MGS）（“以舒适/自然的步伐行走”）、最大4米步速（“尽可能安全地快速行走”）、常规10米步速（10MGS）和最大10米步速。使用秒表和自动计时系统测量行走速度。在可行性/实施阶段，来自整个呼吸系统疾病谱的患者完成了可接受性调查，临床助理使用自动计时系统进行步速测量。评估了培训和进行测试的时间以及工作人员的可接受性。
70名受试者入组；60%为男性，平均年龄±标准差为69±10岁。所有方法均显示出极好的重测可靠性（组内相关系数为0.95 - 0.97）。对于常规步伐指令，两种计时系统之间的差异未超过建议的最小临床重要差异0.1 m/s，但对于最大步伐行走，差异超过了0.1 m/s。4MGS和10MGS之间的差异为0.13±0.10 m/s。
大多数受试者报告称，在预约门诊前进行步速测量非常可接受（66%）或可接受（33%）。测量4MGS增加到门诊就诊的时间为95±20秒，临床助理报告步速测量非常可接受（60%）、可接受（30%）和有点可接受（10%）。
无论指令的步伐、距离或计时机制如何，步速在COPD中都是一项可靠的测量指标；然而，建议遵循一种方案。4MGS很容易在临床实践中实施，患者和门诊工作人员的接受度都很高。
