Amsterdam UMC location University of Amsterdam, Rehabilitation medicine, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands.
Amsterdam UMC location University of Amsterdam, Rehabilitation medicine, Meibergdreef 9, Amsterdam, The Netherlands; Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands.
Gait Posture. 2022 Jul;96:314-321. doi: 10.1016/j.gaitpost.2022.06.008. Epub 2022 Jun 15.
The C-Mill interactive treadmill allows for a safe walking-adaptability assessment, unveiling reduced walking adaptability in polio survivors compared to healthy individuals, possibly related to their high fall rate. However, evidence on its validity and reproducibility is scarce.
What is the validity and reproducibility of C-Mill walking-adaptability assessment in polio survivors?
Polio survivors with a history and/or fear of falling (n = 46) performed two walking-adaptability assessments, 1-2 weeks apart, including target-stepping tests (with 0%, 20% and 30% inter-target variance) and obstacle-avoidance tests (anticipatory and reactive). We examined (1) face validity by determining Group effects (for subgroups stratified for fall frequency, fear of falling and leg muscle weakness) and Condition effects (for difficulty level) on walking-adaptability outcomes, (2) construct validity by correlating walking-adaptability and balance outcomes, and (3) content validity by establishing possible ceiling effects. We determined whether face-validity findings were reproducible over test occasions and calculated Intraclass Correlation Coefficients (ICC) and the 95% Limits of Agreement (LoA) for walking-adaptability outcomes.
Walking-adaptability outcomes differed in to-be-expected directions for subgroups stratified for fall frequency and leg muscle weakness and for difficulty levels, all reproducible over test occasions. Correlations between walking-adaptability and balance outcomes were mainly low (r < 0.587). Ceiling effects were present for anticipatory obstacle-avoidance and balance outcomes, but not for reactive obstacle avoidance. ICCs [95% confidence intervals] were good for the challenging 20% (0.80[0.67-0.88]) and 30% target-stepping conditions (0.74[0.57-0.85]) and for the reactive obstacle-avoidance (0.76[0.59-0.86]) condition, but not for 0% target-stepping and anticipatory obstacle-avoidance (ICC<0.62) conditions. Likewise, the narrowest LoA were observed for the 20% and 30% target-stepping conditions.
We proved face, construct and content validity of C-Mill walking-adaptability assessment in polio survivors with a history of falls and/or fear of falling. Adding walking-adaptability assessment, particularly the more challenging tests given their superior reproducibility, to currently used clinical tests could improve fall-risk evaluation in this population.
C-Mill 互动跑步机可用于进行安全的步行适应能力评估，与健康个体相比，小儿麻痹症幸存者的步行适应能力降低，这可能与他们较高的跌倒率有关。然而，其有效性和可重复性的证据很少。
C-Mill 步行适应能力评估在小儿麻痹症幸存者中的有效性和可重复性如何？
有跌倒史和/或恐跌史的小儿麻痹症幸存者（n=46）进行了两次步行适应能力评估，间隔 1-2 周，包括目标跨步测试（目标间差异为 0%、20%和 30%）和障碍物回避测试（预期和反应性）。我们通过确定（1）小组效应（按跌倒频率、恐跌和腿部肌肉无力的亚组分层）和（2）条件效应（按难度水平分层）对步行适应能力结果的影响来评估表面有效性；通过相关性分析评估结构有效性；通过建立可能的天花板效应来评估内容有效性。我们确定了表面有效性在测试时是否具有可重复性，并计算了步行适应能力结果的组内相关系数（ICC）和 95%置信区间（LoA）。
按跌倒频率和腿部肌肉无力分层的亚组以及难度水平的分组，步行适应能力结果朝着预期的方向变化，所有结果在测试时均具有可重复性。步行适应能力与平衡能力结果的相关性主要较低（r<0.587）。预期性障碍物回避和平衡能力结果存在天花板效应，但反应性障碍物回避无此效应。20%（0.80[0.67-0.88]）和 30%目标跨步条件（0.74[0.57-0.85]）挑战性条件以及反应性障碍物回避条件（0.76[0.59-0.86]）的 ICC[95%置信区间]较好，但 0%目标跨步和预期性障碍物回避条件（ICC<0.62）较差。同样，20%和 30%目标跨步条件的 LoA 最窄。
我们证明了 C-Mill 步行适应能力评估在有跌倒史和/或恐跌史的小儿麻痹症幸存者中的表面有效性、结构有效性和内容有效性。在当前使用的临床测试中增加步行适应能力评估，特别是更具挑战性的测试，因为它们具有更好的可重复性，可能会改善该人群的跌倒风险评估。
