Self-reported Walking Ability Research Articles

Telephone Health Coaching and Remote Exercise Monitoring (TeGeCoach) in Peripheral Arterial Occlusive Disease.

Supervised exercise programs are used to treat intermittent claudication (IC). Home-based exercise programs have been developed to lower barriers to participation. We studied the effects of one such exercise program (TeGeCoach) on self-reported walking ability in patients with IC. In a pragmatic multicenter randomized controlled trial (registration number NCT03496948), 1982 patients with symp - tomatic IC insured by one of three German statutory health insurance funds received either telephone health coaching with remote exercise monitoring (TeGeCoach; n = 994) or routine care (n = 988). The primary outcome was the change in Walking Impairment Questionnaire (WIQ) scores after 12 and 24 months in the intention-to-treat population. The secondary outcomes were healthrelated quality of life, symptoms of depression or anxiety, health competence, patient activation, alcohol use, and nicotine depen - dence. There was a significant group difference in WIQ score in favor of TeGeCoach (p < 0.0001), amounting to 6.30 points at 12 months (Bonferroni-corrected 95% CI [4.02; 8.59], Cohen's d = 0.26) and 4.55 points at 24 months ([2.20; 6.91], d = 0.19). Some of the secondary outcomes also showed positive results in favor of TeGeCoach at 12 months with small effect sizes (d ≥ 0.20), including physical health-related quality of life and patient activation. The average daily step count was not higher in the TeGeCoach group. Significant improvements regarding symptom burden demonstrate the benefit of a home-based exercise program and thus expand the opportunities for guideline-oriented treatment of IC. Future studies should additionally address the effect of home-based exercise programs on clinical variables by means of, for example, the 6-minute walk test.

Effects of Analgesics on Self-Reported Physical Function and Walking Ability in People With Hip or Knee Osteoarthritis: A Systematic Review and Meta-Analysis.

Hip and knee osteoarthritis are among the leading causes of global disability, and one of the main aims of the management is to improve physical function. The objective of this review was to investigate the effect of analgesics on physical function (self-reported physical function and walking ability). A systematic review and meta-analysis of the findings were performed. Randomized controlled trials investigating the effect of analgesics on self-reported physical function and walking ability were included. Analgesics were orally administered acetaminophen, nonsteroidal antiinflammatory drugs (NSAIDs), or opioids. Data were pooled in a random-effects model, and the standardized mean difference (SMD) with 95% CI was calculated (SMDs: 0.2-0.4 = small, 0.5-0.7 = medium, and ≥0.8 = large effect sizes). The quality of the evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation approach. A total of 1454 studies were identified, of which 33 were included. On self-reported physical function, the results showed low- to moderate-quality evidence for a small beneficial effect of acetaminophen (SMD = -0.13 [95% CI = -0.26 to 0.00]), NSAIDs (SMD = -0.32 [95% CI = -0.37 to -0.27]), or opioids (SMD = -0.20 [95% CI = -0.32 to -0.09]). There was moderate-quality evidence for a small effect of NSAIDs on pain during walking (SMD = -0.34 [95% CI = -0.45 to -0.23]). In people with hip or knee osteoarthritis, there was low- to moderate-quality evidence for small beneficial effects of analgesics on physical function and walking ability. Analgesics may improve physical function by reducing pain during exercise and walking.

O.4.1-6 Multidimensional physical activity profiles and changes in physical function and self-reported walking ability among community-dwelling older adults – a 4-year follow-up

Abstract Purpose Physical activity (PA) is multidimensional but often assessed using single metrics. We studied how data-driven PA profiles predict changes in physical functioning and self-reported walking ability over time among older adults. Methods Participants (n = 318) were community-dwelling 75-, 80- and 85-year-olds who wore a thigh-mounted accelerometer for 3-7 days at baseline. PA intensity, fragmentation, absolute and relative PA minutes, sit-to-stand transitions, and gait bout characteristics were used in PA profiling using k-means cluster analysis. Physical function was assessed at baseline and at follow-up 4 years later. Substantial decline in physical function was operationalized as decline of at least 2 points in the Short Physical Performance Battery (SPPB, range 0-12) and at least 0.2 m/s decline in habitual 10-m walking speed. Change in self-reported walking ability during 2 km walk was assessed using a 5-point scale (decline vs. no change/improvement for all). Data were analyzed using logistic regression analysis. Results Three physical activity profiles were identified, and named as Exercisers, Actives and Inactives. Exercisers and Actives accumulated high PA minutes, but Actives engaged in predominantly light intensity PA that was accumulated in shorter bouts. The largest difference was observed in relative PA minutes (minutes exceeding participants’ preferred walking speed). Inactives accumulated the lowest PA minutes, intensity and highest activity fragmentation. During the follow-up period, 32% of participants experienced a substantial decline in walking speed, 24% in SPPB score and 21% in self-reported walking ability. Among women, Exercisers, but not Actives, had lower risk for a substantial decline in walking speed (OR 0.30, 95% CI 0.10-0.95) and SPPB score (0.33, 0.12-0.88) compared to Inactives after adjusting for age, depressive symptoms, comorbidity and baseline walking speed or SPPB score. Among women, Exercisers also had lower risk for decline in self-reported walking ability, but this was explained by differences in health. For men, the differences were not statistically significant. Conclusions Daily PA that is accumulated in longer bouts and at intensity exceeding one’s preferred walking speed may be especially beneficial for the maintenance of physical function with advancing age. Funding Source Academy of Finland, Finnish Ministry of Education &amp; Culture and European Research Council.

Subjective and objective health predicting mortality and institutionalization: an 18-year population-based follow-up study among community-dwelling Finnish older adults

BackgroundObjective health measures, such as registered illnesses or frailty, predict mortality and institutionalization in older adults. Also, self-reported assessment of health by simple self-rated health (SRH) has been shown to predict mortality and institutionalization. The aim of this study was to assess the association of objective and subjective health with mortality and institutionalization in Finnish community-dwelling older adults.MethodsIn this prospective study with 10- and 18-year follow-ups, objective health was measured by registered illnesses and subjective health was evaluated by simple SRH, self-reported walking ability (400 m) and self-reported satisfaction in life. The participants were categorized into four groups according to their objective and subjective health: 1. subjectively and objectively healthy, 2. subjectively healthy and objectively unhealthy, 3. subjectively unhealthy and objectively healthy and 4. subjectively and objectively unhealthy. Cox regression model was used in the analyses. Death was used as a competing factor in the institutionalization analyses.ResultsThe mean age of the participants (n = 1259) was 73.5 years (range 64.0–100.0). During the 10- and 18-year follow-ups, 466 (37%) and 877 (70%) died, respectively. In the institutionalization analyses (n = 1106), 162 (15%) and 328 (30%) participants were institutionalized during the 10- and 18-year follow-ups, respectively. In both follow-ups, being subjectively and objectively unhealthy, compared to being subjectively and objectively healthy, was significantly associated with a higher risk of institutionalization in unadjusted models and with death both in unadjusted and adjusted models.ConclusionsThe categorization of objective and subjective health into four health groups was good at predicting the risk of death during 10- and 18-year follow-ups, and seemed to also predict the risk of institutionalization in the unadjusted models during both follow-ups. Poor subjective health had an additive effect on poor objective health in predicting mortality and could therefore be used as part of an older individual’s health evaluation when screening for future adverse outcomes.

Frailty, walking ability and self-rated health in predicting institutionalization: an 18-year follow-up study among Finnish community-dwelling older people

BackgroundIn clinical practice, there is a need for an instrument to screen older people at risk of institutionalization.AimsTo analyze the association of frailty, walking-ability and self-rated health (SRH) with institutionalization in Finnish community-dwelling older people.MethodsIn this prospective study with 10- and 18-year follow-ups, frailty was assessed using FRAIL Scale (FS) (n = 1087), Frailty Index (FI) (n = 1061) and PRISMA-7 (n = 1055). Walking ability was assessed as self-reported ability to walk 400 m (n = 1101). SRH was assessed by a question of general SRH (n = 1105). Cox regression model was used to analyze the association of the explanatory variables with institutionalization.ResultsThe mean age of the participants was 73.0 (range 64.0‒97.0) years. Prevalence of institutionalization was 40.8%. In unadjusted models, frailty was associated with a higher risk of institutionalization by FS in 10-year follow-up, and FI in both follow-ups. Associations by FI persisted after age- and gender-adjustments in both follow-ups. By PRISMA-7, frailty predicted a higher risk of institutionalization in both follow-ups. In unadjusted models, inability to walk 400 m predicted a higher risk of institutionalization in both follow-ups and after adjustments in 10-year follow-up. Poor SRH predicted a higher risk of institutionalization in unadjusted models in both follow-ups and after adjustments in 10-year follow-up.DiscussionSimple self-reported items of walking ability and SRH seemed to be comparable with frailty indexes in predicting institutionalization among community-dwelling older people in 10-year follow-up.ConclusionsIn clinical practice, self-reported walking ability and SRH could be used to screen those at risk.

PREDICTORS OF FALLS IN OLDER ADULTS ACROSS PARTNER SETTINGS

Falls cause significant morbidity and mortality in older adults. We explored predictors of falls in older adults completing Rapid Geriatric Assessments in Missouri (N=7796). Assessments were completed by health professionals and students at community sites (n= 1817), physician practices/clinics (n= 4441), nursing homes (n=525), and hospitals (n=1013). Multinomial regression analyses were used to identify predictors of falls from: age, gender, frailty score, self-reported walking ability, and cognition. Participants had a mean age of 78.4±8.4, were 65.2% female, 41.7% fallers, 28.1% frail, and 40.5% pre-frail. All variables except gender were associated with falls. For the total sample, frailty (OR 2.11 for 1-3 falls, OR 3.74 for 4+ falls; p<.001) and self-reported walking difficulty (OR 1.85 for 1-3 falls, OR 2.36 for 4+ falls; p<.001) had the highest odds ratios and were consistent predictors of falls in site-specific analyses. Self-rated walking, age, and cognition were risk factors in some settings.

HEALTH AND PHYSICAL FUNCTIONING AS DETERMINANTS OF PURPOSE IN LIFE IN OLD AGE

AbstractPurpose in life reflects the feeling of having goals and meaning in life. Higher purpose in life has been shown to predict better health outcomes in old age and even buffer against mortality. However, it is not known how current health and functional status reflect on the possibilities of older people to live a meaningful life. Therefore, this study aimed to explore associations of health and physical functioning with purpose in life. The participants were 273 community-dwelling 75-year-old men and women from the AGNES study. Purpose in life was assessed with the subscale of the Scales of Psychological well-being (range 7–42). Current health situation and walking ability were self-reported (range 1–5). Physical performance was measured with the Short Physical Performance Battery (range 0–12). Linear regression models adjusted for sex, years of education and marital status were used in the analyses. Better self-rated health (β=1.49, p<.001) and self-reported walking ability (β=0.69, p=.016) were associated with higher purpose in life. Physical performance was not associated with purpose in life (β=0.19, p=.187). Based on the results, it seems that self-reports of health and functioning may be more relevant when considering older people’s possibilities to live a meaningful life than objective measures of functioning.

Effect of testosterone replacement on measures of mobility in older men with mobility limitation and low testosterone concentrations: secondary analyses of the Testosterone Trials

The Physical Function Trial (PFT) was one of seven Testosterone Trials (TTrials), the aim of which was to assess the effect of testosterone on mobility, self-reported physical function, falls, and patient global impression-of-change (PGIC) in older men with low testosterone concentrations, self-reported mobility limitation, and walking speed of less than 1·2 m/s. Using data from the PFT and the overall TTrials study population, we also aimed to identify whether the effect of testosterone on mobility differed according to baseline walking speed, mobility limitation, or other participant-level factors. The TTrials included 790 men aged 65 years or older and with an average of two total testosterone concentrations below 275 ng/dL (9·5 nmol/L), of whom 390 had mobility limitation and a walking speed below 1·2 m/s and were enrolled in the PFT. Participants were assigned (by minimisation method) to 1% testosterone gel or placebo gel daily for 12 months, with participants and study staff masked to intervention allocation. The primary outcome of the PFT was an increase in 6 min walk test (6MWT) distance of 50 m or more. Here we report data for absolute change in 6MWT distance and physical component of Short Form-36 (PF10), and for PGIC and falls. Data are reported for men enrolled in the PFT and those who were not, and for all men in TTrials; data are also reported according to baseline walking speed and mobility limitation. Analyses were done in a modified intention-to-treat population in all patients who were allocated to treatment, had a baseline assessment, and at least one post-intervention assessment. The TTrials are registered with ClinicalTrials.gov, number NCT00799617. The TTrials took place between April 28, 2011 and June 16, 2014. Of 790 TTrials participants, 395 were allocated to testosterone and 395 to placebo; of the 390 participants enrolled in the PFT, 193 were allocated to testosterone and 197 to placebo. As reported previously, 6MWT distance improved significantly more in the testosterone than in the placebo group among all men in the TTrials, but not in those who were enrolled in the PFT; among TTrials participants not enrolled in the PFT, 6MWT distance improved with a treatment effect of 8·9 m (95% CI 2·2-15·6; p=0·010). As reported previously, PF10 improved more in the testosterone group than in the placebo group in all men in TTrials and in men enrolled in the PFT; among those not enrolled in the PFT, PF10 improved with an effect size of 4·0 (1·5-6·5; p=0·0019). Testosterone-treated men with baseline walking speed of 1·2 m/s or higher had significantly greater improvements in 6MWT distance (treatment effect 14·2 m, 6·5-21·9; p=0·0004) and PF10 (4·9, 2·2-7·7; p=0·0005) than placebo-treated men. Testosterone-treated men reporting mobility limitation showed significantly more improvement in 6MWT distance (7·6 m, 1·0-14·1; p=0·0237) and PF10 (3·6, 1·3-5·9; p=0·0018) than placebo-treated men. Men in the testosterone group were more likely to perceive improvement in their walking ability (PGIC) than men in the placebo group, both for men enrolled in the PFT (effect size 2·21, 1·35-3·63; p=0·0018) and those not enrolled in the PFT (3·01, 1·61-5·63; p=0·0006). Changes in 6MWT distance were significantly associated with changes in testosterone, free testosterone, dihydrotestosterone, and haemoglobin concentrations. Fall frequency during the intervention period was identical in the two treatment groups of the TTrials (103 [27%] of 380 analysed in both groups had at least one fall). Testosterone therapy consistently improved self-reported walking ability, modestly improved 6MWT distance (across all TTtrials participants), but did not affect falls. The effect of testosterone on mobility measures were related to baseline gait speed and self-reported mobility limitation, and changes in testosterone and haemoglobin concentrations. US National Institute on Aging and AbbVie.

Self-directed exercise in multiple sclerosis: Evaluation of a home automated tele-management system

Introduction Physical rehabilitation is one of the few non-pharmaceutical therapies for maintaining or improving walking ability for patients with multiple sclerosis. However, travel distance to rehabilitation clinics, neurological disability and insurance coverage often limit access to specialised rehabilitation services. To address these issues, we utilised a web-based system to support a home-based self-directed exercise programme. Methods Patients (n = 24) were randomised to either routine home rehabilitation or to the multiple sclerosis home automated tele-management system for a six-month period. The study group had a mean age of 50.4 years, 56% of patients were male, and 67% had progressive multiple sclerosis with an overall mean Patient Determined Disease Steps score of 4.4 (cane or crutch required for walking). Key outcomes included the timed 25-foot-walk, six-minute-walk and the Berg Balance Scale. Results There was no statistically significant difference in the change of the primary walking outcome measure, timed 25-foot-walk, at six months between the home automated tele-management intervention and control groups (p = 0.44). Similarly, change scores for the six-minute-walk were not significantly different between the home automated tele-management or control groups at six months. Discussion Maintaining overall gait abilities in this group of predominantly progressive multiple sclerosis patients is notable. Exercise adherence was positively associated with higher multiple sclerosis disability and self-reported walking ability. Study engagement and participation in routine home-based exercise for the entire study period was challenging. Further research using clinical video telerehabilitation techniques that optimise patient involvement warrants further study.

Longitudinal changes in self-reported walking ability in multiple sclerosis.

BackgroundPatient-reported outcomes are increasingly used to understand the clinical meaningfulness of multiple sclerosis disability and its treatments. For example, the 12-item Multiple Sclerosis Walking Scale (MSWS-12) measures the patient-reported impact of the disease on walking ability.ObjectiveWe studied longitudinal changes in walking ability using the MSWS-12 in a cohort of 108 patients with relapsing-remitting multiple sclerosis and moderate-to-severe disability from a single US center cohort study investigating multiple sclerosis symptoms and physical activity.MethodsThe MSWS-12 was completed every 6 months over 2 years together with self-reported measures of disease impact on daily life (Multiple Sclerosis Impact Scale) and walking disability (Patient Determined Disease Steps scale).ResultsThe results revealed a high frequency of self-reported changes in walking ability at the individual level, affecting approximately 80% of patients for all four time periods. MSWS-12 scores remained stable at the group level for all four time periods. The magnitude of observed changes at the individual level was higher than the proposed minimal clinically important differences of 4 or 6 points and correlated better with Multiple Sclerosis Impact Scale physical scores than psychological scores, but little with self-reported Patient Determined Disease Steps Scale scores.ConclusionsThis novel finding of frequent fluctuations in self-reported walking ability is new and requires further investigation.

Predicting 5- and 10-year survival in older women with early-stage breast cancer: self-rated health and walking ability.

To determine life expectancy for older women with breast cancer. Prospective longitudinal study with 10 years of follow-up data. Hospitals or collaborating tumor registries in four geographic regions (Los Angeles, California; Minnesota; North Carolina; Rhode Island). Women aged 65 and older at time of breast cancer diagnosis with Stage I to IIIA disease with measures of self-rated health (SRH) and walking ability at baseline (N = 615; 17% aged ≥80, 52% Stage I, 58% with ≥2 comorbidities). Baseline SRH, baseline self-reported walking ability, all-cause and breast cancer-specific estimated probability of 5- and 10-year survival. At the time of breast cancer diagnosis, 39% of women reported poor SRH, and 28% reported limited ability to walk several blocks. The all-cause survival curves appear to separate after approximately 3 years, and the difference in survival probability between those with low SRH and limited walking ability and those with high SRH and no walking ability limitation was significant (0.708 vs 0.855 at 5 years, P ≤ .001; 0.300 vs 0.648 at 10 years, P < .001). There were no differences between the groups in breast cancer-specific survival at 5 and 10 years (P = .66 at 5 years, P = .16 at 10 years). The combination of low SRH and limited ability to walk several blocks at diagnosis is an important predictor of worse all-cause survival at 5 and 10 years. These self-report measures easily assessed in clinical practice may be an effective strategy to improve treatment decision-making in older adults with cancer.

Clinical Outcomes for Neurogenic Claudication Using a Multimodal Program for Lumbar Spinal Stenosis: A Retrospective Study

ObjectiveThe purpose of this preliminary study was to assess the effectiveness of a 6-week, nonsurgical, multimodal program that addresses the multifaceted aspects of neurogenic claudication. MethodsIn this retrospective study, 2 researchers independently extracted data from the medical records from January 2010 to April 2013 of consecutive eligible patients who had completed the 6-week Boot Camp Program. The program consisted of manual therapy twice per week (eg, soft tissue and neural mobilization, chiropractic spinal manipulation, lumbar flexion-distraction, and muscle stretching), structured home-based exercises, and instruction of self-management strategies. A paired t test was used to compare differences in outcomes from baseline to 6-week follow-up. Outcomes included self-reported pain, disability, walking ability, and treatment satisfaction. ResultsA total of 49 patients were enrolled, with a mean age of 70 years. The mean difference in the Oswestry Disability Index was 15.2 (95% confidence interval [CI], 11.39-18.92), and that for the functional and symptoms scales of the Swiss Spinal Stenosis Questionnaire was 0.41 (95% CI, 0.26-0.56) and 0.74 (95% CI, 0.55-0.93), respectively. Numeric pain scores for both leg and back showed statistically significant improvements. Improvements in all outcomes were clinically important. ConclusionsThis study showed preliminary evidence for improved outcomes in patients with neurogenic claudication participating in a 6-week nonsurgical multimodal Boot Camp Program.

Assessing Fatigability in Mobility‐Intact Older Adults

To evaluate the criterion validity of two measures of fatigability, defined as performance deterioration or perceived effort to perform a standardized task. Cross-sectional analysis of data from the Baltimore Longitudinal Study of Aging (BLSA). National Institute on Aging, Intramural Research Program, Clinical Research Unit, Baltimore, Maryland. Six hundred five men (53.7%) and women aged 65 to 97 participating in the BLSA and eligible for endurance walk testing without a walking aid. Fatigability was assessed using completion status and lap times from a 400-m walk performed "as quickly as possible" and perceived exertion rating using the Borg scale (range 6-20) after 5 minutes of treadmill walking at 1.5 miles per hour (0.67 m/s). Criterion measures included self-report of tiredness, level of weakness and energy in past month, and walking ability and objective measures of usual and fast gait speed, time to complete 10 chair stands, and grip strength. Covariates included age, race, sex, obesity, smoking status, and walking activity. Of mobility-intact older persons, 23% exhibited performance deterioration (slowed or stopped) during the 400-m walk, and one-third reported more than very light exertion after a 5-minute slow walk. Slowing was strongly associated with self-reported fatigue and walking ability but weakly associated with performance-based mobility measures. High perceived exertion was associated with tiredness, weakness, and reported and observed mobility deficits. Slowing down may have low sensitivity for identifying fatigability in older persons, but ascertaining perceived exertion during a defined workload shows promise. In seemingly healthy, motivated individuals, fatigue and fatigability were common and may affect socially meaningful mobility behaviors. Assessment of fatigability in well-elderly examinations may help identify threats to independent functioning earlier in the decline process.

Relationship between self-reported walking ability and objectively assessed gait performance in persons with late effects of polio

Muscle weakness in the lower limbs and impeded gait performance are common in persons with late effects of polio. To assess self-reported walking ability in persons with late effects of polio and determine the relationship with objectively assessed gait performance. One-hundred and twenty-two individuals with prior polio (65 women and 57 men, mean age 65 [SD ± 9] years) participated in the study. The main outcome measures were: Walk-12 (Swedish version) to assess self-reported walking ability, and Timed "Up & Go", Comfortable Gait Speed, Fast Gait Speed and 6-Minute Walk Tests to assess gait performance objectively. More than 50% of the participants reported limitations (moderately or quite a bit) related to standing or walking, climbing stairs, walking speed and distance, concentration and effort, and gait quality aspects. Half of the participants reported no need to use support when walking indoors or outdoors, but 58% reported that their ability to run was extremely limited. Significant correlations (P < 0.01) were found between the Walk-12 and the four gait performance tests (rho -0.66 to 0.63). The strength of the relationship implies that Walk-12 reflects broader dimensions than the objective gait performance tests and can be a complement when the walking ability in persons with late effects of polio is evaluated.

Timed 25-Foot Walk

In this study, we used data from clinical trials of dalfampridine (fampridine outside the United States) to re-examine the clinical meaningfulness of Timed 25-Foot Walk (T25FW) changes. Pooled data were analyzed from 2 phase III randomized placebo-controlled clinical trials of dalfampridine in multiple sclerosis (MS) (n = 533). Walking speed (T25FW) and patient-reported walking ability (MS Walking Scale-12 [MSWS-12]) were measured, concurrently, multiple times before and during treatment. We examined T25FW speed variability within and between visits, correlations of T25FW speed with MSWS-12 score, and changes in MSWS-12 (mean scores, effect sizes) associated with percent T25FW changes. T25FW speed variability was small (within- and between-visit averages = 7.2%-8.7% and 14.4%-16.3%). Correlations between T25FW and MSWS-12 values were low (-0.20 to -0.30), but relatively stronger between their change values (-0.33 to -0.41). Speed improvements of >20%, and possibly 15%, were associated with clinically meaningful changes in self-reported walking ability using MSWS-12 change score and effect size criteria. This study builds on existing research and provides direct evidence that improvements in T25FW speed of ≥ 20% are meaningful to people with MS. The dalfampridine data enabled examinations previously not possible, including spontaneous and induced speed changes, speed change anchored to change in self-reported walking ability, and a profile of speed changes. Results support the T25FW as a clinically meaningful outcome measure for MS clinical trials.

Preoperative Prediction of Ambulatory Status at 6 Months After Total Hip Arthroplasty

Total hip arthroplasty (THA) is an effective procedure that provides patients with long-term relief from pain and enables them to resume their normal daily activities. Preoperative instruction about the functional outcomes and optimum goal of rehabilitation is helpful for patients undergoing THA. The purposes of this study were: (1) to examine the relationships between preoperative physical functions and ambulation following THA and (2) to identify optimal cutoff values for estimating ambulatory status at 6 months after THA. This was a retrospective study. The study participants were 204 patients who underwent a unilateral THA. Hip abductor and knee extensor strength were measured and the Timed "Up & Go" Test (TUG) was conducted preoperatively. The patients were divided into 2 groups according to self-reported walking ability at 6 months postoperatively: an independent ambulation group (n=118) and a cane-assisted ambulation group (n=86). Differences between the 2 groups were examined using an unpaired t test or the chi-square test. A stepwise multiple logistic regression analysis was performed with walking ability at 6 months postoperatively as a dependent variable and age, sex, contralateral hip osteoarthritis (ie, whether a participant had contralateral hip osteoarthritis or not), body mass index, hip abductor strength, knee extensor strength, and TUG score as independent variables. Receiver operating characteristic curve analysis was used to identify a cutoff point for classifying the participants into the 2 groups. A stepwise multiple logistic regression analysis selected 3 factors (age, knee extensor strength, and TUG score) as significant variables affecting the midterm ambulatory ability after THA. Moreover, receiver operating characteristic curve analyses revealed that the midterm (ie, 6-month) ambulatory status after THA was more accurately predicted by the patient's TUG score (cutoff point=10 seconds, sensitivity=76.7%, specificity=93.2%, area under the curve=0.93) than by age and knee extensor strength. The categorization of ambulatory status in this study was based solely on self-reported walking ability. The findings indicate that patients with a preoperative TUG score of less than 10 seconds are likely to walk without an assistive device at 6 months after THA.

Patients Overestimate Their Walking Disability

Barcelona – People with knee and hip osteoarthritis tend to overstate their walking disability, but timed walking tests provide an accurate assessment of disability, according to a new study. “We found a very poor correlation between self-reports and objective tests,” said Dr. Luke Brunton, an orthopedic surgeon at the musculoskeletal research unit at the University of Bristol (England). “There was a much better correlation between the observers’ reports and the tests than the patient’s self-reported walking ability.” Walking impairment is particularly important because it is linked to reduced lifespan, social isolation, and dementia, Dr. Brunton noted. “Questions on walking are very often used to assess function, quality of life, and disability in people with OA,” he pointed out during his presentation at the World Congress on Osteoarthritis. He and his colleagues used data from a large U.K. community-based cohort study known as the South West and Avon Survey of Health (SASH) cohort. Self-assessment questions were taken from the commonly used Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Lequesne assessment. WOMAC asks, “What degree of difficulty have you experienced walking on flat ground in the last week due to your hips or knees?” while Lequesne asks, “What is the maximum distance you can walk with pain?” The study involved 806 participants with a mean age of 68 years and body mass index of 28.6 kg/m. They were asked to carry out a timed 6-meter walking test and a “get up and go” test. “We tell the observers it doesn’t matter how long the person is taking. The important thing is how easy it is for the patient to complete the test or not,” explained Dr. Brunton. A stronger association was found between observer evaluation of walking ability and the timed walk (ANOVA r2 = 0.58) and “get up and go” tests (ANOVA r2=0.56), than patient selfreports (ANOVA r2=0.23 and ANOVA r2 =0.27) with the objective tests. ANOVA r2 is a measure of the statistical correlation between the two variables “It is notable that the observers were watching the patients actually carry out a test, whereas patients were asked generally how well they walked,” which are different scenarios, he said. “But if you are only asking patients one question on walking you are assuming that their self-assessment and their functional test should be very similar. We have showed this isn’t the case.” He acknowledged that“most clinicians would assess patients themselves rather than relying solely on questionnaires.” Dr. Brunton disclosed no relevant financial conflict of interest. CfA Becky McCall is an IMNG Medical News freelance writer based in London. Patients Overestimate Their Walking Disability

Self-reported Walking Ability in Persons With Chronic Stroke and the Relationship With Gait Performance Tests

To assess self-reported walking ability in individuals with chronic stroke and to determine the relationship with gait performance tests. Descriptive analysis of a convenience sample. A university hospital rehabilitation medicine clinic. Fifty ambulatory community-dwelling poststroke individuals (mean age, 64 years [range, 44-74 years] and mean time since stroke onset 42 months [range, 6-101 months]). The Walking Impact Scale (the Walk-12) to assess self-reported walking ability, and the Timed "Up & Go" test, 10-m Comfortable Gait Speed and Fast Gait Speed tests, and 6-Minute Walk Test to assess gait performance. A majority of the participants (94%) reported limitations in their walking ability. The most common limitations were related to standing or walking, walking speed and distance, effort, and gait quality aspects. The ability to run was reported as most affected, whereas the need for support indoors or outdoors was least affected. Significant correlations (P < .01) were found between the Walk-12 and the 4 gait performance tests (ρ = -0.60 to 0.60). Persons with chronic stroke perceive limitations in their walking ability. The relationship between the Walk-12 and the 4 gait performance tests indicates that self-reports and quantitative assessments are associated. Because the Walk-12 reflects broader dimensions than the gait performance tests, it can be a complementary tool when walking ability in persons with chronic stroke is evaluated.

Clinically meaningful change in stair negotiation performance in older adults

Stair negotiation is a key marker for independence among older adults; however, clinically meaningful change has not been established. Our objective was to establish the values of clinically meaningful change in stair negotiation time using distribution- and anchor-based approaches.Study participants were 371 community residing older adults (age≥70) in the Einstein Aging Study with time to ascend and descend 3 steps measured at baseline and at one-year follow-up. Anchor-based estimates were obtained using functional decline (defined as one-point increment in disability score) and change in self-reported walking ability over the one-year follow-up period. Small, moderate, and large meaningful change estimates were 0.28, 0.71, and 1.15s for stair ascent time (0.31, 0.78, and 1.25s for stair descent time) using the distribution-based approach of effect size. The estimates of meaningful decline range from 0.47 to 0.53s for stair ascent time (0.33–0.53s for stair descent time) using the anchor-based approach. The estimates of meaningful improvement were smaller (0.13–0.18s for stair ascent, 0.06–0.15 for stair descent) compared to those for decline. Based on general consistency between distribution- and anchor-based approaches, preliminary criteria suggested for stair negotiation time is 0.5s for meaningful decline and 0.2s for meaningful improvement.

Depression Is Associated With a Poorer Outcome of Lumbar Spinal Stenosis Surgery

Prospective clinical study. To investigate the effect of depressive symptoms on the surgery outcome on 2-year follow-up among lumbar spinal stenosis (LSS) patients. Previous research has suggested an association between preoperative depressive symptoms and a poorer surgery outcome among LSS patients. There have been no previous studies on the effect of depressive symptoms on the surgery outcome at the 2-year postoperative phase. A total of 96 patients (mean age, 62 years) with symptomatic LSS underwent decompressive surgery. They completed the same set of questionnaires before surgery and 3 months, 6 months, 1 year, and 2 years after surgery. Depression was assessed with the 21-item Beck Depression Inventory (BDI). Physical functioning and pain were assessed with the Oswestry Disability Index, the Stucki Questionnaire, self-reported walking ability, he visual analogue scale, and pain drawing. Comparisons were made according to depression status. Logistic regression analysis was used to examine the factors associated with a poorer surgery outcome on 2-year follow-up. After surgery, the patients with continuous depression showed poorer improvement in symptom severity, the disability score, and walking capacity than the patients who did not have depression in any phase. In those patients who recovered from depression, the postoperative improvement resembled that of the constant normal mood group. In regression analyses, an independent association was detected between high preoperative BDI scores and 2-year disability and symptom severity. Strong independent associations were seen between depression burden (the sum of preoperative, 3-month and 6-month BDI scores) and 2-year disability, symptom severity, and poor walking capacity. The patients with a normal mood and those who recovered from depressive symptoms enjoyed the most favorable outcome. Depressive symptoms interfere strongly with the ability of patients to obtain an optimal surgery outcome. Treatment models including the assessment and treatment of depression are encouraged.