Timed Walk Test Research Articles

P229 The impact of early RA on lower limb kinematics

Abstract Background Despite advancements in the pharmacological management of early rheumatoid arthritis (RA), walking impairments remain a key feature of this disease. With limited published research analysing the impact of early RA on lower limb movement patterns during gait, more comprehensive data are required to optimise the recognition and targeted management of early musculoskeletal pathology in RA. This study compared lower limb biomechanical function in early RA participants to age and gender-matched healthy controls, determining explanatory relationships with measures of disease activity and physical function. Methods In a cross-sectional study using three-dimensional (3D) motion capture, lower limb kinematic data from 18 RA participants with disease duration ≤ 2 years were compared to 18 adults matched for age and gender. Standard clinical measures were used to collect data on disease activity, rheumatology physical function and self-reported physical impairment. Between-group differences in lower limb kinematics were investigated using principal component analysis (PCA). Explanatory variables of significantly altered lower limb kinematics in early RA were investigated using linear regression analysis. Results Of the lower limb parameters analysed, eversion of the rearfoot and midfoot were found to be significantly increased (p < 0.05) in early RA, with two principal components explaining 91.94% and 97.57% of the respective between-group variance. Rearfoot motion in early RA was explained by single regression models incorporating walking speed (R2 of 0.456, F ratio = 12.585, p = < 0.003), the footwear/impairment domain of the Leeds Foot Impact Scale (R2 = 0.358, F ratio = 8.371, p = <0.011) and rheumatoid factor (R2 = 0.358, F ratio = 8.371, p = <0.011). Midfoot eversion was explained by single regression models incorporating the timed walk test (R2 = 0.372, F ratio = 4.507, p = < 0.031), the percentage of gait at which toe-off occurred (R2 of 0.253, F ratio = 5.425, p = < 0.033) and walking speed (R2 = 0.235, F ratio = 4.912, p = < 0.042). Abduction of the rearfoot and midfoot were also significantly increased (p < 0.05) in early RA. Two principal components explained 97.67% and 97.2% of the respective between-group variance observed. No variables were found to explain altered motion at these sites. Dorsiflexion at the first metatarsophalangeal joint (MPJ) was significantly reduced (p < 0.05) in early RA, with a single principal component explaining 97.43% of between-group variance which was explained by a single regression model incorporating step length (R2 = 0.372, F ratio = 4.507, p = <0.031). Conclusion Within two years following diagnosis of RA, significant alterations in foot kinematics were observed despite management using current treat to target protocols. These alterations were of a greater magnitude than previously reported and were largely independent of current measures of disease activity, physical function and disease impact. Disclosures A.G. Izod Grants/research support; Dr William Scholl Research and Develpment Fund. C. Bowen None. K. Gallagher None. M. Seed None.

Reference Values and Correlations for Multiple Physical Performance Measures: A Cross-Sectional Study among Independently Mobile Older Men in Japan.

Purpose: Japan is one of few countries with a male life expectancy over 80 years. The gap between the healthy life span and the total life expectancy is large, highlighting the importance of maintaining physical performance. The present study aims to establish reference values for multiple physical performance measures among high-functioning oldest-old Japanese men and to investigate the correlations among these measurements to understand how these variables are related. Methods: This study was conducted with 120 Japanese males aged 80 years or older who were able to walk independently. Seven measures of physical performance were assessed: handgrip strength, quadriceps strength, static balance ability (one-legged stance), dynamic balance ability (Functional Reach Test; FRT), walking ability (5-m walking time test), combined movement ability (Timed Up & Go test), and bone quality. Cognitive function was also measured (Mini-Mental State Examination; MMSE). Results: Specific reference values are reported for each physical performance measurement explored in this study. Only six participants were classified as cognitively impaired, and 16 had mild cognitive impairment. There were significant correlations of varying levels among all of the measures of physical performance. Age was significantly correlated with all performance measures except FRT, and there was no correlation between age and MMSE. MMSE was weakly correlated with FRT and unrelated to the other performance measures. Conclusions: The reference ranges can be used by older men who have not yet reached 80 years and their health care providers as physical performance targets to facilitate the maintenance of independent mobility in later life.

Does disability level impact the relationship of muscle strength to walking performance in people with multiple sclerosis? a cross-sectional analysis

Background and PurposeStrength training can improve muscle weakness in people with multiple sclerosis (MS), but does not consistently improve walking. Disability level may impact the relationship of muscle weakness and walking performance in people with MS, but few studies have investigated the impact of disability on the relationship of strength and walking. The purpose of this study was to compare the relationships of strength in lower body and trunk muscles to walking performance between mild and moderate disability groups in people with MS. MethodsData from 36 participants with MS who had mild disability (Expanded Disability Status Scale - EDSS 0 to 3.5) and 36 participants who had moderate disability (EDSS 4.0 to 5.5) were analyzed. Hand-held dynamometry measured strength in eight muscle groups from the ankle, knee, hip, and trunk. Timed 25-Foot Walk (T25FW) and 6-Minute Walk Test (6MWT) measured walking speed and endurance, respectively. Pearson correlations and beta coefficients (ß) were reported for each bivariate relationship of muscle strength to T25FW and 6MWT from both mild and moderate disability groups. Linear regression was then used to compare differences in beta coefficients (Δß) between disability groups for the relationship of each muscle variable to T25FW and 6MWT. A positive Δß indicated a stronger relationship of strength to walking performance in the mild disability group, while a negative Δß favored the moderate disability group. ResultsOverall, there were stronger Pearson correlations between muscle strength variables to T25FW and 6MWT in the mild (r = 0.57 to 0.77) compared to moderate disability group (r = 0.10 to 0.54). The mild disability group had significantly greater beta coefficients for T25FW with ankle dorsiflexion (Δß = 0.67, 95%CI: 0.27–1.07), knee extension (Δß = 0.68, 95%CI: 0.28–1.08), and hip abduction (Δß = 0.77, 95%CI: 0.01–1.52); and for 6MWT with knee extension (Δß = 0.47, 95%CI: 0.06 to 0.88). Discussion and ConclusionFor people with MS, muscle strength in the lower extremity and trunk may be a more important contributor to T25FW in mild versus moderate disability, but not for 6MWT. While more studies are needed, these results may help to inform rehabilitation intervention when prioritizing strength training to improve walking.

Effects of Whole-Body Vibration Training on the Physical Function of the Frail Elderly: An Open, Randomized Controlled Trial

ObjectiveTo investigate the feasibility and benefits of whole-body vibration (WBV) exercise as a safe and effective training tool for countering sarcopenia and age-related declines in mobility and function in the frail elderly. DesignAn open, randomized controlled trial. SettingResidential care facilities. ParticipantsMale and female volunteers (N=117; 82.5±7.9y). InterventionsAfter prescreening for contraindications, participants were randomly allocated to a control, simulated WBV (SIM), or WBV exercise group. All participants received regular care, whereas WBV and SIM participants also underwent thrice-weekly exercise sessions for 16 weeks. Delivered by overload principle, WBV training began with 5 × 1-minute bouts at 6 Hz/2 mm (1:1 min exercise:rest), progressing to 10 × 1 minute at up to 26 Hz/4 mm, maintaining knee flexion. Training for SIM participants mimicked WBV exercise stance and duration only. Main Outcome MeasuresThe timed Up and Go, Parallel Walk, and 10-m Timed Walk (10mTW) tests performance were assessed, in addition to the Barthel Index Questionnaire, at baseline, 8, and 16 weeks of exercise, and 3, 6, and 12 months postexercise. ResultsHigh levels of compliance were reported in SIM (89%) and WBV training (93%), with ease of use and no adverse effects. In comparison to baseline levels, WBV training elicited clinically important treatment effects in all parameters compared to SIM and control groups. Treatment effects remained apparent up to 12 months postintervention for Parallel Walk Test and 6 months for 10mTW Test. Functional test performance declined during and postintervention in non-WBV groups. ConclusionsFindings indicate that 16 weeks of low-level WBV exercise provides easily accessible, adequate stimulus for the frail elderly to attain improved levels of physical functionality.

The Influence of Kinesio Taping on the Increase of Effort Tolerance in Patients after Laparoscopic Cholecystectomy

Physiotherapy in patients after laparoscopic cholecystectomy (CHL) is impeded by post-operative pain which causes a decline in patients’ activity, reduces respiratory muscle function and affects patients’ ability to look after themselves. The aim of this study was to assess the influence of Kinesio Taping (KT) on the increase in effort tolerance in patients after laparoscopic cholecystectomy. The task of the research was to compare results of 100-meter walk test in test group and control group before surgery, during and after physiotherapy. The research included 63 patients after CHL treated in General Surgery Department of Hospital in Nysa. Both test group (BA) and control group (KO) included randomly selected volunteers who met test qualification criteria. BA group consisted of 32 patients (26 females and 6 males), KO group consisted of 31 patients (22 females and 9 males). Both groups were subjected to complex physiotherapy and group BA had additional KT applications. The results were subjected to statistical analysis with the use of U MannWhitney test. The level of statistical significance was established at p < 0.05. The results showed that in the test conducted before surgery the level of median time recorded in the 100-meter test did not differ significantly between the two research groups. In further tests, the 100-meter walk test time was significantly shorter in the test group in comparison with the patients from the control group. Conclusion: The improvement in effort tolerance observed in the research indicates the efficiency of Kinesio Taping as a method complementing physiotherapy in patients after laparoscopic cholecystectomy.Keywords: Kinesio Taping, laparoscopic cholecystectomy, physiotherapy.

Perceptions and Practices Regarding Frailty in Kidney Transplantation: Results of a National Survey.

Given the potential utility of frailty, a clinical phenotype of decreased physiologic reserve and resistance to stressors, to predict postkidney transplant (KT) outcomes, we sought to understand the perceptions and practices regarding frailty measurement in US KT programs. Surveys were emailed to American Society of Transplantation Kidney/Pancreas Community of Practice members and 202 US transplant programs (November 2017 to April 2018). Program characteristics were gleaned from Scientific Registry of Transplant Recipients. The 133 responding programs (response rate = 66%) represented 77% of adult KTs and 79% of adult KT candidates in the United States. Respondents considered frailty to be a useful concept in evaluating candidacy (99%) and endorsed a need to develop a frailty measurement specific to KT (92%). Frailty measurement was more common during candidacy evaluation (69%) than during KT admission (28%). Of the 202 programs, 38% performed frailty assessments in all candidates while 23% performed assessments only for older candidates. There was heterogeneity in the frailty assessment method; 18 different tools were utilized to measure frailty. The most common tool was a timed walk test (19%); 67% reported performing >1 tool. Among programs that measure frailty, 53% reported being less likely to list frail patients for KT. Among US KT programs, frailty is recognized as a clinically relevant construct and is commonly measured at evaluation. However, there is considerable heterogeneity in the tools used to measure frailty. Efforts to identify optimal measurement of frailty using either an existing or a novel tool and subsequent standardization of its measurement and application across KT programs should be considered.

Potential of Timed 25-Foot Walk Values in Predicting Maximum Walking Distance in Persons with Multiple Sclerosis.

Expanded Disability Status Scale (EDSS) scores of 4.0 or greater are determined primarily by maximum walking distance (MWD). Estimation of MWD by persons with multiple sclerosis (MS) is often used due to the impracticality of formally walking a person with MS in a clinic setting. Previous studies have demonstrated discrepancies between estimated and actual MWDs. Whether Timed 25-Foot Walk test (T25FW) values can be used to predict MWD is currently unknown. This study aimed to determine whether T25FW time is predictive of MWD in persons with MS. This study is a post hoc analysis of a previously described prospective cohort study. Persons with MS with an EDSS score of 3.5 to 5.5 were included. The participant's T25FW values and MWD were measured. Of the 38 adult participants (mean age, 50.8 years; 27 women [71%]), 24 (63%) had relapsing-remitting MS. The median EDSS score was 4.5 (range, 3.5-5.5). The T25FW times were divided into seven categories (<5.0, 5.0-5.9, 6.0-6.9, 7.0-7.9, 8.0-8.9, 9.0-9.9, and ≥10.0 seconds). The MWDs were divided into corresponding EDSS score categories: ≥500, 300-499, 200-299, 100-199, and ≤99 m. Ordinal logistic regression, when controlled for age, found the T25FW categories to be predictive of EDSS score (χ2 = 17.630, df = 7, P = .014). The T25FW value may be used as a surrogate estimate of MWD. Further studies are needed to confirm the reliability of the T25FW in predicting MWD.

Using Body-Worn Sensors to Detect Changes in Balance and Mobility After Acute Aerobic Exercise in Adults with Multiple Sclerosis.

Current mobility and functional assessments do not capture the subtle changes in balance and gait that may predispose people with multiple sclerosis (MS) to falling. The purpose of this study was to use clinical and instrumented measures to examine the effects of an acute bout of aerobic exercise on balance and gait in individuals with MS. Ten adults with MS performed 15 minutes of moderate-intensity recumbent cycling or 15 minutes of rest. Exercise and rest visit order was randomized and separated by 1 week. Balance and mobility were assessed before, immediately after, and 2 hours after each test condition. There were no significant differences across measurement periods for Timed 25-Foot Walk test times or Brief Balance Evaluation Systems Test scores. Significant improvements in mean sway radius and sway velocity when standing on foam and in percentage of stance stride time variability were found immediately after exercise compared with immediately after rest. This study lends further evidence that individuals with MS can safely engage in single bouts of aerobic exercise without detrimental short-term effects on function and may actually receive some short-term benefit regarding standing postural sway and gait variability. Future research should examine the dose-dependent relationship of varying types, intensities, or timing of exercise necessary to elicit short-term functional benefit and long-term health outcomes.

Robotic mechanotherapy in patients with multiple sclerosis with impaired walking function

To study an effect of robotic mechanotherapy on the functional condition of patients with multiple sclerosis (MS) with impaired walking function using the ExoAtlet exoskeleton. A prospective open-source, uncontrolled, single-center study included 44 patients (main group, MG) with remitting course in remission (RRS) and secondary-progressive course (VPRS) of MS with 3 to 8 points on the Extended Disability Status Scale (EDSS). Eighteen people (subgroup 1) of this group were re-examined after 3 months and 8 people completed the second rehabilitation course (subgroup 2). Neurological deficits and functional condition of patients were assessed using the EDSS, the Multiple sclerosis functional composite (MSFC) test, which includes the assessment of walking - Timed 25- Footwalk, the assessment of upper limb functions - 9-HolePegTest (9-HPT), the assessment of mental abilities - Symbol Digit Modalities Test (SDMT). Additionally, cognitive functions were assessed by the Montreal Cognitive Assessment Scale (MoCA). The improvement in the EDSS score was 0.23 points (5%, p<0.001) after the first course and 0.64 points (12%, p<0.02) after 3 months. The study of the pyramid system showed an improvement of this indicator by 0.29 points (10.2%, p<0.02) in patients of MG and by 1 point (32.3%, p<0.05) in subgroup 2. The SDMT subtest showed the improvement by 2.3 points (4.5%, p<0.02) in MG. In subgroup 2, the improvement by 17.1 points (38.9%), p<0.05) before the start of the 2nd course and by 22.9 points (52%, p<0.02) at the end of the 2nd course of rehabilitation was observed. The improvement of the Timed 25-Foot walk test in MG patients was 3.1 seconds (19.6%, p<0.001), the 9-Hole Peg Test on the dominant hand was 1.56 seconds (5.1%, p<0.02), and on the non - dominant hand 2.28 seconds (6.2%, p<0.02). After rehabilitation, the MoCA test showed the significant (p<0.001) improvement in cognitive functions by 1.6 points (6.1%) in MG and by 1.9 points (7.5%, p<0.05) in subgroup 2. The results have shown the effectiveness regarding the problems in MS patients and the prospects for further study of the possibilities of robotic assistance to walking and support a vertical posture using the ExoAtlet exoskeleton in order to restore walking function in MS patients with motor deficits.

The association between fear of falling and functional tests in older adults with diabetes mellitus

Background: The number of older adults with diabetes mellitus (DM) is increasing. Falling during walking and the fear of it are prevalent in older adults with DM. Objective: This study aimed to examine the association between fear of falling (FoF) and functional tests in older adults with DM and to determine other factors affecting functional tests in these people. Methods: A cross-sectional study was conducted on 134 older adults with DM who had referred to the diabetes clinic of Matini Hospital in Kashan, Iran. The participants were selected through sequential sampling and then were categorized into two groups of “with” and “without FoF.” In addition to responding to a demographic questionnaire, the participants were assessed by the Mini-Mental State Examination, Diabetic Neuropathy Symptom Score, and Falls Efficacy Scale-International version. Walking performance of the participants was also measured using the Timed Up-and-Go, 5-Sit-to-Stand, and 50-Foot Timed Walk tests. Data were analyzed using the Chi-square, t-, and Mann–Whitney U-tests and linear regressions analysis. Results: Significant associations were found between FoF and education level, body mass index, waist-to-hip ratio, and having neuropathy (P

Effect of whole-body cryotherapy treatments on the functional state of patients with MS (multiple sclerosis) in a Timed 25-Foot Walk Test and Hand Grip Strength Test

Abstract Introduction: Whole-body cryotherapy (WBC) is one of the main elements of comprehensive rehabilitation of patients with multiple sclerosis (MS). It is used both to improve the mental and physical condition of patients. The study attempts to assess the effect of a series of 20 daily WBC treatments on global walking function and muscle strength in patients with MS. Materials and methods: The study included 25 patients with diagnosed MS (ICD10-G35), mean age 44.58 ±12.15 years, who after a detailed medical examination were qualified to a series of 20 daily WBC treatments. Treatments lasted 2–3 min at -110°C. Before and after the series of WBC treatments, all subjects were tested for global hand grip and thumb strength using a hydraulic dynamometer (kg) for both the right and the left hands, as well as measuring the time needed to walk a distance of 7.6 metres, in accordance with the Timed 25-Foot Walk Test, a standardised diagnostic test recommended for the global assessment of walking function by the National Multiple Sclerosis Society. The obtained results were subjected to statistical analysis. Results: After the series of WBC treatments, a marginal but statistically significant increase in thumb strength was observed in the right hand (p &lt; 0.01). Other changes in the value of hand-grip and thumb strength were not statistically significant. In addition, there were no statistically significant changes in the average time needed to cover the walking distance of 7.6 metres. Conclusions: The series of 20 daily WBC treatments for patients with MS did not significantly improve global walking function, although a beneficial effect on the thumb strength of the right hand was observed.

Recommended motor assessments based on psychometric properties in individuals with dementia: a systematic review

BackgroundMotor assessments are important to determine effectiveness of physical activity in individuals with dementia (IWD). However, inappropriate and non-standardised assessments without sound psychometric properties have been used. This systematic review aims to examine psychometric properties of motor assessments in IWD combined with frequency of use and effect sizes and to provide recommendations based on observed findings.We performed a two-stage systematic literature search using Pubmed, Web of Science, Cochrane Library, ALOIS, and Scopus (inception - July/September 2018, English and German). The first search purposed to identify motor assessments used in randomised controlled trials assessing effectiveness of physical activity in IWD and to display their frequency of use and effect sizes. The second search focused on psychometric properties considering influence of severity and aetiology of dementia and cueing on test-retest reliability. Two reviewers independently extracted and analysed findings of eligible studies in a narrative synthesis.ResultsLiterature searches identified 46 randomised controlled trials and 21 psychometric property studies. While insufficient information was available for validity, we observed sufficient inter-rater and relative test-retest reliability but unacceptable absolute test-retest reliability for most assessments. Combining these findings with frequency of use and effect sizes, we recommend Functional Reach Test, Groningen Meander Walking Test (time), Berg Balance Scale, Performance Oriented Mobility Assessment, Timed Up & Go Test, instrumented gait analysis (spatiotemporal parameters), Sit-to-Stand assessments (repetitions> 1), and 6-min walk test. It is important to consider that severity and aetiology of dementia and cueing influenced test-retest reliability of some assessments.ConclusionThis review establishes an important foundation for future investigations. Sufficient relative reliability supports the conclusiveness of recommended assessments at group level, while unacceptable absolute reliability advices caution in assessing intra-individual changes. Moreover, influences on test-retest reliability suggest tailoring assessments and instructions to IWD and applying cueing only where it is inevitable. Considering heterogeneity of included studies and insufficient examination in various areas, these recommendations are not comprehensive. Further research, especially on validity and influences on test-retest reliability, as well as standardisation and development of tailored assessments for IWD is crucial.This systematic review was registered in PROSPERO (CRD42018105399).

Muscle Dysfunction and Walking Impairment in Women with Multiple Sclerosis.

Recent evidence suggests that skeletal muscle dysfunction is involved in disability progression in people with multiple sclerosis (MS). However, the relationship between muscle dysfunction and walking impairments in MS remains unclear. Thus, the cross-sectional relationships between muscle-specific oxidative capacity and walking endurance in women with MS were evaluated. Twenty women with MS (11 African American, 9 white) were tested. Muscle oxidative capacity of the medial gastrocnemius was measured using near-infrared spectroscopy after electrical stimulation. Muscle endurance was evaluated using accelerometer-based mechanomyography during electrical stimulation. Muscle strength was measured during maximal voluntary plantarflexion using handheld dynamometry. Walking function was measured using the Timed 25-Foot Walk test and the 6-Minute Walk Test (6MWT). Reduced muscle oxidative capacity (R 2 = 0.68-0.71, P < .01) and muscle endurance (R 2 = 0.59-0.78, P < .01) were associated with lower Timed 25-Foot Walk time and 6MWT distance. Muscle strength was weakly correlated to 6MWT distance (R 2 = 0.21, P = .02). No differences in muscle function or clinical outcome measures were found between African American and white subgroups. Women with moderate-to-severe disability (Expanded Disability Status Scale [EDSS] score, 5.0-6.5) had significantly reduced muscle oxidative capacity, muscle endurance, and walking ability compared with women with mild disability (EDSS score, 2.5-4.5). Reductions in muscle function in people with MS are related to declines in walking function across all levels of disability. Muscle dysfunction is not differentially related to walking impairment in African American and white women with MS.

Assessing mobility for persons with lower limb amputation: the Figure-of-Eight Walk Test with the inclusion of two novel conditions

Purpose To investigate the internal consistency, convergent and known-groups construct validity of the Figure-of-Eight Walk Test with two novel conditions in persons with lower limb amputation, and to examine differences in walking performance between the three conditions within a group of persons with transtibial amputation and transfemoral amputation/knee disarticulation. Materials and methods Fifty adults with unilateral amputation participated, 28 of whom had undergone a transtibial amputation and 22 a transfemoral amputation/knee disarticulation. Three Figure-of-Eight Walk Test conditions were investigated: 1) walking at a self-selected walking speed, 2) walking while carrying a tray with two cups of water, and 3) walking on uneven terrain. Internal consistency was evaluated using Cronbach's alpha. Convergent construct validity was examined by analysing the relationship between the Figure-of-Eight Walk Test parameters and performance-based parameters (Amputee Mobility Predictor, Ten-Meter Walk Test, Six-Minute Walk Test) and self-report measures (Prosthetic Limb Users Survey of Mobility, Activities-specific Balance Confidence Scale) using Spearman’s rank-order correlations. Known-groups construct validity was assessed by comparing the Figure-of-Eight Walk Test parameters based on anatomical level of amputation. Friedman’s test and post hoc analysis were used to examine differences between the walking conditions within each group. Results Cronbach's alpha coefficients of the Figure-of-Eight Walk Test parameters for all three conditions ranged from 0.89 to 0.99. The Figure-of-Eight Walk Test time and step parameters demonstrated moderate to good correlation (ρ = −0.50 to −0.77) for performance-based mobility measures. The correlations were stronger during Condition 3 in comparison with the original Figure-of-Eight Walk Test. The correlation was fair to good (ρ = −0.41 to −0.57) for the self-report mobility measures. Comparison between groups showed a difference between transtibial and transfemoral amputation/knee disarticulation participants when it comes to the Figure-of-Eight Walk Test time and smoothness parameters in Condition 2 (p < 0.05). Comparison between walking conditions within each group showed significant differences in the Figure-of-Eight Walk Test parameters in the two novel conditions in comparison with the original Figure-of-Eight Walk Test. The Figure-of-Eight Walk Test and the novel conditions demonstrated excellent internal consistency, good convergent construct validity, and evidence of known-groups construct validity. Future studies should further develop and standardise the smoothness scale to better quantify walking performance and assess the responsiveness and reliability (inter-rater and intra-rater) of the Figure-of-Eight Walk Test (time and steps) and the novel conditions, while studies on known-groups validity should include persons with a wider mobility range. IMPLICATIONS FOR REHABILITATION Figure-of-Eight Walk Test with the two novel conditions, which include carrying a load and walking on uneven terrain, may help to provide meaningful information about walking ability in daily life. The two novel conditions pose different challenges to persons with lower limb amputation when compared to the original Figure-of-Eight Walk Test and underscore the relevance to assess mobility under challenging walking conditions. The Figure-of-Eight Walk Test and the two novel conditions demonstrated excellent internal consistency, good convergent construct validity, and evidence of known-groups construct validity.

Algorithm Assignment to Stereotactic Body Radiation Therapy Is Associated with High Risk of Post-Surgical Serious Adverse Events in Stage I Non-small Cell Lung Cancer Patients

For clinical Stage I non-small cell lung cancer (NSCLC) patients, identifying patients at increased risk for adverse events from surgical intervention, and thus more appropriate for stereotactic body radiation therapy (SBRT), remains a clinical challenge. Using a prospective treatment allocation model, we evaluated whether serious surgical events could identify high risk patients prior to treatment selection. From 2016 – 2018, clinical Stage I NSCLC patients receiving treatment in either the Department of Radiation Oncology or Division of Thoracic Surgery were invited to participate in a prospectively maintained database that included physiologic, pathologic, and functional status metrics. A multivariable logistic regression model was made to characterize the likelihood of SBRT receipt for all participating patients, and used to generate a predicted group value (allocation to surgery versus SBRT). From this, ≥ Grade 3 Common Terminology Criteria for Adverse Events (CTCAE) were compared among those surgical patients that the model allocated to surgery (concordant), versus those assigned to SBRT (discordant). In this prospective database, 104 (53%) received SBRT, 91 (47%) received surgery. Variables independently associated with allocation to SBRT included current smoking status (Odds Ratio 8.2, 95% CI 1.5 – 44.7), Global Initiative for Chronic Obstructive Lung Disease (GOLD) score ≥2, (OR 2.7, 95% CI 1.1 – 6.6), increasing 15-foot walk test time (per second increase OR 1.7, 95% CI 1.2 – 2.5), and ECOG ≥1 (OR 8.0, 95% CI 3.0 – 21.4). Of the 73 (80%) surgical patients with complete data for model allocation, 60 patients (82%) were predicted to receive surgery and 13 (18%) were predicted to receive SBRT. The rate of ≥Grade 3 CTCAE among discordantly assigned surgical patients was significantly higher than concordantly assigned surgical patients, 6/13 (46.2%) versus 10/60 (16.7%) respectively, p=0.03. Discordant allocation to SBRT was significantly associated with experiencing a ≥Grade 3 CTCAE following surgery (OR 4.3, 95% CI 1.2 – 15.5). Prospectively collected patient information that includes baseline functional and performance status metrics may assist in identifying surgical patients that are high-risk for ≥ Grade 3 CTCAE events. Identifying these patients at the time of consultation may assist in consideration for SBRT and shared-decision making.

Cognition Mediates the Relationship Between Sensory Function and Gait Speed in Older Adults: Evidence from the English Longitudinal Study of Ageing.

Gait speed is an important indicator for assessing overall health status. Previous studies have reported the important role of sensory function in gait speed; however, the underlying mechanism is still unclear. This study aimed to examine whether cognition mediates the association of sensory function with gait speed among English older adults. Gait speed was assessed by "timed walking test". Hearing was measured by using a hearing screening device. Vision was self-reported. Cognition was assessed by questionnaire. Baron and Kenny's causal steps method and Sobel test were used to examine the mediating effect. Among 4,197 participants aged 60 years and older, 13.5% had poor hearing and 12.6% had poor vision, 2.6% had both poor hearing and poor vision. Multiple linear regression models suggested that poor hearing (β= - 1.905, p < 0.001), poor vision (β= - 1.309, p = 0.004), and poor dual sensory function (β= - 2.442, p = 0.013) was associated with worse cognition. Cognition was correlated with gait speed (β= 0.004, p < 0.001). Poor hearing (β= - 0.072, p < 0.001), poor vision (β= - 0.031, p = 0.029), and poor dual sensory function (β= - 0.081, p = 0.011) was associated with slower gait speed. After introducing cognition into the models, regression coefficients between sensory function and gait speed decreased (β= - 0.066, p < 0.001 for hearing; β= - 0.027, p = 0.054 for vision; β= - 0.073, p = 0.020 for combined hearing and vision). Sobel test identified the significant mediating effect of cognition on the association between sensory function and gait speed. Cognition partially mediates the association between sensory function and gait speed. Efforts to maintain mobility performance in older adults should consider protecting both sensory function and cognition.

Walking time measures for evaluating OA of the knee

This study assessed the test-retest reliability and the sensitivity of self-paced walking time measurements for evaluating the functional performance of persons with knee osteoarthritis (OA). The 13 m timed walking tests were carried out on two separate occasions over a six-week period for 10 patients using a standardised protocol. The same measurements were recorded also for three additional patients before and after a six-week quadriceps strength training regimen. As indicated by an intraclass correlation coefficient of 0.83 with no significant intersession test differences for the group (P=0.98), the gait measurements were reliable. However, despite marked increase in knee extensor strength and significant subjective improvements in walking time for the three experimental subjects were smaller than the error of measurement. The findings suggest that regardless of reliability, measurements of self-paced level walking time might not be sufficiently sensitive for evaluating longitudinal changes in functional performance in this patient population.

Effects Of A Cooling Vest On Dual-task Performance And Fatigability In Persons With Multiple Sclerosis

Fatigue and heat sensitivity are commonly reported symptoms in persons with multiple sclerosis (PwMS). PwMS also often have difficulty performing concurrent cognitive and motor tasks that presents as a dual-task decrement. Heat sensitivity along with a dual-task decrement may hinder activities of daily living and quality of life for PwMS. Though using a cooling vest could help decrease heat sensitivity, it is currently unknown if it improves dual-tasking performance in PwMS. PURPOSE: To examine the effects of a cooling vest on cognitive-motor dual-task cost (DTC) and fatigability in PwMS. METHODS: 5 PwMS participated in two sessions that were at least 1 week apart. During one session participants wore a sham cooling vest and the other session an actual cooling vest. During each session participants completed a Timed 25-Foot Walk Test (T25FWT), 6 Minute Walk Test (6MWT), T25FWT while performing Serial 3’s, and a 6MWT while narrating a story. The type of vest and order of tests was randomized for each participant. Total times for T25FWT and total distances for 6MWT were recorded. DTC, defined as the percent change between single- and dual-task performance, was calculated. Fatigability, defined as the difference between the averages of the first two and the last two lap times of the 6MWT, was calculated. Paired samples t-tests were used to compare DTC during cooling and non-cooling sessions and fatigability during single- and dual-task conditions within each session. RESULTS: The mean DTC during the 6MWT for cooling and non-cooling was -4.1% and -6.5%, respectively. The DTC during the T25FWT for cooling was 7.3% and 11.5% for non-cooling. The mean distance walked during 6MWT dual-task increased from 275.5m without cooling to 285.6m with cooling. There was a trend towards significant difference between single- and dual-task fatigability during 6MWT for non-cooling session (Single: 1.6±7.6m; Dual: 6.2±5.3m; p=.051), but not for cooling session (Single: 0.7±3.8m; Dual: 12±16.4m; p=.082). CONCLUSION: Preliminary results with lower DTC and no significant difference between single- and dual-task fatigability when using a cooling vest suggests that a cooling vest may have a benefit PwMS while dual-tasking during endurance activities. Further research with a larger sample size is needed to confirm these findings.

Effects of Dance on Gait, Cognition, and Dual-Tasking in Parkinson's Disease: A Systematic Review and Meta-Analysis.

Dance-based interventions have been proposed for the management of Parkinson's disease (PD) symptoms. This review critically appraises and synthesises the research on the effects of dance interventions on gait, cognition and dual-tasking in PD, through a meta-analysis of peer-reviewed literature from seven databases. Eligible studies included people with PD, used a parallel-group or cohort design with a dance-based intervention, reported outcome measures of gait, cognition or dual-tasking, and were published in English up until September 2017. Of the initial 1079 articles, 677 articles were reviewed for eligibility, and 25 articles were retained. Only 12 articles had sufficient common assessment items for meta-analysis. Two independent reviewers extracted the data and assessed the risk of bias of each study using the Cochrane risk-of-bias tool. Based on pre-post change scores, gait speed, Timed Up and Go (TUG) test performance, freezing of gait questionnaire, and six-minute walk test times significantly improved after a dance intervention compared to controls. Global cognition assessed with Montreal Cognitive Assessment, and cognitive dual-tasking measured using dual-task TUG, also exhibited greater improvement in dance groups. There was limited evidence to determine the most effective intensity, frequency, duration of dance interventions or the most beneficial music. Findings must be interpreted cautiously because of the lack of randomised control trials, and the moderate to high risk of bias of studies. However, the results of papers with level-I and level-II.1 evidence suggest that dance may have the potential to ameliorate PD symptoms, particularly gait, global cognition and cognitive dual-tasking.

Why patients with multiple sclerosis perceive improvement of gait during treatment with natalizumab?

Gait impairment is one of the common manifestations of multiple sclerosis (MS) and contributes to a loss of quality of life. Natalizumab, an anti-α4 integrin monoclonal antibody, has been shown to have an effect in treatment of MS, reducing relapses and inflammatory lesions. Aim of our study was to assess how patients perceive gait impairment over the first year of treatment with natalizumab and what is the objective correlate of this change. This is an open-label prospective observational study. Subjective gait evaluation was measured by Multiple Sclerosis Walking Scale-12 (MSWS-12). Objective gait assessment included Timed 25-Foot Walk Test (T25FW) and spatiotemporal parameters of gait measured by a GAITRite instrument during a self-selected speed of walking (normal walk) and a fast speed of walking (fast walk). We analysed data of 50 patients with a relapsing-remitting form of MS, median EDSS 3.5 (range 1.5-5). MSWS-12 score significantly decreased between the baseline and month 12 of treatment (p < 0.001). Walking velocity and step length were significantly improved in Normal walk tests (p < 0.001). During the Fast walk tests, a step length and a double support time of the gait cycle were significantly improved (p = 0.001). Change in MSWS-12 score confirmed the clinically significant improvement of gait in patients with MS treated with natalizumab for 1 year. The analysis of spatiotemporal gait parameters has shown a significant improvement in self-selected gait velocity and step length.