Purpose: The purpose of this study was to establish reliability and validity of a clinically useful gait classification system for older adults using gait and physical performance measures in 2 different populations. Methods: We classified gait patterns using structured clinical observation and expected the gait patterns to be defined by variability of movement (consistent, inconsistent) and postural biomechanical factors (usual, flexed, extended, crouched) observed in walking. Male veterans (n=106) referred to the VA GEM Program (mean age, 76; SD, 7.1; range, 63-97 years) were videotaped for analyses. The inter- and intra-rater reliability was determined. Pair-wise comparisons across various groups were performed to validate the gait classification using gait parameters (gait speed, step length, width and variability), lower extremity range of motion and muscle strength, physical function in ADL (Physical Performance Test, PPT) and gait abnormalities (GARS-M). The validity of the gait classification system was further validated in a different population consisting of 34 community-dwelling older adults (mean age, 84; SD, 5.0; range, 70-91 years). Results: Kappas for interrater reliability of the variability and postural components of the gait classification system were 0.59 and 0.75, respectively; for intrarater reliability, 0.82 and 0.72, respectively. Consistent and inconsistent groups were different in gait speed (0.66 and 0.49m/s, respectively; p=0.003), step length (0.46 and 0.38m; p=0.008), step length variability (7.47% and 12.74%; p=0.043), the PPT (15.80 and 11.73; p<0.001) and GARS-M (5.83 and 10.66; p<0.001). Within both consistent and inconsistent groups, three postural pattern groups (usual, flexed, crouched) differed in gait speed, step length, PPT and GARS-M (p<0.05). When validated in a different population, the mean difference of gait speed across groups was greater than the reported meaningful change. Conclusions: Gait patterns of older adults, based on biomechanics and movement control, were reliably recognized and validated by mean differences in abnormal characteristics of gait and physical performance measures across patterns. The variability and postures determined by observation of gait by the therapists can be used to quickly identify and classify older adults with mobility problems in clinical settings, allowing for possible targeted interventions for specific gait deficits.
| Identifer | oai:union.ndltd.org:PITT/oai:PITTETD:etd-08082006-172300 |
| Date | 08 September 2006 |
| Creators | Huang, Wen-Ni Wennie |
| Contributors | Jessie VanSwearingen, Stephanie Studenski, Jennifer Brach, Subashan Perera |
| Publisher | University of Pittsburgh |
| Source Sets | University of Pittsburgh |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | http://etd.library.pitt.edu/ETD/available/etd-08082006-172300/ |
| Rights | unrestricted, I hereby certify that, if appropriate, I have obtained and attached hereto a written permission statement from the owner(s) of each third party copyrighted matter to be included in my thesis, dissertation, or project report, allowing distribution as specified below. I certify that the version I submitted is the same as that approved by my advisory committee. I hereby grant to University of Pittsburgh or its agents the non-exclusive license to archive and make accessible, under the conditions specified below, my thesis, dissertation, or project report in whole or in part in all forms of media, now or hereafter known. I retain all other ownership rights to the copyright of the thesis, dissertation or project report. I also retain the right to use in future works (such as articles or books) all or part of this thesis, dissertation, or project report. |
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