Spatio-temporal Gait Parameters in Older Patients: Comparaison of a Hospitalized Population of Fallers and Non-fallers

doi:10.21203/rs.3.rs-1618919/v1

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Spatio-temporal Gait Parameters in Older Patients: Comparaison of a Hospitalized Population of Fallers and Non-fallers

https://doi.org/10.21203/rs.3.rs-1618919/v1

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Background: The prevention of falls is a major public health issue. A fall can have serious consequences in frail patients, as are most patients hospitalized in acute geriatrics department. Gait disorders are predisposing factors for falls. They are accessible to rehabilitation and can be analyzed using tools that collect spatio-temporal parameters of walking, such as the GAITRite® mat.

Objective: To find differences between the spatio-temporal gait parameters in patients who fall compared to patients who do not fall in a population of older patients hospitalized in acute geriatrics department.

Material and methods: In this retrospective, observational, single-center study, patients over 75 years hospitalized in acute geriatrics department were included. For each patient, spatio-temporal gait parameters were collected using the GAITrite® mat. The patients were divided into two groups according to whether or not they had a history of fall. The spatio-temporal parameters were compared between the two groups and in relation to the general population.

Results: 67 patients, with an average age of 85.9 ± 6 years, were included. Seventy percent of patients had cognitive impairment and 66% required technical walking assistance. The mean Charlson score was 7.00 +/- 1.87 and a large majority of patients was polymedicated with a mean of 7.04 +/- 3.25 medications at admission. The mean walking speed was 51.4 ± 19.9 cm/s in non-fallers group, and 47.3 ± 17.7 cm/s in fallers group (p = 0.539), indicating pathological walking in comparison with the general population of the same age (average 100 cm/s). No association was found between the spatio-temporal gait parameters and fall.

Conclusion: In our population of hospitalized older adults, the spatio-temporal gait parameters didn’t seem to discriminate anymore a faller from a non-faller, probably linked to many confounding factors such as the pathological gait of the entire study population and their comorbidities.

Clinical Trial registration: NCT05152069.

Gait disorders

Older people

Fall

GAITRite® mat

Learning to walk takes place during early childhood and becomes automatic and natural in adulthood. As we age, it will progressively become more complex and therefore require more attention [1].

The prevalence of gait disorders in the elderly is high and has been estimated at 35% by Verghese et al in a population of adults aged 70 years and older living at home in the state of New York, United States [2]. It seems therefore difficult to define precisely the pathological character of a change in the gait of the elderly, and the study of spatio-temporal parameters of gait can help to solve this problem by comparing the parameters of gait to predefined standards.

These modifications, which are sometimes difficult to detect during a routine clinical examination, sometimes require measurement tools such as the GAITRite® mat, which allows the measurement of spatio-temporal gait parameters [3].

Gait disorders can lead to falls, which represent a major public health issue in terms of hospitalization, morbidity and cost. Indeed, one third of the subjects over 65 years old and half of the persons over 80 years old fall at least once a year [4], which represents 450 000 falls each year in France [5]. Several studies analyzing the link between spatio-temporal parameters of walking and falls have already been performed, but most of them were carried out in a population of older adults living at home and presenting no or few comorbidities [6–9]. Very few studies have been performed in a frail old population with multiple comorbidities or polymedication [10], which is the case for most patients hospitalized in acute geriatric department. The consequences of a fall in this frail population, in whom the risk factors for falls accumulate, can be dramatic, and the study of gait disorders is all the more important.

The objective of our study was to evaluate the spatio-temporal gait parameters using the GAITRite® mat in patients hospitalized in acute geriatrics station and to compare them between a population of patients with an history of fall and a population of patients with no history of fall.

This study was a retrospective, observational, single-center study.

Study population

Patients were retrospectively included if they were hospitalized in an acute geriatric department at the University Hospital of Strasbourg between June 2019 and February 2020, were older than 75 years of age and had autonomously walked on a GAITrite® mat with or without technical walking aids during a physiotherapy session during their hospitalization. The study population consisted of two group, a faller group which consisted of patients with a history of fall, and a non-faller group with patients with no previous history of fall.

End-points

The primary end-point of our study was to compare spatio-temporal gait parameters between the faller group and the non-faller group. The secondary end-points were to compare the spatio-temporal gait parameters between the study population and the general population, between single-task gait and dual-task gait, and to compare the demographic characteristics between the two groups of the study population.

Gait parameters

The study population gait parameters were assessed using the GAITrite® mat, a computerized walkway (701×90cm) with embedded pressure sensors, which is widely used in clinical and research settings, and for which excellent reliability has been reported in several studies [11, 12]. The gait parameters were recorded in single-task during the first one-way and dual-task during return. The dual-task consisted of counting down from fifty to zero, from one to one. The general population reference values, classified by age and gender, were issued from the GAITrite® software [13].

Data collection

Recorded GAITrite® data was extracted automatically from the software, and consisted of walked distance, ambulation time, gait speed, mean normalized velocity, number of steps, cadence, step time, cycle time, step time differential, cycle time differential, step length, step length differential, stride length, heal-heal base support, single support, double support, swing, stance, step/extremity ratio, and toe in/out position.

Patients’ medical records were reviewed, and collected data included : demographic data (age, gender, institutionalized or at home); neurological, rheumatological, cardiovascular and psychiatric history, Charlson Comorbidity Index; clinical examination focusing on the presence of extra-pyramidal syndrome, undernutrition, hypoacusis, low visual acuity, cognitive disorders (with the value of the Mini-Mental State Examination (MMSE)) and presence of technical walking aid; medication history (number of drugs, type of drugs); history of fall and presence of post-fall syndrome. Regarding the history of falls, the information was also asked orally to the patient.

Data Analysis

In a first step, we compared demographic characteristics between fallers and non-fallers. Continuous variables were presented as means or medians and were compared using Wilcoxon test, categorical variables were presented as frequencies and percentages and were compared using Chi² tests of conformity or exact Fisher test.

In a second step we compared the gait parameters between the study population and the reference values of the general population, stratified by age and gender. For each parameter, the mean difference between the study population and the reference value was calculated and then compared to 0 using a Student’s test. In order to consider the multiplicity of tests and thus the increase in alpha risk, an adjustment of the p values was performed.

In a third step, we compared the gait parameters between fallers and non-fallers, using Wilcoxon tests. The variability of gait parameters has been reported as a predictive factor for falls [14], therefore gait parameters’ variation coefficients (standard-deviation/mean x 100) were calculated. Additionally, these coefficients were compared between faller and non-faller with a Students’ test.

In a final step, the gait parameters recorded during single-task were compared to dual-task recorded parameters. For each parameter, the mean difference between single-task and dual-task was calculated and compared to 0 using a paired Student’s test, with a p value adjustment.

Study population

Among 67 patients in the study sample, 46 were categorized as fallers and 21 as non-fallers. At baseline, average age was 85.9 years, 60% were women and 93% lived at home. There were significantly more patients with a history of stroke (mainly ischemic) in the faller population compared with non-faller patients (p = 0.044). The patients who fell had significantly more osteoporosis than the patients who did not fall (p = 0.044). However, there was no statistically significant difference in the presence of traumatic fracture between fallers and non-fallers (p = 0.06). The patients who fell had significantly more history of hypertension than non-fallers (p = 0.046). Of the 67 patients, 47 (70%) were cognitively impaired, with a mean MMSE of 19.4 +/- 6.4, there was no statistically significant difference between the two groups (p = 0.67). The mean Charlson score was 7.00 +/- 1.87, and there was also no significant difference between the two groups (p = 0.64). A large majority of patients had multiple medications with a mean of 7.04 +/- 3.25 medications at admission, with no significant difference between the two groups (p = 0.22). Two-third of the study population used a technical aid to get around, mainly a Rollator or a cane/crutch. The demographic characteristics of the study population are shown in Table 1.

Table 1

Demographic characteristics of the study population
		Non-fallers	Fallers	p-value
		n = 21	n = 46
Mean Age, years (s.d.)		85.9 (5.9)	85.9 (6.1)	0.802
Living at home, n (%)		19 (90)	43 (93)	0.65
Female, n (%)		13 (62)	27 (59)	0.8
Mean Charlson score (s.d.)		6.90 (2.02)	7.04 (1.81)	0.64
Neurological history, n (%)
	Ischemic stroke	2 (9.5)	15 (33)	0.044*
	Hemorrhagic stroke	0 (0)	4 (8.7)	0.3
	Peripheral neuropathy	2 (9.5)	3 (6.5)	0.65
	Parkinson’s syndrome	1 (4.8)	4 (8.7)	1
	Extra pyramidal syndrome	6 (29)	8 (17)	0.34
Rheumatological history, n (%)
	Osteoarthritis	6 (29)	14 (30)	0.88
	Osteoporosis	2 (9.5)	15 (33)	0.044*
	Traumatic fractures	3 (14%)	17 (37%)	0.06
Cardiovascular history, n (%)
	Persistent atrial fibrillation	7 (33)	17 (37)	0.77
	Hypertension	12 (57)	37 (80)	0.046*
	Diabetes	4 (19)	9 (20)	1
	Ischemic heart disease	2 (9.5)	9 (20)	0.48
Psychiatric history, n (%)
	Depressive syndrome	6 (29)	15 (33)	0.74
	Chronic alcoholism	4 (19)	4 (8.7)	0.25
Physical examination, n (%)
	Undernutrition	4 (19)	7 (15)	0.73
	Hypoacusis	6 (29)	6 (13)	0.17
	Low visual acuity	3 (14)	5 (11)	0.7
	Post-Fall syndrome	0 (0)	2 (4.3)	1
Cognitive variables
	Cognitive disorders, n (%)	14 (67)	33 (72)	0.67
	Mean MMSE score (s.d.)	21.8 (4.7)	18.3 (6.8)	0.089
Medication at hospital admission
	N of drugs, mean (s.d.)	6.38 (3.17)	7.35 (3.27)	0.22
	Antihypertensive drugs, n (%)	16 (76)	38 (83)	0.53
	Anticoagulants, n (%)	5 (24)	16 (35)	0.37
	Anti-patelet aggregation, n (%)	8 (38)	17 (37)	0.93
	Antiarrhytmic drugs, n (%)	3 (14)	6 (13)	1
	Anti-pain drugs, n (%)	11 (52)	32 (70)	0.17
	Benzodiazepines, n (%)	11 (52)	22 (48)	0.73
Technical walking aid, n (%)		13 (62)	31 (67)	0.66
	Walker	1 (4.8)	4 (8.7)	1
	Rollator	6 (29)	11 (24)	0.68
	Curtches/Canes	6 (29)	16 (35)	0.62
MMSE = Mini-Mental Status Examination
*Statistically significative

Gait parameters and comparison with reference values

Gait parameters of the study population were compared to reference values, stratifying by age, gender and faller or non-faller group. The study population had a statistically significant difference compared to the general population for many values. Walking speed, step and stride length were almost twice lower in the study population compared to the general population (about 100 cm/s), and the double support phase was twice longer in the study population. Gait parameters and comparison with reference values are shown in Table 2.

Table 2

Gait parameters and comparison with reference values
Parameter	Gender	Non-Fallers		Fallers
Parameter	Gender	Mean difference*	p-value	Mean difference*	p-value
Gait speed (cm/s)	Women	+ 54.18	< 0.001	+ 52.71	< 0.001
Gait speed (cm/s)	Men	+ 46.96	< 0.001	+ 59.69	< 0.001
Cadence (step/min)	Women	+ 28.08	0.002	+ 25.48	< 0.001
Cadence (step/min)	Men	+ 5.64	0.138	+ 19.31	0.005
Step time (s)	Women	-0.27	0.084	-0.26	0.017
Step time (s)	Men	-0.03	0.138	-0.23	0.087
Step lenght (cm)	Women	+ 22.11	< 0.001	+ 21.72	< 0.001
Step lenght (cm)	Men	+ 24.87	< 0.001	+ 28.80	< 0.001
Stride lenght (cm)	Women	+ 44.98	< 0.001	+ 43.91	< 0.001
Stride lenght (cm)	Men	+ 50.37	< 0.001	+ 58.26	< 0.001
Base of support (cm)	Women	-2.95	0.089	-4.08	< 0.001
Base of support (cm)	Men	-4.65	0.082	-2.57	0.036
Swing (% cycle)	Women	-4.43	0.134	-6.46	0.015
Swing (% cycle)	Men	-9.64	< 0.001	-5.37	0.078
Stance (% cycle)	Women	-8.66	0.006	-7.31	< 0.001
Stance (% cycle)	Men	-5.23	0.001	-8.16	< 0.001
Single support (% cycle)	Women	+ 8.79	0.006	+ 7.48	< 0.001
Single support (% cycle)	Men	+ 5.37	0.001	+ 8.37	< 0.001
Double support (% cycle)	Women	-17.65	0.006	-15.63	< 0.001
Double support (% cycle)	Men	-10.53	0.001	-16.13	< 0.001
*Mean difference = reference value – study population value

Gait parameters and comparison between faller and non-faller

The mean walking speed was 51.4 ± 19.9 cm/s in non-fallers group, and 47.3 ± 17.7 cm/s in fallers group (p = 0.539). In both groups, the double support phase averaged > 40% of the gait cycle, the step length was < 40 cm, and the stride length was < 70 cm.

In both single and dual tasks, there was no statistically significant difference between fallers and non-fallers for any spatio-temporal gait parameters. Nine patients were unable to perform the dual-task walk. Gait parameters and comparison between faller and non-faller are shown in Table 3.

Table 3

Gait parameters and comparison between fallers and non-fallers
Parameter	Task	Non-Fallers	Fallers	p value
Parameter	Task	Mean (± SD)	Mean (± SD)	p value
Distance (cm)	Single	853 (± 299.3)	895.9 (± 315.5)	0.566
Distance (cm)	Dual	906.6 (± 335.6)	892.9 (± 275.9)	0.705
Ambulation time (s)	Single	20 (± 12.9)	22.9 (± 14.4)	0.32
Ambulation time (s)	Dual	25 (± 12.7)	25.3 (± 14.2)	0.926
Gait speed (cm/s)	Single	51.4 (± 19.9)	47.3 (± 17.7)	0.539
Gait speed (cm/s)	Dual	42.4 (± 17.7)	41.9 (± 16.2)	0.987
Mean Normalized Velocity	Single	0.6 (± 0.2)	0.5 (± 0.2)	0.631
Mean Normalized Velocity	Dual	0.5 (± 0.2)	0.5 (± 0.2)	0.953
Number of steps	Single	26.2 (± 9.9)	28.6 (± 12.1)	0.65
Number of steps	Dual	30.1 (± 14.1)	28.5 (± 11.3)	1
Cadence (step/min)	Single	87.2 (± 18.2)	83.3 (± 20.7)	0.402
Cadence (step/min)	Dual	75.8 (± 16.6)	74.4 (± 21.2)	0.562
Step Time differential	Single	0.1 (± 0.3)	0.1 (± 0.3)	0.71
Step Time differential	Dual	0.1 (± 0.3)	0.1 (± 0.3)	0.687
Step Length Differential	Single	6.1 (± 8)	3.1 (± 3)	0.166
Step Length Differential	Dual	4.4 (± 6.4)	3.1 (± 3.5)	0.794
Cycle Time Differential	Single	0 (± 0)	0 (± 0.1)	0.176
Cycle Time Differential	Dual	0 (± 0)	0 (± 0)	0.873
Step time L/R (s)	Single	0.8 (± 0.5) / 0.7 (± 0.2)	0.8 ± 0.4 / 0.9 ± 0.5	0.32
Step time L/R (s)	Dual	0.9 (± 0.4) / 0.8 (± 0.2)	0.9 (± 0.4) / 0.9 (± 0.3)	0.608 / 0.788
Cycle time L/R (s)	Single	1.5 (± 0.6) / 1.5 (± 0.6)	1.6 (± 0.8) / 1.6 (± 0.8)	0.41
Cycle time L/R (s)	Dual	1.7 (± 0.5) / 1.7 (± 0.5)	1.8 (± 0.7) / 1.8 (± 0.7)	0.86 / 0.568
Step lenght L/R (cm)	Single	33.6 (± 11.2) / 35.1 (± 10.8)	33 (± 8.7) / 33.4 (± 9.4)	0.792 / 0.429
Step lenght L/R (cm)	Dual	32.3 (± 10.5) / 33 (± 11.3)	33.2 (± 8) / 33.3 (± 9.5)	0.693 / 0.98
Stride lenght L/R (cm)	Single	68.9 (± 19.6) / 69.1 (± 19.7)	66.8 (± 17.7) / 66.8 (± 17.5)	0.866 / 0.803
Stride lenght L/R (cm)	Dual	65.7 (± 20.4) / 65.5 (± 20.5)	66.8 (± 17) / 66.7 (± 17)	0.794 / 0.807
Base of support L/R (cm)	Single	12.8 (± 4.9) / 12.8 (± 4.9)	12.8 (± 4) / 12.8 (± 4)	0.941
Base of support L/R (cm)	Dual	14.1 (± 5.1) / 14.1 (± 5.1)	13.2 (± 4.5) / 13.2 (± 4.6)	0.551 / 0.529
Single support L/R (%)	Single	28.8 (± 6.5) / 27.7 (± 6.3)	28.3 (± 6.4) / 27.6 (± 6.9)	0.665 / 0.892
Single support L/R (%)	Dual	27 (± 7.3) / 26.1 (± 6.3)	27.2 (± 7.5) / 26.7 (± 6.7)	0.893 / 0.608
Double support L/R (%)	Single	43.7 (± 12.1) / 43.9 (± 11.8)	44.5 (± 13.6) / 44.6 (± 13.5)	0.914 / 0.829
Double support L/R (%)	Dual	47.3 (± 12.8) / 47.5 (± 13.1)	46.5 (± 13.7) / 46.4 (± 13.4)	0.769
Swing L/R (%)	Single	27.8 (± 6.2) / 28.8 (± 6.5)	27.6 (± 6.7) / 28.3 (± 6.5)	0.876 / 0.7
Swing L/R (%)	Dual	26 (± 6.4) / 27 (± 7.1)	26.8 (± 6.7) / 27.1 (± 6.5)	0.632 / 0.827
Stance L/R (%)	Single	72.3 (± 6.2) / 71.3 (± 6.6)	72.4 (± 6.7) / 71.7 (± 6.5)	0.855 / 0.685
Stance L/R (%)	Dual	74 (± 6.4) / 73 (± 7.1)	73.2 (± 6.7) / 72.9 (± 6.5)	0.638 / 0.827
Step/Extremity ratio L/R	Single	0.4 (± 0.1) / 0.4 (± 0.1)	0.4 (± 0.1) / 0.4 (± 0.1)	0.745 / 0.445
Step/Extremity ratio L/R	Dual	0.4 (± 0.1) / 0.4 (± 0.1)	0.4 (± 0.1) / 0.4 (± 0.1)	0.632 / 0.86
Toe In/Out L/R	Single	6.4 (± 5.7) / 11.2 (± 8.1)	6.3 (± 7.1) / 11 (± 7.4)	0.989 / 0.749
Toe In/Out L/R	Dual	6.1 (± 5.4) / 10.4 (± 8.6)	6.1 (± 8) / 9.1 (± 7.2)	0.834 / 0.253
L/R = Left/Right

Variability of gait parameters between faller and non-faller

Variation coefficients were used to reflect variability of gait parameters. In the study population, the variation coefficients ranged between 7.8 and 19.1%, which is significantly more than the variability of the general population (range between 3 to 8%) [13]. No significant difference in variability between fallers and non-fallers was observed, and the variability of parameters increased during the dual task. The variability of gait parameters between faller and non-faller is shown in Table 4.

Table 4

Variability of gait parameters between faller and non-faller
Parameter	Task	Non-Fallers	Fallers	p value
Parameter	Task	Variation coeff. (%)	Variation coeff. (%)	p value
Step time L/R	Single	7.9 / 11.1	14.08 / 14.82	0.06 / 0.45
Step time L/R	Dual	14.03 / 10.89	14.65 / 16.99	0.89 / 0.11
Step lenght L/R	Single	12.33 / 13.86	13.78 / 14.46	0.63 / 0.87
Step lenght L/R	Dual	11.98 / 13.5	13.23 / 14.03	0.43 / 0.81
Stride lenght L/R	Single	8.53 / 8.72	9.74 / 9.96	0.28 / 0.31
Stride lenght L/R	Dual	8.86 / 8.92	9.98 / 10.04	0.25 / 0.27
Swing L/R	Single	11 / 10.97	12.20 / 13.49	0.49 / 0.31
Swing L/R	Dual	16.73 / 11.56	14.27 / 13.83	0.63 / 0.2
Stance L/R	Single	9.65 / 8.7	11.73 / 12.07	0.51 / 0.32
Stance L/R	Dual	10.03 / 10.67	13.54 / 14.75	0.27 / 0.24
Single support L/R	Single	10.97 / 11	13.49 / 12.2	0.31 / 0.49
Single support L/R	Dual	11.56 / 16.73	13.83 / 14.27	0.20 / 0.63
Double support L/R	Single	14.77 / 15.17	17.39 / 18.32	0.64 / 0.57
Double support L/R	Dual	14.27 / 15.21	18.98 / 19.14	0.22 / 0.33
Stride speed L/R	Single	10.56 / 10.66	12.34 / 12.95	0.25 / 0.2
Stride speed L/R	Dual	11.81 / 11.65	14.63 / 14.05	0.15 / 0.17
L/R = Left/Right

Gait parameters and comparison between single-task and dual-task

Comparison between single-task and dual-task revealed a shorter step length, a longer double support phase, a lower walking speed. These results are shown in Table 5.

Table 5

Comparison of gait parameters between single-task and dual-task
Parameters	Mean difference*	p-value
Gait speed (cm/s)	-7.04	< 0.001
Step length (cm)	-1.39	< 0.001
Stride length (cm)	-2.44	0.003
Step time (s)	+ 0.09	< 0.001
Swing time (s)	+ 0.03	< 0.001
Stance time (s)	+ 0.15	< 0.001
Single support time (s)	+ 0.03	< 0.001
Double support time (s)	+ 0.12	< 0.001
*Mean difference = dual-task value - single-task value

Study population characteristics

The analysis of the study population characteristics reveals a very high average age (86 years old), a large number of comorbidities (Charlson score of 7.0 +/- 1.87), the presence of cognitive disorders for 70% of the patients, poly-medication (7.04 drugs on average) and the use of technical aids for two thirds of the population. Statistically significant differences between the population of fallers and non-fallers were also observed. Fallers have significantly more history of stroke, high blood pressure and osteoporosis than non-fallers.

Since patients who fall have significantly greater history of ischemic stroke and hypertension, we can hypothesize that they fall because of a greater proportion of brain vascular damage. Indeed, many studies report that a greater number of white matter hyperintensities are associated with a greater risk of falls [15–17]. However, one study by Srikanth et al. in 2009 showed that this would also be associated with an increase in the variability of the spatio-temporal gait parameters, which was not found in this study [15]. The presence of a more significant vascular history in fallers may also raise suspicion of increased executive impairment. Several studies have indeed shown that executive function is related to functional status, and that impaired executive function is associated with impaired walking and balance [18–20].

Gait parameters of the study population

Analysis of spatio-temporal gait parameters compared with reference values of the general population revealed the pathological gait of the entire study population. The walking speed was slow (around 50 cm/s) the step and stride length was shortened (around 35 and 67cm, respectively) and the double support phase was increased (> 40%). This pathological gait can be explained by the baseline characteristics of our population mentioned above. Indeed, the influence of frailty criteria, comorbidities, and polymedication on spatiotemporal gait parameters was studied by Taller-Kall et al. in 2015 [10]. They were able to demonstrate that these 4 factors had a significant influence on the spatiotemporal gait parameters, with notably a slower walking speed and a shorter step length. In a second study by Härdi et al. [21], the significant impact of a walking aid on spatiotemporal parameters was also demonstrated.

Furthermore, in view of the pathological aspect of walking in patients who do not fall, it is likely that they will fall in the near future. We can therefore ask ourselves the question of the clinical relevance of identifying a faller and a non-faller in a population of patients hospitalized in acute geriatrics department (frail, with comorbidities and polymedication).

Gait parameters and fall

In our study, in both single and dual-task, no association was found between the spatio-temporal gait parameters and fall.

In 2014 Mortaza et al. conducted a meta-analysis of 17 articles on the relationship between falls and spatio-temporal parameters of walking. They show that the variability of the stance phase, gait speed, step length and stride length are the gait parameters that show the most difference between fallers and non-fallers. However, they point out that patient selection criteria and methodologies were inconsistent and that the majority of results are controversial. They conclude that spatio-temporal gait parameters are not sufficient to predict falls in older adults. Furthermore, all the patients were older people in good health, with no notable neurological or rheumatological history, and did not require any technical assistance for walking, unlike the patients in our study [22].

Few studies have been performed in a population of elderly, frail patients with comorbidities and poly-medication. Verghese et al. conducted a prospective study of 597 adults in 2009, average age 80.5 years, and investigated the association between changes in spatio-temporal gait parameters and the occurrence of a fall adjusted for age, sex, education, falls, chronic illnesses, medications, cognition and disability. They found a mean gait speed of 92.8 +/- 24.1 cm/s and a slower gait speed was associated with higher risk of falls in the fully adjusted models. In our study, the average speed in all our patients was 48.6 cm/s, which would reflect a major fall risk. Variability in spatiotemporal gait parameters, primarily variability in stride length, was also associated with fall risk [8]. This is the marker most frequently found in studies in association with the risk of falling. It is even used as a predictive factor for falls by some authors [14] and would be accessible to rehabilitation [8, 23, 24]. This difference tends to be significantly in our study; however, our patient population was much smaller.

Strengths and limitations

The main strength of our study were the use of the GAITRite® mat, which allowed us to have reliable, objective, comprehensive and precise data of the spatio-temporal gait parameters. Additionally, most of the patients had a gait parameter record during a dual-task, which allows a more accurate and objective evaluation of gait disorders [25, 26]. However, our study has limitations. Due to the retrospective design, missing data may have occurred for demographic characteristics, such as history of falls, which may limit internal validity. In addition, the small number of patients included may have decreased the power of our study, which may have accounted for the absence of statistically significant results. The monocentric design may limit the external validity of our study, although a meta-analysis conducted by Peel et al. in 2012 found a similarly impaired walking speed of 0.58 m/s in older patients in clinical settings [27].

To conclude, in a population of older patients hospitalized in acute geriatrics department, gait disorders may be so common and severe, that spatio-temporal gait parameters, as evaluated, didn’t seem to discriminate anymore a faller from a non-faller. These parameters may not be suitable for gait assessment in this type of population. Studies with a larger number of patients are necessary to confirm this hypothesis.

Ethics approval and consent to participate

The study was reviewed and approved by the local ethics committee (Comité d’éthique de la faculté de médecine de Strasbourg), reference code CE-2021-148, and was conducted following the principles of the Declaration of Helsinki. Informed consent was obtained from all subjects and/or their legal guardian(s).

Consent for publication

Not applicable.

Availability of data and materials

All data generated or analysed during this study are included in this article. Further enquiries can be directed to the corresponding author.

Competing interests

The authors declare that they have no competing interests.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Author Contributions

All the named authors contributed significantly to the underlying research and drafting of this manuscript. All authors read and approved the final manuscript:

EB: Study concept and design, acquisition of data, analysis and interpretation of data, and preparation of manuscript.

VG: Data acquisition and analysis, preparation of manuscript

CR: Data analysis and interpretation

FB: Study concept design, manuscript preparation

TV: Study concept and design, data acquisition and interpretation

GK: Study concept and design, manuscript preparation

MM: Data analysis, manuscript preparation

ES: Study concept and design, data interpretation, data analysis, manuscript preparation

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No competing interests reported.

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Spatio-temporal Gait Parameters in Older Patients: Comparaison of a Hospitalized Population of Fallers and Non-fallers

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Abstract

Introduction

Methods

Study population

End-points

Gait parameters

Data collection

Data Analysis

Results

Study population

Gait parameters and comparison with reference values

Gait parameters and comparison between faller and non-faller

Variability of gait parameters between faller and non-faller

Gait parameters and comparison between single-task and dual-task

Discussion

Study population characteristics

Gait parameters of the study population

Gait parameters and fall

Strengths and limitations

Declarations

References

Additional Declarations

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