Abstract
Background and purpose Recent findings suggest that a gait assessment at a discrete moment in a clinic or laboratory setting may not reflect functional, everyday mobility. As a step towards better understanding gait during daily life in neurological populations, we compared gait measures that best discriminated people with multiple sclerosis (MS) and people with Parkinson’s Disease (PD) from their respective, age-matched, healthy control subjects (MS-Ctl, PD-Ctl) in laboratory tests versus a week of daily life monitoring.Methods We recruited 15 people with MS (age mean ± SD: 49 ± 10 years), 16 MS-Ctl (45 ± 11 years), 16 people with idiopathic PD (71 ± 5 years), and 15 PD-Ctl (69 ± 7 years). Subjects wore 3 inertial sensors (one each foot and lower back) in the laboratory followed by 7 days during daily life. Mann–Whitney U test and area under the curve (AUC) compared differences between PD and PD-Ctl, and between MS and MS-Ctl in the laboratory and in daily life.Results Participants wore sensors for 60–68 h in daily life. Measures that best discriminated gait characteristics in people with MS and PD from their respective control groups were different between the laboratory gait test and a week of daily life. Specifically, the toe-off angle best discriminated MS versus MS-Ctl in the laboratory (AUC [95% CI] = 0.80 [0.63–0.96]) whereas gait speed in daily life (AUC = 0.84 [0.69–1.00]). In contrast, the lumbar coronal range of motion best discriminated PD versus PD-Ctl in the laboratory (AUC = 0.78 [0.59–0.96]) whereas foot-strike angle in daily life (AUC = 0.84 [0.70–0.98]). AUCs were larger in daily life compared to the laboratory.ConclusionsLarger AUC for daily life gait measures compared to the laboratory gait measures suggest that daily life monitoring may be more sensitive to impairments from neurological disease, but each neurological disease may require different gait outcome measures.
Highlights
Background and purposeRecent findings suggest that a gait assessment at a discrete moment in a clinic or labo‐ ratory setting may not reflect functional, everyday mobility
The toeoff angle was the most discriminative in the laboratory (p = 0.004; area under the curve (AUC) [95% CI] = 0.796 [0.628–0.964]) whereas gait speed was in daily life (p = 0.001; AUC = 0.842 [0.686–0.998])
Stride length was the second best discriminative measure in the laboratory (p = 0.027; AUC = 0.735 [0.556–0.915]) whereas the duration of swing phase as percent of gait cycle was in daily life (p = 0.002; AUC = 0.812 [0.648–0.977)
Summary
Background and purposeRecent findings suggest that a gait assessment at a discrete moment in a clinic or labo‐ ratory setting may not reflect functional, everyday mobility. Laboratory gait assessments provide information about gait under controlled conditions, they may not reflect actual, functional gait performance during daily activities [4,5,6]. Gait assessment in the laboratory reflects a person’s capacity (what a person can do), whereas gait during daily life reflects a person’s functional performance (what a person is doing) [5, 6]. This understanding is important while conducting research as we might see only optimal performance during clinical or laboratory visits and daily performance may be worse than what is observed in these prescribed tasks. Clinicians might underestimate potential gait impairments related to daily life functional abilities
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