Abstract
Gait impairment and increased gait variability are common among individuals with Parkinson's disease (PD) and have been associated with increased risk for falls. The development of composite scores has gained interest to aggregate multiple aspects of gait into a single metric. The Enhanced Gait Variability Index (EGVI) was developed to compare an individual's gait variability to the amount of variability in a healthy population, yet the EGVI's individual parts may also provide important information that may be lost in this conversion. We sought to contrast individual gait measures as predictors of fall frequency and the EGVI as a single predictor of fall frequency in individuals with PD. 273 patients (189M, 84F; 68 ± 10 yrs) with idiopathic PD walked over an instrumented walkway and reported fall frequency over three months (never, rarely, monthly, weekly, or daily). The predictive ability of gait velocity, step length, step time, stance time, and single support time and the EGVI was assessed using regression techniques to predict fall frequency. The EGVI explained 15.1% of the variance in fall frequency (p < 0.001, r = 0.389). Although the regression using the combined spatiotemporal measures to predict fall frequency was significant (p=0.002, r = 0.264), none of the components reached significance (gait velocity: p=0.640, step length: p=0.900, step time: p=0.525, stance time: p=0.532, single support time: p=0.480). The EGVI is a better predictor of fall frequency in persons with PD than its individual spatiotemporal components. Patients who fall more frequently have more variable gait, based on the interpretation of the EGVI. While the EGVI provides an objective measure of gait variability with some ability to predict fall frequency, full clinical interpretations and applications are currently unknown.
Highlights
Impairment of walking abilities is among the most disabling symptoms associated with Parkinson’s disease [1]
Demographic and clinical scores across fall frequency groups can be found in Table 2, spatiotemporal parameters across fall frequency groups can be found in Table 3. e average number of steps analyzed for the sample was 44 steps, meeting the minimum recommended criteria for studying gait variability in those with Parkinson’s disease (PD) [18]
Differences between fall frequency groups were only found for gait velocities, Hoehn and Yahr (H&Y) scores, and Enhanced Gait Variability Index (EGVI) (p < 0.001)
Summary
Impairment of walking abilities is among the most disabling symptoms associated with Parkinson’s disease [1]. Both pace and rhythm are affected leading to the hallmark features of Parkinsonian gait: slow, shuffling steps. In addition to bradykinesia and balance impairments, a decreased ability to maintain a steady gait pattern (i.e., increased step-to-step variability), is commonly observed [4, 5]. Ese deficits in spatiotemporal parameters and increased gait variability become more pronounced with disease progression, leading to pronounced disability [4, 6]. A variability of spatiotemporal parameters, such as stride time, has been related to increased incidence of falls in individuals with PD [7]. As falls are one of the leading causes of hospitalization, loss of independence, and increased mortality in this population, proper monitoring and prevention of falls is of utmost importance [9,10,11,12]
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