Maggio Marcello, Ceda Gian Paolo, Ticinesi Andrea, De Vita Francesca, Gelmini Giovanni, Costantino Cosimo, Meschi Tiziana, Kressig Reto W, Cesari Matteo, Fabi Massimo, Lauretani Fulvio
Geriatric Rehabilitation Department, University-Hospital of Parma, Parma, Italy.
Department of Clinical and Experimental Medicine, University of Parma, Italy.
PLoS One. 2016 Apr 14;11(4):e0153583. doi: 10.1371/journal.pone.0153583. eCollection 2016.
Manual measurement of 4-meter gait speed by a stopwatch is the gold standard test for functional assessment in older adults. However, the accuracy of this technique may be biased by several factors, including intra- and inter-operator variability. Instrumental techniques of measurement using accelerometers may have a higher accuracy. Studies addressing the concordance between these two techniques are missing. The aim of the present community-based observational study was to compare manual and instrumental measurements of 4-meter gait speed in older individuals and to assess their relationship with other indicators of physical performance.
One-hundred seventy-two (69 men, 103 women) non-disabled community-dwellers aged ≥65 years were enrolled. They underwent a comprehensive geriatric assessment including physical function by Short Physical Performance Battery (SPPB), hand grip strength, and 6-minute walking test (6MWT). Timed usual walking speed on a 4-meter course was assessed by using both a stopwatch (4-meter manual measurement, 4-MM) and a tri-axial accelerometer (4-meter automatic measurement, 4-MA). Correlations between these performance measures were evaluated separately in men and women by partial correlation coefficients.
In both genders, 4-MA was associated with 4-MM (men r = 0.62, p<0.001; women r = 0.73, p<0.001), handgrip strength (men r = 0.40, p = 0.005; women r = 0.29, p = 0.001) and 6MWT (men r = 0.50, p = 0.0004; women r = 0.22, p = 0.048). 4-MM was associated with handgrip strength and 6MWT in both men and women. Considering gait speed <0.6 m/s as diagnostic of dismobility syndrome, the two methods of assessment disagreed, with a different categorization of subjects, in 19% of men and 23% of women. The use of accelerometer resulted in 29 (13 M, 16 F) additional diagnoses of dismobility, compared with the 4-MM.
In an older population, the concordance of gait speeds manually or instrumentally assessed is not optimal. The results suggest that manual measures might lead to misclassification of a substantial number of subjects. However, longitudinal studies using standardized and validated procedures aimed at the comparison of different techniques are needed before recommending the use of accelerometers in comprehensive geriatric assessment.
使用秒表手动测量4米步速是老年人功能评估的金标准测试。然而，该技术的准确性可能受到多种因素的影响，包括测量者内部和测量者之间的变异性。使用加速度计的仪器测量技术可能具有更高的准确性。目前尚缺乏针对这两种技术之间一致性的研究。本基于社区的观察性研究的目的是比较老年人4米步速的手动测量和仪器测量，并评估它们与其他身体性能指标的关系。
招募了172名（69名男性，103名女性）年龄≥65岁的非残疾社区居民。他们接受了全面的老年医学评估，包括通过简短体能测试电池（SPPB）评估身体功能、握力和6分钟步行测试（6MWT）。使用秒表（4米手动测量，4-MM）和三轴加速度计（4米自动测量，4-MA）评估在4米路线上的定时平常步行速度。通过偏相关系数分别评估男性和女性中这些性能指标之间的相关性。
在男性和女性中，4-MA与4-MM相关（男性r = 0.62，p<0.001；女性r = 0.73，p<0.001）、握力（男性r = 0.40，p = 0.005；女性r = 0.29，p = 0.001）和6MWT（男性r = 0.50，p = 0.0004；女性r = 0.22，p = 0.048）。4-MM在男性和女性中均与握力和6MWT相关。将步速<0.6 m/s视为行动不便综合征的诊断标准，两种评估方法存在分歧，在19%的男性和23%的女性中对受试者的分类不同。与4-MM相比，使用加速度计额外诊断出29例（13名男性，16名女性）行动不便。
在老年人群中，手动或仪器评估的步速一致性并不理想。结果表明，手动测量可能导致大量受试者的错误分类。然而，在推荐在全面的老年医学评估中使用加速度计之前，需要进行旨在比较不同技术的标准化和验证程序的纵向研究。
