Confidence In Walking Research Articles

Predicting persistent back pain causing severe interference with daily activities among community-dwelling older adults: the OPAL cohort study.

Many older adults experience disabling back and leg pain. This study aimed to identify factors associated with back pain causing severe interference with daily activities over 2 years. Participants were 2,109 community-dwelling adults (aged 65-100 years; mean age 74.2 (SD 6.3)) enrolled in a prospective cohort study who reported back pain at baseline and provided back pain data at 2 years follow-up. Baseline data included demographics, socio-economic factors, back pain presentation and age-associated adverse health states (e.g. frailty, falls, walking confidence). At 2 years follow-up, we asked if they were currently experiencing back pain and if so, asked participants to rate how much their back pain interfered with their daily activities on a scale of 0-10. Severe back pain interference was defined by a rating of 7 or more. The association between baseline factors and severe back pain interference at two years was assessed using logistic regression models. At two years, 77% of participants (1,611/2,109) still reported back pain, 25% (544/2,083) also reported leg pain and 14% (227/1,611) reported severe back pain interference with activities. Improvements in symptoms were observed over the two years follow-up in 880/2,109 participants (41.7%), 41.2% (869/2,109) of participants report no change and worsening symptoms was reported by 17.1% (360/2109) of participants. After adjusting for back pain troublesomeness at baseline, factors associated with reporting severe interference were adequacy of income (careful with money [OR 1.91; 95% CI 1.19-3.06]; prefer not to say [OR 2.22; 95% CI 1.11-4.43]), low endorsement of exercise in later life (OR 1.18; 95% CI 1.02-1.37), neurogenic claudication symptoms (OR 1.68 (95% CI 1.15-2.46)], multisite pain (OR 1.13; 95% CI 1.02-1.24) and low walking confidence (OR 1.15; 95% CI 1.08-1.22). After adjusting for baseline pain severity, we identified five factors that were associated with severe pain limitation at two years follow-up among a cohort of community dwelling older people reporting back and leg pain. These included other pain characteristics, walking confidence and attitude to activity in later life. We also identified a socioeconomic factor (perceived adequacy of income). Future research should focus on whether identifying individuals using these risk factors in order to intervene improves back pain outcomes for older people.

Motor improvement and spasms recovery with high-frequency 10kHz spinal cord stimulation in a patient with spastic tetraparesis: beyond pain relief.

To describe the clinical outcomes beyond pain relief of high-frequency spinal cord stimulation at 10kHz (10kHz SCS) in a patient with cervical myelopathy and drug-resistant chronic neuropathic pain with spastic tetraparesis. A patient with C3-C6 myelomalacia and spastic tetraparesis previously treated with decompressive laminectomy underwent implantation of 10kHz SCS for pain management through a trial procedure followed by permanent implantation. Due to the presence of epidural fibrotic scar tissue in the area of the previous C3-C6 laminectomy, the leads could not be implanted at the cervical level; therefore, the leads were positioned at the thoracic level. Data were collected during routine follow-up visits up to 15 months after implantation. Since the trialing phase and during all follow-up visits, along with complete pain relief in the lower limbs, a recovery from spasms was observed with an improvement in motor function. The patient recovered from a sensation of stiffness and difficulty in movement, with a significant decrease in muscle tone, regaining confidence in walking, and no longer needing assistance even for long walking distances. Although all disabling and painful symptomatology in the upper limbs instead did not ameliorate, the Oswestry Disability Index (ODI) score decreased from 50% at baseline to 6%. To our knowledge, recovery from spasms and motor improvement in a spastic tetraparesis patient has never been reported before with 10kHz SCS and possibly this new stimulation paradigm may overcome some performance limitations of traditional low-frequency SCS (LF-SCS). Treatment eliminated spasms at the lower limbs but not at the upper ones, thus suggesting that the location of the epidural leads could affect outcomes.

Feasibility of self-management for amputee rehabilitation using technology and peer support for improving walking and confidence in individuals with lower limb loss

Background: Individuals with lower limb loss (LLL) require self-management education for amputation adaptation. eHealth technologies, like online platforms, widen access to educational resources. We developed an online self-management program for individuals with LLL called Self-Management for Amputee Rehabilitation using Technology (SMART). Objective: To assess the feasibility of SMART for improving walking capacity and confidence for adults with recent LLL. Study Design: A single-group pre-post intervention design. Methods: We recruited community-dwelling adults, with unilateral, transtibial, or transfemoral amputation. Self-management for amputee rehabilitation using technology included 6 weekly online educational modules, for example, pain management, diet, and sock management, and 6 weekly online meetings with a peer mentor to discuss goal setting and action planning. Outcomes were assessed at baseline (before SMART) and after 6 weeks using SMART. Feasibility indicators included process (retention rate), resource (duration of training sessions), management (participant processing), and treatment issues (effect size). The primary clinical outcome was walking capacity measured using Timed Up and Go, and secondary outcome was walking confidence measured using the Ambulatory Self-Confidence Questionnaire. Results: Twelve participants were recruited. The median (range) age was 56.0 (26–79) years. The retention rate was 100%. All participants were trained in less than 15 min. Four participants had an enrollment delay of more than 10 days. Two participants reported noninjurious falls because of amputation comorbidities and increased activity. The effect sizes for walking capacity and confidence were 0.51 and 0.86, respectively. Conclusions: Only small intervention and protocol refinements are required to SMART. These will be incorporated for a future multisite randomized controlled trial. SMART is an eHealth education program for people with LLL. Self-management for amputee rehabilitation using technology with peer support is a feasible intervention. However, adjustments to the study protocol and intervention safety are necessary before proceeding with the evaluation of SMART in a larger study.

Cultural Adaptation and Validation of the Ambulatory Self-Confidence Questionnaire (ASCQ), Portuguese (European) Version.

In a world where physical activity and social participation are fundamental pillars of a full and healthy life, confidence in walking has emerged as a fundamental aspect to assess, especially for older adults. Therefore, the purpose of this study was to develop a Portuguese (European) version of the Ambulatory Self-Confidence Questionnaire (ASCQ) that was both linguistically and psychometrically adapted. To do so, a translation method was used, followed by an assessment of its validity and reliability. The Portuguese version was completed by 173 older adults. To assess reliability, Cronbach's alpha and intraclass correlation coefficients (ICCs) were used. For sociodemographic and clinical characterization, as well as questionnaire scoring, descriptive statistical analysis was used. Pearson's correlation (r), Student's t-test, and one-way ANOVA were used to analyze criterion and construction validity. The Portuguese interactions with ASCQ were effectively translated and adjusted, revealing exceptional internal consistency and test-retest reliability, as reflected in Cronbach's alpha and ICC values of 0.95. No floor effect was observed; however, a ceiling effect was identified (3.5%). The criterion and construct validity were verified as all the correlations established were statistically significant. The adaptation of the ASCQ to Portuguese culture is adequate, making it valid for use within the Portuguese population.

Improving the understanding and management of back pain in older adults: the BOOST research programme including RCT and OPAL cohort

Improving the understanding and management of back pain in older adults: the BOOST research programme including RCT and OPAL cohort

Watch your step: A pilot study of smartphone use effect on young females’ gait performance while walking up and down stairs and escalators

The increasingly ubiquitous use of smartphones has made distracted walking common, not only on flat ground, but also on stairs. Available information regarding changes in gait performance while walking and using a smartphone in different environments is still lacking. We aimed to investigate the differences in gait behavior and subjective walking confidence while walking up and down stairs and escalators, with and without smartphone use. A field experiment involving 32 female adults was conducted at a subway station. Gait parameters collected included step frequency, acceleration root mean square, step variability, step regularity, and step symmetry. The results showed that walking task, walking environment, and walking direction significantly affected gait performance and walking confidence. Overall, playing games or texting while walking down escalators resulted in the lowest walking confidence and the largest gait performance decrement: slower step frequency; reduced root mean square; decreased step regularity and step symmetry; and increased step variability. Step frequency, step variability, and step regularity significantly correlated with walking confidence. Smartphone use while walking on stairs and escalators significantly affects gait behavior and might increase the risk of falls. Interventions and prevention are needed to increase safety education and hazard warnings for the general population.

Walking speed, hip muscles strength, aerobic capacity, and self-perceived locomotion ability most explain walking confidence after stroke: a cross-sectional experimental study.

Identifying the determinants of walking confidence can be crucial in therapeutic terms. On these bases, interventions to improve these factors could improve, in turn, walking confidence. Objective is to explore the relationship between motor impairments and activity limitation measures and walking confidence in people with chronic stroke. Walking confidence was assessed using the modified Gait Efficacy Scale. The independent variables were: strength of the hip flexors and knee flexors/extensors (measured with a dynamometer), lower limb coordination (assessed by the Lower Extremity Motor Coordination Test), dynamic balance (assessed by the Four-Square Step Test), walking speed (from the 10-m Walk Test), aerobic capacity (from the 6-Minute Walk Test), and self-perceived locomotion ability (assessed by the ABILOCO). Pearson correlation was used to explore the relationships between the variables, and multiple linear regression to identify the independent explainers of walking confidence after stroke. Ninety chronic stroke individuals (35 men), with a mean age of 68 (SD 13) years were assessed. All independent variables were significantly correlated with walking confidence. Regarding the regression analysis, these measures explained 44% ( F = 9.21; P < 0.001) of the variance in walking confidence; however, only walking speed, strength of the hip flexor muscles, aerobic capacity, and perceived locomotion ability showed significance. All motor impairment and activity limitation measures correlated with walking confidence. However, the regression analysis highlighted that only walking speed, aerobic capacity, the strength of the hip flexor muscles, and perceived locomotion were independent explainers of walking confidence after stroke.

A walking programme for adults living in the community after hip fracture: A feasibility randomized controlled trial

Objective To test the feasibility of a walking programme for community-dwelling adults recovering from hip fracture. Design A randomized controlled trial with embedded qualitative analysis. Setting Community. Participants Aged at least 60 years and living in the community after hip fracture. Interventions In addition to standard care, the experimental group received weekly home-based physiotherapy for 12 weeks to facilitate 100 minutes/week of moderate-intensity walking. Main outcome measures Feasibility domains of demand, acceptability, implementation, practicality and limited efficacy. Results Of 158 potentially eligible, 38 participated (23 women, mean age 80 years, SD 9). The recruitment rate of 24% indicated low demand. Participants considered the walking programme highly acceptable. The programme was implemented as intended; the experimental group received a mean of 11 (SD 1) consultations and averaged more than 100 min of walking per week. The programme was practical with no serious adverse events and no between-group difference in risk of falling or hospital readmissions. Demonstrating evidence of efficacy, there were moderate standardized mean differences for physical activity favouring the experimental group, who increased daily moderate-intensity physical activity compared to the control group (MD 8 min, 95% CI 2–13). There were no between-group differences in mobility, walking confidence or quality of life. Conclusion A walking programme for community-dwelling older adults after hip fracture was acceptable, could be implemented as intended and was practical and demonstrated preliminary evidence of efficacy in increasing physical activity. However, low demand would threaten the feasibility of such a programme.

Walking confidence and perceived locomotion ability explain participation after stroke: A cross-sectional experimental study.

To explore the relationship between walking measurements (i.e., walking speed, walking performance and walking confidence), and participation in ambulatory people with chronic stroke. Participation was measured using the mobility domain of Brazilian version of the Stroke Impact Scale 3.0. Walking measures were walking speed, assessed by 10-m Walk Test, walking performance, assessed by ABILOCO, walking confidence, assessed by mGES. Pearson correlation coefficients were used to explore the relationships between the walking measures and social participation, and step-wise multiple linear regression analysis was used to identify which walking measures would explain participation after stroke. Ninety-five chronic stroke individuals (38 men), with a mean age of 67 (SD 13) years were assessed. Significant positive correlations, of high magnitude, were found between participation and all walking measures (r ≥ .53; p < .001). Regarding the regression analysis, walking confidence alone explained 44% (F=72.4; p < .001) of the variance in participation. When perceived locomotion ability was included in the model, the explained variance increased to 48% (F=42.8; p < .001). All walking measures were correlated with social participation after stroke, but only perceived locomotion ability and walking confidence explained the variance in participation. Clinicians should be encouraged to evaluate real-life performance and personal factors that may limit community participation after stroke.

Optimally-calibrated non-invasive feedback improves amputees’ metabolic consumption, balance and walking confidence

Objective. Lower-limb amputees suffer from a variety of health problems, including higher metabolic consumption and low mobility. These conditions are linked to the lack of a natural sensory feedback (SF) from their prosthetic device, which forces them to adopt compensatory walking strategies that increase fatigue. Recently, both invasive (i.e. requiring a surgery) and non-invasive approaches have been able to provide artificial sensations via neurostimulation, inducing multiple functional and cognitive benefits. Implants helped to improve patient mobility and significantly reduce their metabolic consumption. A wearable, non-invasive alterative that provides similar useful health benefits, would eliminate the surgery related risks and costs thereby increasing the accessibility and the spreading of such neurotechnologies. Approach. Here, we present a non-invasive SF system exploiting an optimally-calibrated (just noticeable difference-based) electro-cutaneous stimulation to encode intensity-modulated foot-ground and knee angle information personalized to the user’s just noticeable perceptual threshold. This device was holistically evaluated in three transfemoral amputees by examination of metabolic consumption while walking outdoors, walking over different inclinations on a treadmill indoors, and balance maintenance in reaction to unexpected perturbation on a treadmill indoors. We then collected spatio-temporal parameters (i.e. gait dynamic and kinematics), and self-reported prosthesis confidence while the patients were walking with and without the SF. Main results. This non-invasive SF system, encoding different distinctly perceived levels of tactile and knee flexion information, successfully enabled subjects to decrease metabolic consumption while walking and increase prosthesis confidence. Remarkably, more physiological walking strategies and increased stability in response to external perturbations were observed while walking with the SF. Significance. The health benefits observed with the use of this non-invasive device, previously only observed exploiting invasive technologies, takes an important step towards the development of a practical, non-invasive alternative to restoring SF in leg amputees.

Transcranial direct current stimulation (tDCS) in addition to walking training on walking, mobility, and reduction of falls in Parkinson\u2019s disease: study protocol for a randomized clinical trial

BackgroundTranscranial direct current stimulation (tDCS) has the potential to modulate cortical excitability and enhance the effects of walking training in people with Parkinson’s disease. This study will examine the efficacy of the addition of tDCS to a task-specific walking training to improve walking and mobility and to reduce falls in people with Parkinson’s disease.MethodsThis is a two-arm, prospectively registered, randomized trial with concealed allocation, blinded assessors, participants and therapists, and intention-to-treat analysis. Twenty-four individuals with Parkinson’s disease, categorized as slow or intermediate walkers (walking speeds ≤ 1.0 m/s), will be recruited. The experimental group will undertake a 30-min walking training associated with tDCS, for 4 weeks. The control group will undertake the same walking training, but with sham-tDCS. The primary outcome will be comfortable walking speed. Secondary outcomes will include walking step length, walking cadence, walking confidence, mobility, freezing of gait, fear of falling, and falls. Outcomes will be collected by a researcher blinded to group allocation at baseline (week 0), after intervention (week 4), and 1 month beyond intervention (week 8).DiscussiontDCS associated with walking training may help improve walking of slow and intermediate walkers with Parkinson’s disease. If walking is enhanced, the benefits may be accompanied by better mobility and reduced fear of falling, and individuals may experience greater free-living physical activity at home and in the community.Trial registrationBrazilian Registry of Clinical Trials (ReBEC) RBR-6bvnx6. Registered on September 23, 2019

Effects of Light Conditions and Falls Concerns on Older Adults’ Gait Characteristics: A Preliminary Study

Falls are one of the main safety concerns for the aging population, possibly caused by the difficulty in maintaining the gait and balance during walking. Vision and psychological effects are reported to be major factors affecting human gait and balance. However, only a few studies have collectively investigated the effects of vision and psychological status on gait characteristics. Therefore, this study aimed to compare the gait characteristics of older adults with different falls concerns under usual ambient and visual-guided light conditions. Twelve community-dwelling adults (five males and seven females, seven with eye diseases, all over 75 years old, 164.5 ± 9.1 cm in stature) were recruited. Participants were instructed to walk from their bed to the bathroom with their normal walking speed four times (two light conditions x two repetitions). Participants’ gait characteristics, including the walking performance, posture, and stability measures, were compared using mixed analyses of variance with light conditions as the within-subject factor, and falls concerns as the between-subject factor. The study found: (1) When compared to the usual ambient night light condition, the lighting with a visual-based guiding prompted participants to have a lower maximum value of right hip flexion and a higher maximum value of trunk accelerometry. Higher confidence in walking and increased numbers of walking direction corrections might contribute to the changes under the visual-guided light conditions. (2) When compared to older adults with low fall concerns, those with high fall concerns demonstrated a slower walking speed as well as a reduction in motion smoothness.

Spatiotemporal Gait Parameters and Walking Characteristics in Community-Dwelling Ambulatory Stroke Survivors

Background: Gait dysfunction is a major sequalae of stroke which negatively affect stroke survivors’walking and community re-integration. Understanding the impairments that determine their communityfunctioning willassist in development of effective treatment strategies for them to overcome theirdisability.Aim: The aim of the study was to explore thespatiotemporal gait parameters and walking characteristicsin community-dwelling ambulatory stroke survivors and determined howthey differ across time ofcommencement of ambulation and duration of ambulation post-stroke.Method: This study involved 164 (83males) community-dwelling ambulatory stroke survivors inKano, Nigeria. The spatiotemporal gait parameters wereassessed along 12-meter distance walkingpath. Spatiotemporal symmetry was computed from the spatiotemporal parameters. Lower limb motorimpairment, lower extremity function, and functional ambulation were assessed using Fugyl-Meyerassessment scale, Lower Extremity Functional scale, and Modified Emory functional ambulatoryprofile respectively. Their physical mobility was assessed using Modified Rivermead mobility index,walking confidence using ambulatory self-confidence questionnaire while Berg balance scale was usedto measure balance. Functional mobility and walking endurance was assessed using the Time up andgo test and 6-minute walk test respectively.Walking status was assessed with functional ambulatorycategory.Results: The participants were aged30years and abovewith 61% above 50years. Most (59.8%)participants commenced ambulation within 1-month of stroke with 65.9% being independent infunctional ambulation. Their spatiotemporal, mobility and balance parameters as well as spatiotemporalsymmetry characteristics were severely affected and are significantly inversely related to their times ofcommencement of ambulation post-stroke.Conclusion: Spatiotemporal gait parameters, mobility parametersand balance performances areseverely abnormal in community-dwelling stroke survivors and negatively impact on their walkingability and community functioning.

Using a cane for one month does not improve walking or social participation in chronic stroke: An attention-controlled randomized trial

Objective: To examine the effects of the provision of a cane, delivered to ambulatory people with chronic stroke, for improving walking and social participation. Design: Two-arm, randomized trial. Setting: Community-based. Participants: Ambulatory individuals with chronic stroke. Interventions: The experimental intervention was the provision of a single-point cane during one month. The control group received a placebo intervention. Outcome measures: Walking speed, step length, cadence, walking capacity, and walking confidence were measured without the cane to examine its rehabilitative effect. Walking speed was also measured with the cane for inclusiveness, and social participation was measured for examining carry over effects. Outcomes were measured at baseline, and after one and two months. Results: Fifty individuals were included. In the experimental group, mean age was 69 years (SD 14), and walking speed was 0.58 m/s (SD 0.17). In the control group, mean age was 68 years (SD 13), and walking speed was 0.63 m/s (SD 0.15). When walking without the cane, after one and after two months, there were no between-group differences in any measures. When walking with the cane, after one month, the experimental group walked 0.14 m/s (95% CI 0.05–0.23) faster than the control group and after two months, they were still walking 0.18 m/s (95% CI 0.06–0.30) faster. Conclusion: Use of a cane improved walking speed, only when participants walked with the cane. Use of cane for one month did not improve walking outcomes, when walking without the cane. People with stroke would need to continue to use the cane to maintain any benefits in walking speed.

Mobility of Older Adults: Gait Quality Measures Are Associated With Life-Space Assessment Scores.

The relation of gait quality to real-life mobility among older adults is poorly understood. This study examined the association between gait quality, consisting of step variability, smoothness, regularity, symmetry, and gait speed, and the Life-Space Assessment (LSA). In community-dwelling older adults (N = 232, age 77.5 ± 6.6, 65% females), gait quality was derived from (i) an instrumented walkway: gait speed, variability, and walk ratio and (ii) accelerometer: signal variability, smoothness, regularity, symmetry, and time-frequency spatiotemporal variables during 6-minute walk. In addition to collecting LSA scores, cognitive functioning, walking confidence, and falls were recorded. Spearman correlations (speed as covariate) and random forest regression were used to assess associations between gait quality and LSA, and Gaussian mixture modeling (GMM) was used to cluster participants. Spearman correlations of ρ p = .11 (signal amplitude variability mediolateral [ML] axis), ρ p = .15 and ρ p = -.13 (symmetry anterior-posterior-vertical [AP-V] and ML-AP axes, respectively), ρ p = .16 (power V), and ρ = .26 (speed), all p <.05 and marginally related, ρ p = -.12 (regularity V), ρ p = .11 (smoothness AP), and ρ p = -.11 (step-time variability), all p <.1, were obtained. The cross-validated random forest model indicated good-fit LSA prediction error of 17.77; gait and cognition were greater contributors than age and gender. GMM indicated 2 clusters. Group 1 (n = 189) had better gait quality than group 2 (n = 43): greater smoothness AP (2.94 ± 0.75 vs 2.30 ± 0.71); greater similarity AP-V (.58 ± .13 vs .40 ± .19); lower regularity V (0.83 ± 0.08 vs 0.87 ± 0.10); greater power V (1.86 ± 0.18 vs 0.97 ± 1.84); greater speed (1.09 ± 0.16 vs 1.00 ± 0.16 m/s); lower step-time coefficient of variation (3.70 ± 1.09 vs 5.09 ± 2.37), and better LSA (76 ± 18 vs 67 ± 18), padjusted < .004. Gait quality measures taken in the clinic are associated with real-life mobility in the community.

Telephone-based assessment of walking confidence in older people.

To validate the telephone-based application of the modified Gait Efficacy Scale (mGES) for the assessment of walking confidence in older people. Participants answered the mGES-Brazil on two randomized occasions, face-to-face and by telephone. The mean difference (MD) between the interviews was reported. Intraclass correlation coefficient (ICC3,1) was used to investigate the levels of agreement between the two occasions for total mGES-Brazil scores and for the individual items. A total of 78 individuals were included. There was no significant difference in the MD obtained between applications of the mGES (1 point, 95% confidence interval -6 to 7). A very high level of agreement was found between the mGES total scores during face-to-face and telephone applications (ICC = 0.98; 95% CI 0.97-0.99). All items, except one (item 3), had a very high agreement between the two applications. The mGES showed to be reliable to be applied for telephone assessments of walking confidence in older people.

Testing of path-based visual cues on patterned carpet to assist older adults' gait in a continuing care retirement community

Fall accidents lead to hospitalization and medical costs among all age groups, especially severe for older adults. Both intrinsic (e.g., visual impairment, fear of falling) and extrinsic (e.g., inappropriate carpet design, poor lighting) factors contribute to fall accidents. Older adults increasingly rely on visual perception to maintain balance as their health conditions decline. Patterned carpet is common in the built environment, which is one of the factors contributing to fall accidents among older adults. This study examined the role of path-based visual cues (provide visual guidance while walking along the patterned carpet) in helping older adults maintain safe movement and overcome the fear of falling. The experimental field study was conducted at a Continuing Care Retirement Community. Thirty-two residents were recruited. Within-subjects design was employed to examine the effects of path-based visual cues (light color and brightness) on the gait characteristics of older adults with and without visual impairment while walking on patterned carpet. Wearable sensors collected older adults' gait characteristics and questionnaires were used to evaluate their perceptions of confidence and safety with different visual cues provided. Individual repeated measures analysis results indicated that older adults significantly decreased stride length and stride velocity under 8.3fc white and 7.3fc blue lighting conditions compared to the baseline condition. In addition, the principal component analysis also indicated significant differences in gait performance among lighting colors and lighting brightness. The subjective responses indicated that the path-based visual cues were helpful in improving walking confidence, particularly for older adults with visual impairment.

Construct validity and reliability of the modified gait efficacy scale for older adults

Purpose To perform a cross-cultural adaptation of the mGES into Dutch and investigate its construct validity, internal consistency, test-retest reliability and floor and ceiling effects in a large cohort of community-dwelling older adults. Materials and methods We translated the British version of the mGES into Dutch, back into English, and had a native English speaker review the final version. Next, we included 223 community-dwelling older adults from the ‘Veilig in Beweging Blijven’ (VIBE) cohort (69.8 [67.6–74.3] years old, 155 (69.5%) female), who filled out both the mGES and the Falls Efficacy Scale-International (FES-I) twice, with a month in between. Construct validity was assessed by Spearman’s correlation between the scores on the mGES and the FES-I. Internal consistency was assessed with Cronbach’s alpha and test-retest reliability was assessed with the intra class correlation coefficient (ICC(2,1)). Results Construct validity (rho = −0.81, p < 0.001), internal consistency (α = 0.95), and test-retest reliability (ICC(2,1)=0.90, 95%CI = [0.87–0.92]) were all excellent. Ceiling effect was observed in 44 (19.7%) participants which suggest caution when evaluating the mGES for fit and confident older adults. Conclusion The Dutch mGES is a valid and reliable tool to assess confidence in walking and is suggested as a tool for evaluating self-efficacy after interventions aimed at improving gait. IMPLICATIONS FOR REHABILITATION Assessment and rehabilitation of gait may be affected by self-efficacy of walking performance. We show that the Dutch translation of the modified gait efficacy scale is a valid and reliable tool for assessing self-efficacy of walking. A ceiling effect was observed that was associated with muscle strength and symptoms of depression. The results of the present study underline the use of the modified gait efficacy scale in the assessment and evaluation of self-efficacy of walking in rehabilitation.

The Prevalence of Back and Leg Pain and the Cross-sectional Association With Adverse Health Outcomes in Community Dwelling Older Adults in England.

Cross-sectional analysis of the Oxford Pain, Activity and Lifestyle (OPAL) Cohort Study. The aim of this study was to assess the prevalence of back pain (BP) and leg pain and determine their relationship with adverse health states among older adults in England. Epidemiological data describing the prevalence of BP and leg pain in older adults in England is lacking. A total of 5304 community-dwelling adults (aged 65-100 years) enrolled in the OPAL cohort study who provided data on BP and leg pain were included. Participants were classified into four groups based on reports of back and leg pain: no BP, BP only, BP and leg pain which was likely to be neurogenic claudication (NC), and BP and leg pain which was not NC. Adverse health states were frailty, falls, mobility decline, low walking confidence, poor sleep quality, and urinary incontinence. We collected demographic and socioeconomic information, health-related quality of life, and existing health conditions, and estimated the association between BP presentations and adverse health states using regression analysis. Thirty-four percent of participants (1786/5304) reported BP only, 11.2% (n = 594/5304) reported BP and NC and 8.3% (n = 441/5304) reported BP and non-NC leg pain. Participants with BP had worse quality of life compared to those without BP. All BP presentations were significantly associated with adverse health states. Those with NC were most affected. In particular, there was greater relative risk (RR) of low walking confidence (RR 3.11, 95% confidence interval [CI] 2.56-3.78), frailty (RR 1.88, 95% CI 1.67-2.11), and mobility decline (RR 1.74, 95% CI 1.54-1.97) compared to no BP. Back and leg pain is a common problem for older adults and associated with reduced quality of life and adverse health states. Findings suggest a need to develop more effective treatment for older adults with BP especially for those with neurogenic claudication. 2.

Charcot - Marie - Toots disease: description of 2 clinical cases of the disease in members of the same family (father and daughter)

Charcot — Marie — Tooth disease belongs to a genetically heterogeneous group of monogenic diseases with a predominant lesion of the peripheral nervous system associated with predominant degeneration of the myelin sheath and/or axon of the motor and sensory nerves and spinal roots, accompanied by motor disorders and specific pain syndrome. The article presents a description of 2 clinical cases of patients (father and daughter), whose disease was manifested by chronically progressive weakness and atrophy of the distal limb muscles, reflexes reduction, foot and hand deformation, gait changes and sensory disorders. Genetic tests were performed to detect duplication/deletion of the PMP22 gene and the expansion of GAA repeats in the FXN gene, which yielded negative results. Based on complaints, neurological examination, family medical history and data of instrumental research (EMNG), we made a clinical diagnosis of the CMT with an autosomal dominant type of inheritance and a high degree of penetrance. At the department, patients received the infusion therapy (neurometabolic therapy, vitamin therapy), physical therapy courses according to an individual plan, physiotherapy and reflexotherapy with a moderate positive effect in the form of a subjective increase in muscle strength in the lower extremities, increasing walking stability and confidence. The article also highlights the peculiarities of the pathogenesis of different genetic variants of CMT and prospect for pathogenetic treatment of this disease.