Rubin Daniel Steven, Straczkiewicz Marcin, Yamamoto Emi, Madariaga Maria Lucia L, Ferguson Mark, Brach Jennifer S, Glynn Nancy W, Lee Sang Mee, Danilovich Margaret, Huisingh-Scheetz Megan
Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL, USA.
Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
Digit Biomark. 2025 Jun 12;9(1):113-123. doi: 10.1159/000545982. eCollection 2025 Jan-Dec.
Preoperative physical functional assessments (i.e., assessments that measure capability to perform physical activity) are integral to estimate perioperative risk for older adults. However, these assessments are not routinely performed in-clinic prior to surgery. Walking cadence, or the number of steps walked in a specified amount of time (i.e., steps/min), measures activity intensity and may be able to identify high-risk patients prior to surgery. Smartphones can measure walking characteristics and guide patients through remote functional assessments. Here, we assess feasibility, acceptability, and accuracy of Walk Test, a smartphone application designed to measure walking cadence.
We performed a prospective cohort study of older adults prior to abdominal surgery and enrolled them remotely to perform at-home usual- and fast-paced walks with subsequent validation in-clinic. Each walk (usual- and fast-paced) was 2 min in duration. Feasibility was assessed if 80% of patients could perform all study procedures; acceptability was measured using the Post-Study Survey Usability Questionnaire (PSSUQ); accuracy of our approach was assessed with Lin's concordance coefficient (CCC). activPAL thigh worn accelerometer worn during the in-clinic walk served as a gold standard comparison. We used the CCC to compare the at-home and in-clinic walks as performed by Walk Test.
We enrolled 41 participants (mean age 69 ± 5 years, 26 (63%) female); 88% (36/41) successfully completed entire study protocol including independent installation of the application, walk tests (at-home and in-clinic) and questionnaires. Median (interquartile range) overall score of PSSUQ was 1 (1, 1) indicating strong acceptability and usability. The Lin's CCC between the in-clinic activPAL and Walk Test for usual-paced walk was 0.97 (95% CI: 0.96, 0.99, < 0.001) and for fast-paced walks 0.96 (95% CI: 0.93, 0.98, < 0.001). The CCC between the at-home and in-clinic walks for usual-paced walks was 0.70 (95% CI: 0.53, 0.86) and for fast-paced walks was 0.46 (95% CI: 0.21, 0.72).
We successfully demonstrated the feasibility, acceptability and accuracy of Walk Test to measure walking cadence. Future work is needed to standardize walk test performance at-home to ensure consistency between in-clinic and at-home measures.
术前身体功能评估（即测量身体活动能力的评估）对于估计老年人围手术期风险至关重要。然而，这些评估在手术前并非在诊所常规进行。步行节奏，即在特定时间内行走的步数（即步/分钟），可衡量活动强度，并且可能能够在手术前识别高危患者。智能手机可以测量行走特征并指导患者进行远程功能评估。在此，我们评估一款旨在测量步行节奏的智能手机应用程序“步行测试”的可行性、可接受性和准确性。
我们对腹部手术前的老年人进行了一项前瞻性队列研究，并远程招募他们在家中进行平常节奏和快节奏的步行，随后在诊所进行验证。每次步行（平常节奏和快节奏）持续2分钟。如果80%的患者能够完成所有研究程序，则评估可行性；使用研究后调查可用性问卷（PSSUQ）测量可接受性；我们的方法的准确性用林氏一致性系数（CCC）进行评估。在诊所步行期间佩戴的activPAL大腿加速度计用作金标准对照。我们使用CCC比较“步行测试”所进行的家庭步行和诊所步行。
我们招募了41名参与者（平均年龄69±5岁，26名（63%）为女性）；88%（36/41）成功完成了整个研究方案，包括独立安装应用程序、步行测试（在家中和诊所）以及问卷调查。PSSUQ的中位数（四分位间距）总分为1（1，1），表明具有很强的可接受性和可用性。诊所内activPAL与“步行测试”平常节奏步行之间的林氏CCC为0.97（95%置信区间：0.96，0.99，P<0.001），快节奏步行之间为0.96（95%置信区间：0.93，0.98，P<0.001）。家庭步行和诊所内平常节奏步行之间的CCC为0.70（95%置信区间：0.53，0.86），快节奏步行之间为0.46（95%置信区间：0.21，0.72）。
我们成功证明了“步行测试”测量步行节奏的可行性、可接受性和准确性。未来需要开展工作以规范家庭步行测试表现，以确保诊所测量和家庭测量之间的一致性。
