Limited Walking Research Articles

Abstract PD6-01: PD6-01 Association between the CARG-BC score and clinical decline after adjuvant chemotherapy in fit older adults with breast cancer: Results from the Hurria Older PatiEnts (HOPE) Prospective Study

Abstract Association between the CARG-BC score and clinical decline after adjuvant chemotherapy in fit older adults with breast cancer: Results from the Hurria Older PatiEnts (HOPE) Prospective Study Background: We previously developed and validated a risk prediction model for grade 3-5 chemotherapy toxicity in patients age ≥65 with early breast cancer, known as the Cancer and Aging Research Group-Breast Cancer (CARG-BC) score. The CARG-BC score is calculated by combining eight clinical variables that classify patients as low, intermediate, and high risk for grade 3-5 chemotherapy toxicity. However, whether this score can also identify individuals most likely to experience a clinical decline after chemotherapy remains unknown. Here, we evaluated the association between the CARG-BC score and decline in health status. Methods: This is a pre-specified secondary analysis of the Hurria Older PatiEnts (HOPE) with Breast Cancer Study (NCT01472094). This multicenter, prospective cohort study gathered biological and clinical data from women ≥65 with stage I-III breast cancer scheduled to receive neo/adjuvant chemotherapy. Health status was measured pre- (≤14 days) and post-chemotherapy (≤30 days) using a Deficit Accumulation Index (DAI), derived from geriatric assessment data (Cohen et al Cancer 2017). The DAI categorized patients as robust (0.0< 0.2), prefrail (0.2< 0.35), or frail (≥0.35). Baseline clinical characteristics, blood biomarkers of inflammation (interleukin-6 [IL-6] and C-reactive protein [CRP]), and CARG-BC scores (classified as low [0-5], intermediate [6-11] or high [≥12]) were collected pre-chemotherapy. The population of interest was older women who were clinically fit (defined as robust per the DAI) pre-chemotherapy. The primary outcome was chemotherapy-induced decline in health status, a dichotomized (yes/no) variable defined as a decline in DAI from robust pre-chemotherapy to pre-frail or frail post-chemotherapy. Multivariable logistic regression was used to examine the association between baseline CARG-BC score and chemotherapy-induced decline in health status. Results: Of 392 women included in this analysis, 316 (80.6%) were clinically fit based on DAI assessment pre-chemotherapy. The median age was 70 (range 65-86), 61.7% had stage II or III disease, 31% had HR+/HER2+ disease, 22% had HR-/HER2- disease, 36% received an anthracycline, and 74% received prophylactic WBC growth factors. At baseline, 38.7% had low, 53.4% had intermediate, and 7.9% had high CARG-BC scores. Among the 316 clinically fit patients, 80 (25.3%) experienced a decline in health status at the end of chemotherapy. In univariate analysis, we observed that patients with high IL-6 (odds ratio [OR]=2.24, 95% CI: 1.32-3.79, p=0.003), high CRP (OR=1.84, 95%: CI 1.10-3.09, p=0.02), and intermediate (OR=3.29, 95% CI 1.72-6.29, p< 0.001) or high (OR=6.29, 95% CI 2.36-16.71, p< 0.001) CARG-BC scores were more likely to experience chemotherapy-induced decline in health status. After adjusting for IL-6 and CRP, patients with both intermediate (OR=3.25, 95% CI 1.68-6.27, p< 0.001) and high (OR=5.17, 95% CI 1.90-14.02, p=0.001) CARG-BC scores had significantly higher odds of experiencing chemotherapy-induced clinical decline as compared to patients with low CARG-BC scores. Conclusions: In this cohort of older women with early breast cancer who were clinically fit pre-chemotherapy, 25% experienced a decline in health status after neo/adjuvant chemotherapy. Women with an intermediate/high CARG-BC score prior to chemotherapy had 3-5-fold increased odds of experiencing chemotherapy-induced decline in health status independent of baseline clinical characteristics and biomarkers of inflammation. These findings may be useful to clinicians for predicting individual probability of chemotherapy-induced clinical decline and informing treatment decisions in older adults with early breast cancer. Table 1. Univariate and multivariable association of the CARG-BC score with chemotherapy-induced decline in health status. Multivariable analysis adjusted for baseline demographic, clinical, and inflammatory levels (IL-6 and CRP); *CARG-BC score is calculated using 8 independent predictors (each assigned weighted points): anthracycline use (1 point), stage II or III (3 points), planned treatment duration > 3 months (4 points), abnormal liver function (3 points), low hemoglobin (3 points), falls (4 points), limited walking (3 points), and lack of social support (3 points). The total CARG-BC risk score is the sum of each point derived from these 8 predictors. Each patient’s total CARG-BC score can then be classified into three risk groups: low (0-5 points), intermediate (6-11 points), or high (≥ 12 points). Citation Format: Jingran Ji, Canlan Sun, Hyman B. Muss, Harvey J. Cohen, Mina S. Sedrak. PD6-01 Association between the CARG-BC score and clinical decline after adjuvant chemotherapy in fit older adults with breast cancer: Results from the Hurria Older PatiEnts (HOPE) Prospective Study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD6-01.

Optimal Intensity and Duration of Walking Rehabilitation in Patients With Chronic Stroke

For walking rehabilitation after stroke, training intensity and duration are critical dosing parameters that lack optimization. To assess the optimal training intensity (vigorous vs moderate) and minimum training duration (4, 8, or 12 weeks) needed to maximize immediate improvement in walking capacity in patients with chronic stroke. This multicenter randomized clinical trial using an intent-to-treat analysis was conducted from January 2019 to April 2022 at rehabilitation and exercise research laboratories. Survivors of a single stroke who were aged 40 to 80 years and had persistent walking limitations 6 months or more after the stroke were enrolled. Participants were randomized 1:1 to high-intensity interval training (HIIT) or moderate-intensity aerobic training (MAT), each involving 45 minutes of walking practice 3 times per week for 12 weeks. The HIIT protocol used repeated 30-second bursts of walking at maximum safe speed, alternated with 30- to 60-second rest periods, targeting a mean aerobic intensity above 60% of the heart rate reserve (HRR). The MAT protocol used continuous walking with speed adjusted to maintain an initial target of 40% of the HRR, progressing up to 60% of the HRR as tolerated. The main outcome was 6-minute walk test distance. Outcomes were assessed by blinded raters after 4, 8, and 12 weeks of training. Of 55 participants (mean [SD] age, 63 [10] years; 36 male [65.5%]), 27 were randomized to HIIT and 28 to MAT. The mean (SD) time since stroke was 2.5 (1.3) years, and mean (SD) 6-minute walk test distance at baseline was 239 (132) m. Participants attended 1675 of 1980 planned treatment visits (84.6%) and 197 of 220 planned testing visits (89.5%). No serious adverse events related to study procedures occurred. Groups had similar 6-minute walk test distance changes after 4 weeks (HIIT, 27 m [95% CI, 6-48 m]; MAT, 12 m [95% CI, -9 to 33 m]; mean difference, 15 m [95% CI, -13 to 42 m]; P = .28), but HIIT elicited greater gains after 8 weeks (58 m [95% CI, 39-76 m] vs 29 m [95% CI, 9-48 m]; mean difference, 29 m [95% CI, 5-54 m]; P = .02) and 12 weeks (71 m [95% CI, 49-94 m] vs 27 m [95% CI, 3-50 m]; mean difference, 44 m [95% CI, 14-74 m]; P = .005) of training; HIIT also showed greater improvements than MAT on some secondary measures of gait speed and fatigue. These findings show proof of concept that vigorous training intensity is a critical dosing parameter for walking rehabilitation. In patients with chronic stroke, vigorous walking exercise produced significant and meaningful gains in walking capacity with only 4 weeks of training, but at least 12 weeks were needed to maximize immediate gains. ClinicalTrials.gov Identifier: NCT03760016.

Influence of circumferential ankle pressure of shoe collar on the kinematics, dynamic stability, electromyography, and plantar pressure during normal walking.

The shoe's collar plays a significant role in supporting the ankle during walking. Since the protective effect of the collar requires the circular embracing of the ankle and shank, a stiffer collar might be involved with increased circumferential ankle pressure (CAP). It is not clear how collar CAP affects walking performance. Therefore, this study was aimed at examining the influence of the collar CAP on the kinematics, dynamic stability, electromyography (EMG), and plantar pressure during normal walking. Sixteen healthy male participants walked on a treadmill while wearing a custom-designed high-collar shoe with 10 (low), 30 (medium), and 60 mmHg (high) CAP conditions, and the joint angles, dynamic stability index, EMG, and plantar pressure were measured. While the low CAP condition did not affect the ankle range of motion (ROM), The high CAP condition restricted both the ankle sagittal and frontal ROM, whereas the medium CAP condition limited only the ankle frontal ROM. The knee and hip ROM did not differ between conditions. The dynamic stability for the high and medium CAP cases was comparable but significantly higher than that of the low CAP condition. The ankle muscle activity and corresponding co-contraction increased with increasing CAP for gastrocnemius medialis (GM), soleus (SOL), peroneus longus (PL), tibialis anterior (TA) muscles in the weight acceptance and push-off phases but not in the single limb support. Knee muscle activity, including vastus lateralis (VL) and semitendinosus (SEMI) was similar between all conditions. A higher relative pressure was observed under the lateral aspect of the heel when walking in the high CAP condition. The results suggest that a high-collar shoe with a high CAP may not be an appropriate choice for walking owing to the injury risk factors and limited walking efficiency. A medium CAP is associated with certain advantages and, thus, a superior choice for high-collar shoe design.

Neuroimaging Correlates of Patient-Reported Outcomes in Multiple Sclerosis.

Patient-reported outcomes (PROs) are increasingly associated with concurrent and future impairments in persons with multiple sclerosis (pwMS). The structural and pathological relationships with PROs in pwMS have not been elucidated. One hundred and forty-two pwMS and 47 healthy controls (HCs) were scanned using 3T MRI and completed a PRO questionnaire named Lifeware® that outlines the physical and psychosocial abilities. Beck's Depression Inventory (BDI) assessed levels of depression. T1- and T2-lesion volume, volumes of the whole brain (WBV), gray matter (GMV), white matter (WMV) and lateral ventricle (LVV) were derived using JIM and SIENAX software. Additional deep GM (DGMV) and nuclei-specific volumes of the thalamus, caudate, globus pallidus, putamen, and hippocampus were calculated using FIRST. Ordinal regression models adjusted for age and depression and mediation analyses were used. When compared to HCs, pwMS reported significantly greater limitations in mobility domains, including standing up from low seat (p < 0.001), climbing flight of stairs (p < 0.001), lower limb limitation (p < 0.001), limitations in bladder continence (p = 0.001) and fatigability (p < 0.001). Patient-reported limitations related to lower extremity function were explained by age, BDI, and all DGM nuclei volumes (p < 0.029). No such relationships were seen in the HCs. Fatiguability and the extent of life satisfaction were only related to depression (BDI p < 0.001) and not associated with any MRI-based outcomes. Most relationships between structural pathology and PROs were mediated by BDI scores (p < 0.001). In the pwMS group, there were no significant differences in any MRI-based brain volumes between the levels of reported life satisfaction. PRO measures of lower extremity limitations were associated with DGM structures and DGM-specific nuclei. These findings promote the relevance of measuring DGM structures as measures directly related to subjective well-being and walking limitations. Depression is a significant mediator of PROs and in particular of life satisfaction.

Research Progress of Traditional Chinese Medicine in the Treatment of Post-Stroke Depression

Stroke is one of the public health problems widely concerned by many countries in the modern world. It is a kind of cerebrovascular disease with high risk. Most patients will have sequelae after stroke, such as hemiplegia, speech impairment, limited walking, etc. Depression is also one of the common sequelae. Patients are mainly characterized by low mood, unwilling to communicate with others, insomnia, and even negative thoughts of suicide. Post-stroke depression has adverse effects on patients and society, which greatly affects the normal life and work of patients and affects social stability. Western medicine treatment of post-stroke depression is mainly based on oral drugs, but it will bring many adverse reactions, such as drug resistance, dependence, and drug toxicity. Long-term medication treatment brings certain economic pressure. Traditional Chinese medicine (TCM) is a medicine with rich experience accumulated for a long time in China. It has a positive effect on the treatment of stroke and post-stroke depression. It has the characteristics of simplicity, low price and low toxicity, and is widely accepted by society and patients. There are various treatment methods of traditional Chinese medicine. This article reviews a large number of clinical observations to clarify the effectiveness of traditional Chinese medicine in the treatment of post-stroke depression.

Effectiveness of a 6-week specific rehabilitation program combining education and exercises on walking capacity in patients with lumbar spinal stenosis with neurogenic claudication: a randomized controlled clinical trial protocol

BackgroundLumbar spinal stenosis (LSS) causing neurogenic claudication (NC) is a leading cause of disability which is intimately related to a decrease in walking capacity. Walking limitation has negative physical and mental impacts on patients. Recent guidelines recommend the use of conservative treatment options such as exercises before considering surgery. Unfortunately, dedicated healthcare resources for the conservative management of patients with LSS causing NC are uncommon. Thus, it is important to develop accessible and specific rehabilitation programs aimed at improving patients’ self-management, especially with regard to walking capacity. The aim of this study is to evaluate the effectiveness of a 6-week specific rehabilitation program combining education and exercises on walking capacity in patients with LSS causing NC.Methods/designThis is a prospective randomized controlled parallel-group clinical trial. Sixty-six patients with LSS causing NC will be recruited from identified clinics and local advertisements. The intervention group will receive standardized education and specific exercises while the control group will only receive a standardized education. The program in both groups will last for 6 weeks with 5 evaluation time points (baseline, week 2, week 4, week 6, and week 12). The primary outcome will be walking capacity measured with the Self-Paced Walking Test, and the secondary outcomes will be back and leg pain intensity, LSS-related disability, self-efficacy, level of physical activity, anxiety, depression, gait pattern characteristics, balance, and global perceived change.DiscussionThis study will assess the effectiveness of a 6-week specific rehabilitation program combining education and exercises on walking capacity in patients with LSS causing NC. By measuring objective gait pattern characteristics, the study will also provide new information about the impact of NC on gait pattern that could eventually improve the evaluation and the management of LSS.Trial registrationClinicalTrials.gov NCT05513326. Registered on August 22, 2022

Comparing effects of question set order and location within a survey instrument of two commonly used disability question sets among a U.S. population of adults

BackgroundIn nationally representative household surveys conducted in the United States (U.S.), two distinct sets of questions are commonly used to identify persons with disabilities. The six-question sequence (6QS) measures, in a yes/no fashion, limitations in cognition, hearing, independent living, self-care, vision, and walking. The Washington Group Short Set (WG-SS) captures more nuanced yet similar information, although instead of including a measure of independent living asks about communication. To date, research has not estimated, among the same set of survey respondents, variations in disability prevalence using these two sets of questions nor how prevalence estimates vary by question set order and placement of these questions at the beginning or end of a survey. Objective/HypothesisThe objective was to examine adjusted differences in disability prevalence among three measures of disability based on the 6QS and the WG-SS question sets, controlling for differences in question set order and placement within a survey. MethodsWe fielded an Internet survey (N = 13,277) in September 2020 that included these questions, but varied question set order and placement among respondents, using four different versions of the survey. We first tested for bivariate differences by survey design between an “any disability” measure as well as between specific types of limitations using Chi square. Finally, we examined pairwise adjusted differences in prevalence estimates. ResultsThe 6QS provided the most consistent prevalence estimates (26%–28%) (p < .05), regardless of survey design. Estimates varied more widely for the WG-SS measures, ranging from 43 to 60% for WG-SS1 and from 10% to 15% for WG-SS2, among survey versions. ConclusionsQuestion set order and placement was not associated with differences in prevalence for the 6QS but was associated with differences in estimates from the WG-SS. Further research is needed to understand the possible survey priming effects that might influence estimates from the WG-SS.

Strength of hip muscles and bradykinesia contribute to walking speed over a long distance, but not a short distance, in people with mild Parkinson’s disease: An observational study

BackgroundBradykinesia and postural instability contribute to walking limitations in people with Parkinson’s disease (PD), but the contribution of muscle strength to walking speed has not been examined extensively. Research questionDoes strength of the major lower limb muscles contribute to walking speed over short and long distances in people with PD? Methodna. DesignA cross-sectional, observational study. Participants50 people with mild PD. Outcome measuresMaximum isometric strength of the flexors and extensors of the lower limb was measured using hand-held dynamometry. Flexed posture, postural instability and bradykinesia were measured using the MDS-UPDRS part III. Walking speed was measured during the 10-m Walk Test and 6-min Walk Test. ResultsUnivariate analysis revealed that age, bradykinesia, flexed posture, and hip, knee and ankle weakness were all significantly correlated with walking speed over short and long distances. Multiple regression analysis revealed that age, bradykinesia, flexed posture and weakness of the hip and knee muscles together accounted for 47% of the variance in walking speed over a short distance, with age (R2 = 0.11, p = 0.003) making a significant independent contribution. Age, bradykinesia, flexed posture and strength of the hip and knee muscles together accounted for 56% of the variance in walking speed over a long distance. Age (R2 = 0.12, p = 0.001), weakness of the hip muscles (R2 = 0.12, p = 0.001) and bradykinesia (R2 = 0.04, p = 0.04) made significant, independent contributions to the variance in walking speed over a long distance. SignificanceIn people with mild PD, weakness of the hip muscles and bradykinesia only make a significant relative contribution to walking speed over a long distance. Therefore, in people with normal walking speed over a short distance the 6-min Walk Test could be measured to more effectively identify the impact of motor impairments on walking.

One-Kilometer Walking Limit during COVID-19: Evaluating Accessibility to Residential Public Open Spaces in a Major Saudi City

Considering the significance of physical activities in maintaining physical and mental well-being, several nations made exceptions during the COVID-19 lockdowns and allowed residents to walk outdoors, but with time and distance restrictions that varied across countries. This study aimed to identify if such regulations provided residents with equal access to public open spaces (POS) to engage in physical activity during the lockdown. Using a mixed research method (secondary descriptive data, field observations, and spatial analysis), we assessed the one-kilometer walking limit imposed on six typical existing neighborhoods in Jeddah city, Saudi Arabia. We find that the imposed one-kilometer limit was effective in providing accessibility, and the four urban factors ensured the effectiveness of the imposed walking distance: the small scale of residential districts in comparison to the long-imposed walking distance; the presence of neighborhood parks near main local streets; the distribution of neighborhood parks throughout the districts; and the absence of major highways that physically isolated residential districts. Notably, regulations related to walking distances during future pandemics should not be generalized to all cities; instead, they should be based on the existing availability of relatively good POS provisions with easy and equal access to all community members to enhance social sustainability.

Participation and Motor Abilities in Children Aged 5 to 9 Years With Idiopathic Clubfeet After Treatment With the Ponseti Method.

Functioning in children consists of different aspects, including their ability to execute activities and participate in life situations. Several studies on children with clubfeet showed limited motor abilities and walking capacity compared with healthy control children, while other studies showed comparable athletic abilities and gross motor development. Although participation in activities of daily life plays an important role in the development of children, this has not yet been investigated in children with clubfeet. The study aims to determine the level of parents' perceived motor ability and participation in Ponseti-treated children with clubfeet compared with age-matched healthy controls. Parents of children aged 5 to 9 years with and without idiopathic Ponseti-treated clubfeet were asked to complete an online questionnaire about their child's motor abilities and participation level using the Dutch version of the Assessment of Life Habits for Children (LIFE-H) version 3 to assess participation and the Dutch Movement Assessment Battery for Children-2 Checklist (MABC-2 Checklist) to assess motor abilities. Statistical analysis focused on differences between groups and the relationship between motor abilities and level of participation. Questionnaires of 86 children with clubfeet (mean age 7.1, 73% boys) and 62 controls (age 6.7, 53% boys) were analyzed. Despite a large variation, results showed no significant differences between groups on the total scores of the LIFE-H and the MABC-2 Checklist. Children with clubfeet, however, scored lower on Mobility and better on the categories Communication and Responsibility of the LIFE-H. Furthermore, children with clubfeet showed lower scores on the MABC-2 Checklist subscale "movement in a static and/or predictable environment." High levels of the parents' perceived participation correlate with good results, as perceived by the parents, in motor ability. Although differences on some aspects of motor ability and participation existed, children with clubfeet in general showed high levels of parents' perceived motor ability and participation. High levels of participation correlated with good results in motor ability. Level II.

Evaluating balance disorders with different levels of walking impairment in Multiple Sclerosis: correlation between IMU-based parameters and clinical scales

Gait and balance disorders are marked functional deficits in people with multiple sclerosis (MS) [1]. Walking limitations are frequently reported in people with MS despite the Expanded Disability Status Scale (EDSS) indicates normal walking autonomy [2]. To better identify changes due to disease severity, a combined instrumental assessment based on inertial measurement units (IMUs) and clinical scales during walking paths have been recommended [3,4]. The aim of this study is to verify the correlation between objective data extracted from IMUs during walking and scores of a routinely performed clinical scale in patients with MS with different levels of walking impairment. Thirty-three patients with MS (Class 1– mild disability, n=4, 2 F, 53.8±1.3 y, EDSS 0–1.5; Class 2– mild to moderate disability, n=16, 12 F, 50.5±9.7, EDSS 2.0–4.0; Class 3– moderate disability, n=13, 10 F, 49.5±10.4, EDSS 4.5–6.5) participated in this study. All participants performed a 10-meter Walk Test (10mWT) and a Figure-of-8 Walk Test (F8WT) [3] while wearing five IMUs (APDM, Opal, 128 Hz) on both lateral malleoli, pelvis, sternum, and head. Stride segmentation was performed from leg IMUs. Spatio-temporal (ST) parameters (stride frequency-SD and duration-SD) along with gait quality indices related to stability (Root Mean Square-RMS and Attenuation Coefficients-AC), symmetry (improved Harmonic Ratio-iHR), and smoothness (Spectral Arc Length-SPARC) of gait were obtained. In addition, the Mini-Balance Evaluation Systems Test (Mini-BESTest) was also administered. The correlation between biomechanical parameters and the clinical scale was investigated through Pearson’s correlation analysis after verifying for normal data distribution. Significant correlations (moderate to high correlations) were observed between spatio-temporal, stability, symmetry, and smoothness gait parameters and MiniBESTest, especially for patients with higher EDSS (Class 2&3) and for the F8WT (Table 1). In the clinical setting, instrumental gait analysis with IMUs is a useful tool for evaluating balance disorders in patients with MS, especially when clinical scales are not able to detect subtle impairments as in the earliest stages of the disease (Class 1,EDSS ≤ 1.5). Despite linear walking highlights several correlations between the clinical scale and dynamic gait indices, the F8WT confirms to be highly discriminant of the different levels of walking impairment since more challenging [3]. The IMU-based approach could be therefore integrated in clinical practice to quantify gait impairments when undetectable with a standard clinical measure.

Factors associated with levels of health-related quality of life in elderly women: secondary data analysis of the Korea National Health and Nutrition Examination Survey 2019.

The purpose of this study was to investigate factors related to the levels of health-related quality of life (HRQoL) in elderly women based on Wilson and Cleary's HRQoL model. This study analyzed data from the eighth Korea National Health and Nutrition Examination Survey 2019 on 868 women over the age of 65 years. Based on the HRQoL model, parameters were categorized as personal, environmental, and physiological characteristics; symptom status; functional status; and perception of health status. The data were analyzed by quantile regression. The overall level of HRQoL was 0.87. Factors related to HRQoL in the 10% quantile were higher education level, higher economic status, economic activity, more walking days, fewer diseases, lower stress, less activity limitation, and higher perceived health status. Factors related to the 25% quantile of HRQoL were more walking days, fewer diseases, less activity limitation, and higher perceived health status. Factors related to the 50% quantile were age, economic activity, more walking days, fewer disease, lower stress, less activity limitation, and higher perceived health status. Factors related to the 75% quantile of HRQoL were smoking, more walking days, fewer diseases, lower stress, less activity limitation, and higher perceived health status. While differing parameters were identified according to the level of HRQoL of elderly women in Korea, there were five common factors. Interventions that focus on increasing walking, mitigating diseases, stress, and activity limitations, and improving perceived health status can improve HRQoL.

Dynamic Postural Stability Among Individuals With Parkinson's Disease Following Performance-Based Overground Locomotor Training

Individuals with Parkinson’s disease (PD) exhibit compromised dynamic postural stability with impaired gait and balance, which contribute to walking limitations. Performing turns while walking perturbs mediolateral stability, challenges the daily functioning of people with PD, and is attributed to altered thoracic movement patterns that include reducing peak turn velocity (°/s). Although previous studies in our lab demonstrated that individuals with neurological impairments improved walking capacity following performance-based overground locomotor training (OLT), dynamic postural stability changes following OLT in people with PD remain unknown. PURPOSE: Characterize changes in dynamic postural stability during turns while walking among individuals with PD following OLT, evidenced by peak turn velocity change. METHODS: Twelve participants with PD (7 Male / 5 Female; Age: 68.5 ± 6.4 years; Hoehn and Yahr: 1-3) completed 24 60-minute OLT sessions twice-weekly. Baseline (PRE) and follow-up (POST) assessments included the 10-minute walk test (10MWT) indoors along a 60-meter corridor while wearing inertial sensors around the fourth lumbar vertebra and the sternum. Angular velocity was collected from each sensor and processed offline. First, turns were identified using integrated lumbar data and extracted from the sternum sensor. Next, peak turn velocity was averaged across all turns at PRE and POST, respectively. Finally, the mean peak turn velocity changes were calculated in the frontal (PTVF) and transverse (PTVT) planes of motion. Positive (+) change reflects improved dynamic postural stability during turns. Statistical analysis included one-tailed t-tests and Cohen’s d effect size. RESULTS: Completed turns increased after OLT (+1.5 ± 1.51; p < 0.01). PTVF showed a moderate and significant increase following OLT (+1.59 ± 2.18 °/s; 95%CI: 0.20, 2.98; p = 0.014; Cohen’s d = 0.43) while PTVT change was small and not significant (+0.88 ± 3.18 °/s; 95%CI: -2.90, 1.14; p = 0.179; Cohen’s d = 0.25). CONCLUSION: This study provides preliminary evidence suggesting that participants moderately improved frontal plane dynamic postural stability during turns after OLT by adapting thoracic movement patterns in ways that likely attenuated perturbed mediolateral stability.

The relationship between energy cost of walking, ankle push-off and walking speed in persons with multiple sclerosis

BackgroundThe energy cost of walking (ECw) is an important indicator of walking dysfunction in persons with multiple sclerosis (PwMS). However, its underlying causes and its relation with ankle push-off and walking speed are not well understood. Research questionWhat is the contribution of ankle push-off and walking speed to increased ECw in PwMS? MethodsTen PwMS with walking limitations and 10 individually gender- and age-matched healthy controls (HC) were included. All participants performed two 6-min walking trials on a treadmill at comfortable walking speed (CWS of PwMS) and fast walking speed (FWS, 130 % of CWS of PwMS). Kinetics and metabolic cost were evaluated. Generalized estimating equations were performed to investigate effects of group and walking speed, and their interaction. Spearman correlations were conducted to examine whether ECw was related to ankle push-off in PwMS, controlling for differences in walking speed in PwMS. ResultsECw at matched walking speed was significantly higher in PwMS compared to HC. Kinetic parameters were not different between the most impaired leg in PwMS and HC at matched walking speed, but asymmetry between both legs of PwMS was observed. At FWS, ECw reduced and ankle push-off increased similarly in both groups. ECw was inversely related to peak ankle power of the most impaired leg in PwMS at CWS. SignificanceSlow walking speed is one factor that contributes to increased ECw in PwMS. Furthermore, PwMS who had a higher ECw showed a lower peak ankle power, independent of walking speed. This indicates that ankle push-off could be a contributor to increased ECw.

P62. Responsiveness of outcome measures in nonsurgical patients with lumbar spinal stenosis: a secondary analysis from a randomized controlled trial

<h3>BACKGROUND CONTEXT</h3> Lumbar spinal stenosis (LSS) is a prevalent condition associated with limited walking capacity, reduced physical function and increased disability. While many patients with LSS potentially benefit from nonsurgical interventions, it is critical to have sensitive assessment tools to detect changes in these domains over time to guide clinical decisions. However, limited information is available about the responsiveness of performance-based tests and patient-reported outcomes commonly used to assess nonsurgical patients with LSS. <h3>PURPOSE</h3> To assess the responsiveness of the Self-Paced Walking Test (SPWT), Swiss Spinal Stenosis (SSS), and Oswestry Disability Index (ODI) in patients with LSS not surgically treated and derive their Minimal Clinically Important Difference (MCID) values. <h3>STUDY DESIGN/SETTING</h3> Secondary analysis from a randomized clinical trial of nonsurgical interventions for patients with LSS. <h3>PATIENT SAMPLE</h3> A total of 180 patients with complete data for the SPWT, SSS, and ODI at baseline, 2- and 6-month followups were analyzed. <h3>OUTCOME MEASURES</h3> Responsiveness analyzes included the SPWT, SSS, ODI and Patient Global Index of Change (PGIC). <h3>METHODS</h3> The SPWT, SSS, and ODI responsiveness were investigated by distribution- and anchor-based methods at 2- and 6-month followup. The distribution-based responsiveness was assessed using standardized effect sizes, and standardized response means. The anchor-based responsiveness used the PGIC as the external anchor to distinguish responders and non-responders. A 7-point scale was used at 2 and 6 months, ranging from ‘very much worse' to ‘very much improved.' First, Spearman correlation coefficients (Rho) were calculated between the mean change in each outcome measure and the PGIC scores. Next, based on the anchor, we defined the ‘minimal improvement' subgroup, including patients rating their overall status at least as ‘minimal improved,' and the ‘moderate improvement' subgroup, including patients rating theirs overall status at least as ‘much improved.' Then, we calculated Areas Under the Curve and MCIDs for each outcome in both subgroups. <h3>RESULTS</h3> The following values represent indices of responsiveness at 2 and 6 months for each outcome measure: (a) standard effect sizes were 0.48 and 0.50 for SPWT, -0.42 and -0.36 for SSS, -0.29 and -0.25 for ODI; (b) standard response means were 0.44 and 0.37 for SPWT, -0.45 and -0.34 for SSS, -0.33 and -0.27 for ODI; (c) Spearman's correlation coefficients between the PGIC and outcome measures were 0.44 and 0.39 for SPWT, -0.53 and -0.55 for SSS, -0.46 and -0.54 for ODI; (d) in the ‘minimal improvement' subgroup, MCIDs were 376 and 319 meters for SPWT, -5.3 and -5.8 points for SSS, -9.3 and -10.8 points for ODI; (e) AUCs were 0.76 and 0.68 for SPWT, 0.78 and 0.76 for SSS, 0.76 and 0.76 for ODI; (f) in the ‘moderate improvement' subgroup, MCIDs were 344.2 and 538.2 meters for SPWT, -5.5 and -7.5 points for SSS, -9.1 and -13.6 points for ODI; (g) AUCs were 0.71 and 0.74 for SPWT, 0.77 and 0.82 for SSS, 0.73 and 0.81 for ODI. <h3>CONCLUSIONS</h3> The SPWT, SSS, and ODI are similarly responsive outcome measures to assess and monitor changes in walking capacity, physical function, and disability over time in nonsurgical patients with LSS. Based on this finding, clinicians may use the MCIDs to assess patients' clinical progress, treatment effectiveness, and support shared decision-making. Also, researchers may use the MCIDs and effect sizes as references to inform future studies in the field. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Association of disease outcomes with physical activity in multiple sclerosis: A cross-sectional study.

This study included 213 participants who completed walking and cognitive function tests and self-report measures of symptoms and physical activity. Multivariate analysis of variance and discriminant function analysis identified combinations of MS outcomes associated with physical activity. The sample had a mean age of 49.6 years (SD = 13.2), a 3:1 female:male ratio, and a Patient Determined Disease Steps median (interquartile range) score of 1.0 (3.0). Multivariate analysis of variance demonstrated that MS outcome clusters were significantly associated with physical activity, namely walking (i.e., Six-Minute Walk, Timed Up and Go, and MS Walking Scale), Pillai's trace V = .16, F(3, 180) = 11.43, η² = .16; cognition (i.e., Symbol Digits Modalities Test, California Verbal Learning Test-Second Edition, Brief Visuospatial Memory Test-Revised), Pillai's trace V = .04, F(3, 204) = 2.79, η² = .04; and symptoms (i.e., fatigue, anxiety, depression, and pain), Pillai's trace V = .16, F(4, 199) = 9.30, η² = .16. Discriminant function analysis indicated that a significant discriminant function of walking endurance and walking limitations, depression, fatigue, and processing speed was associated with physical activity subgroups. The findings identified walking endurance and limitations, processing speed, depression, and fatigue as primary correlates of physical activity differences in persons with MS. These results may inform researchers and health care providers to consider these factors in behavior change interventions and clinical practices for promoting adequate physical activity levels in MS. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Surgical and Physical Therapy Management for a Medial Ankle Ganglion With Extra-articular Fibrosis in a Speed Skater: A Case Report

Background Ganglion cysts are common benign soft tissue tumors in the ankle that can require surgical removal. Extra-articular causes of fibrosis after cyst removal may require additional intervention. No data regarding the rehabilitation process of these treatments are available. Case Presentation A 28-year-old male speed skater and sports instructor was diagnosed with a ganglion at the medial ankle. Multiple nonsurgical and surgical treatments failed, resulting in limitations in walking, squatting, and skating. The patient developed a severe dorsiflexion (DF) restriction due to extra-articular fibrosis. Open release (OR) with perioperative mobilization was followed by intensive postoperative manual therapy. Outcome and Follow Up Four weeks after the OR, the patient restarted working as a sports instructor, and 8 weeks after the OR, he restarted skating. DF range of motion (ROM) showed a slight deficit, approximating 5° after 6 months. The Foot and Ankle Outcome Score measures were improved until at least 18 months postoperative from 56 to 83 points. Discussion This Case Report illustrates the surgical and physical therapy management in a patient with a medial ankle ganglion that was unresponsive initially. The outcomes of this Case Report suggest that OR with postoperative mobilization might be a treatment option if other procedures fail to restore function. Therefore, further research into the effectiveness of this treatment option in patients with severe ROM limitations of the ankle associated with extra-articular causes of fibrosis is wanted. JOSPT Cases 2022;2(3):132–140. Epub: 21 June 2022. doi:10.2519/josptcases.2022.10860

The Lumbar Stenosis Prognostic Subgroups for Personalizing Care and Treatment (PROSPECTS) study: protocol for an inception cohort study

BackgroundLumbar spinal stenosis (LSS) is a common degenerative condition that contributes to back and back-related leg pain in older adults. Most patients with symptomatic LSS initially receive non-operative care before surgical consultation. However, there is a scarcity of data regarding prognosis for patients seeking non-surgical care. The overall goal of this project is to develop and evaluate a clinically useful model to predict long-term physical function of patients initiating non-surgical care for symptomatic LSS.MethodsThis is a protocol for an inception cohort study of adults 50 years and older who are initiating non-surgical care for symptomatic LSS in a secondary care setting. We plan to recruit up to 625 patients at two study sites. We exclude patients with prior lumbar spine surgeries or those who are planning on lumbar spine surgery. We also exclude patients with serious medical conditions that have back pain as a symptom or limit walking. We are using weekly, automated data pulls from the electronic health records to identify potential participants. We then contact patients by email and telephone within 21 days of a new visit to determine eligibility, obtain consent, and enroll participants. We collect data using telephone interviews, web-based surveys, and queries of electronic health records. Participants are followed for 12 months, with surveys completed at baseline, 3, 6, and 12 months. The primary outcome measure is the 8-item PROMIS Physical Function (PF) Short Form. We will identify distinct phenotypes using PROMIS PF scores at baseline and 3, 6, and 12 months using group-based trajectory modeling. We will develop and evaluate the performance of a multivariable prognostic model to predict 12-month physical function using the least absolute shrinkage and selection operator and will compare performance to other machine learning methods. Internal validation will be conducted using k-folds cross-validation.DiscussionThis study will be one of the largest cohorts of individuals with symptomatic LSS initiating new episodes of non-surgical care. The successful completion of this project will produce a cross-validated prognostic model for LSS that can be used to tailor treatment approaches for patient care and clinical trials.

The Influence of Walking Limitations on Daily Life: A Mixed-Methods Study of 14 Persons with Late Effects of Polio.

Reduced walking ability is common in persons with late effects of polio (LEoP). Here, we explored how many walking limitations persons with LEoP perceive, and how these limitations influence daily life, by using a mixed-methods design. Fourteen persons (mean age 70 years, whereof 7 women) with LEoP responded to the Walking Impact Scale (Walk-12), and were interviewed individually. Qualitative data were analysed by systematic text condensation, and each quotation was deductively analysed in relation to the items in Walk-12. Running was perceived as most limited, whereas walking indoors without using support was perceived as least limited. A majority (>70%) were moderately to extremely limited in standing or walking, in walking speed and distance, which affected concentration and effort, as well as gait quality aspects. The limited walking ability intruded on many everyday activities, both indoors and outdoors, which affected social participation negatively. To increase safety when walking and reduce the fall risk, various strategies were adopted such as using aids, walking carefully, and avoiding risky activities. In conclusion, LEoP-related walking limitations influence participants’ activity and participation greatly. By using both the Walk-12 scale and face-to-face interviews, an increased understanding of how walking limitations influence everyday life was achieved.

The subjective minimal important change for the Six Spot Step Test in people with multiple sclerosis- The Danish MS Hospitals Rehabilitation study.

The Six Spot Step Test has shown good psychometric properties in terms of validity and reliability in people with multiple sclerosis. Yet, the responsiveness and minimal important change are unknown. The objective was to investigate the responsiveness of the Six Spot Step Test against the perceived change of walking limitations and establish estimates for the minimal important change in people with multiple sclerosis. The Six Spot Step Test was performed before and after four weeks of specialised multidisciplinary inpatient rehabilitation by 142 adults with mild to severe multiple sclerosis. Responsiveness was determined based on anchor- and distribution-based methods, using the Multiple Sclerosis Walking Scale-12 as external criterion. In a supplementary analysis, the Six-Minute Walking Test was used as an external criterion. The correlation between the baseline (r = 0.56, p < 0.01) and discharge (r = 0.55, p < 0.01) Multiple Sclerosis Walking Scale-12 and Six Spot Step Test scores were acceptable. Furthermore, the change scores were weakly associated (r = 0.1, p = 0.27). This trend was similar for the Six-Minute Walking Test when used as anchor. The smallest detectable change was estimated to 1.7seconds. An improvement in the Six Spot Step Test exceeding 2.1 (95% CI -0.9 to 5.0) sec and 4.9 (95% CI 1.2-8.6) sec may be considered clinically important on a group level based on the Multiple Sclerosis Walking Scale-12 and the Six-Minute Walking Test, respectively. In a sample of mild to severely disabled people with multiple sclerosis, the Six Spot Step Test showed fair responsiveness against a subjective and objective criterion, indicating a minimal important change between ≥ 2.1 and ≥ 4.9seconds, respectively. However, a weak association between the change in the Six Spot Step Test and the subjective and objective external criterion calls for cautious interpretation. Hence, the results should be further verified against a valid external criterion.