Short-distance walking speed tests in people with Parkinson disease: reliability, responsiveness, and validity. Training dual-task walking in community-dwelling adults within 1 year of stroke: a protocol for a single-blind randomized controlled trial Predictors of falls in the elderly by location The effectiveness of robotic-assisted gait training for paediatric gait disorders: systematic review Six-minute-walk test in idiopathic pulmonary fibrosis: test validation and minimal clinically important difference. Predicting the probability of falls in community-dwelling elderly individuals using the trail-walking test Functional benefits of tai chi training in senior housing facilities. Is gait speed a valid measure to predict community ambulation in patients with Parkinson's disease? [Reference Equations for the 6-Minute Walk Test in Healthy Individuals.] Effectiveness of a specialized asthma clinic in reducing asthma morbidity in an inner-city minority population. Factors That Can Affect the External Validity of Randomised Controlled Trials Analysis of outcome measures for persons with patellofemoral pain: which are reliable and valid? Assessment of aerobic capacity and walking economy of unilateral transfemoral amputees Time dependency of walking classification in stroke. Measuring adherence in a community-based elderly population. Instrumental activities of daily living related to impairments and functional limitations in 70-year-olds and changes between 70 and 76 years of age. Impact of inappropriate drug use on physical performance among a frail elderly population living in the community Predictors for recurrent falls among the home-dwelling elderly. The development of a battery of measures for assessing physical functioning of chronic pain patients Psychometric Comparisons of 3 Functional Ambulation Measures for Patients With Stroke Reliability of Six Physical Performance Tests in Older People With Dementia Walking speed as a good predictor for the onset of functional dependence in a Japanese rural community population. Psychometric evaluation of the original and Canadian French version of the activities-specific balance confidence scale among people with stroke. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. A treadmill and overground walking program improves walking in persons residing in the community after stroke: a placebo-controlled, randomized trial. Submaximal exercise in persons with stroke: test-retest reliability and concurrent validity with maximal oxygen consumption. Psychometric comparisons of the timed up and go, one-leg stand, functional reach, and Tinetti balance measures in community-dwelling older people. Hospitalization, restricted activity, and the development of disability among older persons. Use of Stance Time Variability for Predicting Mobility Disability in Community-Dwelling Older Persons: A Prospective Study Development and validation of the Liverpool infant bronchiolitis severity score: a research protocol. Construct and predictive validity of a self-reported measure of preclinical mobility limitation.
PURPOSE The aims of this study were to determine test-retest reliability and responsiveness of short-distance walking speed tests for persons with Parkinson disease ( PD ) . Discriminant and convergent validity of walking speed tests were also examined . METHODS Eighty-eight participants with PD ( mean age , 66 years ) with mild to moderate severity ( stages 1 - 4 on the Hoehn and Yahr Scale ) were tested on medications . Measures of activity included the  comfortable and fast 10-m walk tests ( CWT , FWT ) , 6-min walk test ( 6MWT ) , mini balance evaluations systems test ( mini-BEST Test ) , fear of falling ( FoF ) , and the Activity-Specific Balance Confidence Scale ( ABC ) . The mobility subsection of the PD quality of life-39 ( PDQ39-M ) served as a participation-based measure . RESULTS Test-retest reliability was high for both walking speed measures ( CWT , ICC(2,1 ) = 0.98 ; FWT , ICC(2,1 ) = 0.99 ) . Minimal detectable change ( MDC(95 ) ) for the CWT and FWT was 0.09 m/s and 0.13 m/s respectively . Participants at Hoehn & Yahr levels 3/4 demonstrated significantly slower walking speed with the CWT and FWT than participants at Hoehn & Yahr levels 1 and 2 ( P < .01 ) . The CWT and FWT were both significantly ( P ≤ .002 ) correlated with all activity and participation-based measures . CONCLUSIONS Short-distance walking speed tests are clinical ly useful measures for persons with PD . The CWT and FWT are highly reliable and responsive to change in persons with PD . Short distance walking speed can be used to discriminate differences in gait function between persons with mild and moderate PD severity . The CWT and FWT had moderate to strong associations with other activity and participation based measures demonstrating convergent validity Background Community ambulation is a highly complex skill requiring the ability to adapt to increased environmental complexity and perform multiple tasks simultaneously . After stroke , individuals demonstrate a diminished ability to perform dual-tasks . Current evidence suggests that conventional rehabilitation does not adequately address gait-related dual-task impairments after stroke , which may be contributing to low levels of participation and physical inactivity in community-dwelling stroke survivors . The objective of this study is to investigate the efficacy of dual-task gait training in community-dwelling adults within 1 year of stroke . Specifically , we will compare the effects of dual-task gait training and single-task gait training on cognitive-motor interference during walking at preferred speed and at fastest comfortable speed ( Aim 1 ) , locomotor control during obstacle negotiation ( Aim 2 ) , and spontaneous physical activity ( Aim 3 ) . Methods / Design This single-blind r and omized controlled trial will involve 44 individuals within 12 months of stroke . Following baseline evaluation , participants will be r and omly allocated to single- or dual-task gait training . Both groups will receive 12 , 30-minute sessions provided one-on-one over 4–6 weeks in an outpatient therapy setting . Single-task gait training involves practice of gait activities incorporating motor relearning principles . Dual-task gait training involves an identical gait training protocol ; the critical difference being that the dual-task gait training group will practice the gait activities while simultaneously performing a cognitive task for 75 % of the repetitions . Blinded assessors will measure outcomes at baseline , post-intervention , and 6 months after completion of the intervention . The primary outcome measure will be dual-task effects on gait speed and cognition during unobstructed walking . Secondary outcomes include spatiotemporal and kinetic gait parameters during unobstructed single- and dual-task walking at preferred and fastest comfortable walking speeds , gait parameters during high and low obstacle crossing , spontaneous physical activity , executive function , lower extremity motor function , Timed Up and Go , balance self-efficacy , number of falls , and stroke-related disability . Hypotheses for each aim will be tested using an intention-to-treat analysis with repeated measures ANOVA design . Discussion This trial will provide evidence to help clinicians make decisions about the types of activities to include in rehabilitation to improve dual-task walking after stroke . Trial registration Clinical Trials.gov Background and aims : In the elderly , balance and walking impairments are assumed to play an important role in causing falls . We have assessed prospect ively the predictive ability of health , function and balance variables regarding falls and their location . Methods : Falls which occurred during one year in a r and om sample of 307 women aged 75 years and over ( mean 80.8 years , response rate 74.5 % ) living in the community were recorded and related to baseline registration s of health , medication and tests of walking and balance . Results : In all , 155 women ( 50.5 % ) reported 308 falls . Outdoor falls were significantly more frequent than indoor falls ( 57.5 vs 42.5 % ) . The variables having had a fall before the start of the study , osteoporosis , hypertension , feeling depressed , unable to climb 40 cm high steps and walking slowly , all independently predicted a higher number of falls overall . Regarding fall location , having experienced a fall before study start was associated with more falls indoors as well as outdoors . Vision impairment , symptoms of depression , a faster comfortable walking speed , and being able to cope with higher steps were all independent predictors of more outdoor falls also after adjustment for outdoor exposure . A slower comfortable walking speed , a higher amplitude of the center of pressure movements in the frontal plane , a poorer score on the Timed Up & Go test , multi-morbidity , poor cognition and hypertension were independent risk factors for indoor falls . Neither number of drugs used nor any specific medication appeared as independent risk factors for falls in this study . Conclusions : The findings of this study suggest that risk factors for  indoor and outdoor falls  are different . Location of fall may be an important confounder in studies of predictors of falls in the elderly which should encompass this type of information Background Robotic-assisted gait training ( RAGT ) affords an opportunity to increase walking practice with mechanical assistance from robotic devices , rather than therapists , where the child may not be able to generate a sufficient or correct motion with enough repetitions to promote improvement . However the devices are expensive and clinicians and families need to underst and if the approach is worthwhile for their children , and how it may be best delivered . Methods The objective of this review was to identify and appraise the existing evidence for the effectiveness of RAGT for paediatric gait disorders , including modes of delivery and potential benefit . Six data bases were search ed from 1980 to October 2016 , using relevant search terms . Any clinical trial that evaluated a clinical aspect of RAGT for children/adolescents with altered gait was selected for inclusion . Data were extracted following the PRISMA approach . Seventeen trials were identified , assessed for level of evidence and risk of bias , and appropriate data extracted for reporting . Results Three r and omized controlled trials were identified , with the remainder of lower level design . Most individual trials reported some positive benefits for RAGT with children with cerebral palsy ( CP ) , on activity parameters such as st and ing ability , walking speed and distance . However a meta- analysis of the two eligible RCTs did not confirm this finding ( p = 0.72 ) . Training schedules were highly variable in duration and frequency and adverse events were either not reported or were minimal . There was a paucity of evidence for diagnoses other than CP . Conclusion There is weak and inconsistent evidence regarding the use of RAGT for children with gait disorders . If clinicians ( and their clients ) choose to use RAGT , they should monitor individual progress closely with appropriate outcome measures including monitoring of adverse events . Further research is required using higher level trial design , increased numbers , in specific population s and with relevant outcome measures to both confirm effectiveness and clarify training schedules RATIONALE The 6-minute-walk test ( 6MWT ) is a practical and clinical ly meaningful measure of exercise tolerance with favorable performance characteristics in various cardiac and pulmonary diseases . Performance characteristics in patients with idiopathic pulmonary fibrosis ( IPF ) have not been systematic ally evaluated . OBJECTIVES To assess the reliability , validity , and responsiveness of the 6MWT and estimate the minimal clinical ly important difference ( MCID ) in patients with IPF . METHODS The study population included all subjects completing a 6MWT in a clinical trial evaluating interferon gamma-1b ( n = 822 ) .  Six-minute walk distance ( 6MWD )  and other parameters were measured at baseline and at 24-week intervals using a st and ardized protocol . Parametric and distribution-independent correlation coefficients were used to assess the strength of the relationships between 6MWD and measures of pulmonary function , dyspnea , and health-related quality of life . Both distribution-based and anchor-based methods were used to estimate the MCID . MEASUREMENTS AND MAIN RESULTS Comparison of two proximal measures of 6MWD ( mean interval , 24 d ) demonstrated good reliability ( coefficient = 0.83 ; P < 0.001 ) . 6MWD was weakly correlated with measures of physiologic function and health-related quality of life ; however , values were consistently and significantly lower for patients with the poorest functional status , suggesting good construct validity . Importantly , change in 6MWD was highly predictive of mortality ; a 24-week decline of greater than 50 m was associated with a fourfold increase in risk of death at 1 year ( hazard ratio , 4.27 ; 95 % confidence interval , 2.57- 7.10 ; P < 0.001 ) . The estimated MCID was 24 - 45 m. CONCLUSIONS The 6MWT is a reliable , valid , and responsive measure of disease status and a valid endpoint for clinical trials in IPF Background Falling is a common problem in the fast-growing elderly population .  Multitasking or engaging in two or more activities at the same time is common in daily living . Objective To determine the usefulness of the  trail-walking test ( TWT ) for predicting a fall in community-dwelling elderly individuals . Methods This was a prospect i ve study in which the TWT was used to evaluate the risk of falling among a group of community-dwelling elderly individuals ( n = 171 ) with a mean age of 80.5 ± 5.6 years . The following tests were conducted :  TWT , trail-making test ( TMT ) , timed-up- and -go test ( TUG ) , functional reach ( FR ) test , one-leg st and ing ( OLS ) test , and 10-m walking time test . Test – retest reliability was assessed by repeating the TWT within 2 weeks of the first trial , and there was a 1-year follow-up . Stepwise logistic regression analysis was used to analyze whether the TWT , TMT , TUG , FR , OLS , or 10-m walking tests predicted falling . Results The test – retest reliability  of TWT was high ( intraclass correlation coefficient 0.945 , p < 0.001 ) . Fifty-nine participants ( 34.5 % ) had reported a fall during the year preceding the 1-year follow-up . The stepwise logistic regression analysis revealed that only the TWT was significantly related to falling ( odds ratio 1.160 , 95 % confidence interval 1.107–1.214 ; p < 0.001 ) . In total , 77.8 % of cases were correctly classified . Conclusion When reliability and validity were considered , the TWT was most useful test of those evaluated for assessing the risk of fall among our elderly cohort OBJECTIVES To determine the effects of tai chi training on functional performance and walking with and without the addition of the performance of a cognitive task , in older adults living in supportive housing facilities . DESIGN Secondary data analysis comparing a single-blind , r and omized controlled trial of tai chi training with an attention-matched educational control intervention with crossover to tai chi . SETTING Two supportive housing facilities . PARTICIPANTS Sixty-six men and women living in supportive housing facilities entered the study , and 57 aged 87±7 completed all study procedures . INTERVENTION Interventions consisted of two 1-hour-long instructor-led group sessions per week for 12 weeks . Tai chi training consisted of movements based upon the Yang-style short form . Educational sessions consisted of lectures and discussion s of age-related health topics . MEASUREMENTS Subjects were tested for physical function ( Short Physical Performance Battery , SPPB ) , balance ( Berg Balance Scale , BBS ) , mobility ( timed up- and -go , TUG ) , and walking speed under normal and cognitive dual-task conditions . RESULTS The tai chi group exhibited greater improvement in SPPB scores ( baseline 8.1±2.9 , follow-up 9.0±2.6 ) than controls ( baseline 8.2±2.6 , follow-up 8.2±2.6 ) ( P=.005 ) . Tai chi also increased normal and dual-task walking speed ( P<.001 ) yet did not affect BBS ( P=.02 ) or TUG ( P=.02 ) after accounting for multiple comparisons . The dual-task cost ( percentage change ) to walking speed was unaffected . After the crossover tai chi intervention , the control group improved performance in the SPPB , BBS , and TUG , and increased walking speed under normal and dual-task conditions ( P=.008 ) . CONCLUSION Tai chi training may be a safe and effective therapy to help improve physical function and dual-task walking in very old adults living in supportive housing facilities OBJECTIVE To investigate the predictive value of gait speed for community walking in Parkinson 's disease and to develop a multivariate prediction model for community walking . DESIGN Data from baseline assessment s in a r and omized clinical trial were used . SUBJECTS A total of 153 patients with Parkinson 's disease were included . METHODS  Community walking  was evaluated using the mobility domain of the Nottingham extended activities of daily living index ( NEAI ) . Patients who scored 3 points on item 1 ( " Did you walk around outside ? " ) and item 5 ( " Did you cross roads ? " ) were considered community walkers .  Gait speed was measured with the 6-m or 10-m timed walking test . Age , gender , marital status , disease duration , disease severity , motor impairment , balance , freezing of gait , fear of falling , previous falls , cognitive function , executive function , fatigue , anxiety and depression were investigated for their contribution to the multivariate model . RESULTS Seventy patients ( 46 % ) were classified as community walkers . A gait speed of 0.88 m/s correctly predicted 70 % of patients as community walkers . The multivariate model , including gait speed and fear of falling , correctly predicted 78 % of patients as community walkers . CONCLUSION Timed walking tests are valid measurements to predict community walking in Parkinson 's disease . However , evaluation of community walking should include an assessment of fear of falling The six-minute walk test ( 6MWT ) has been broadly used in clinical setting s. Several reference equations for prediction of the total distance walked during the test ( 6MWD ) are available in literature . The present review aim ed to critically discuss studies , published in Portuguese and English ( LILACS , SCIELO , MEDLINE , PUBMED ) , which evaluated normal values and created reference equations for predicting 6MWD in healthy subjects , comparing them with the results that were recently obtained in Brazilian individuals . Age , sex , weight , height and body mass index were the main demographic and anthropometric features more often correlated with 6MWD . The equations derived from these characteristics were able to explain between 25 and 66 % of the total variability in the 6MWD . Unfortunately , the foreign equations were not applicable to the Brazilian population . Even when the 6MWT was performed following strict st and ardization , the difference in 6MWT performance between foreign and Brazilian individuals remains , indicating the necessity of providing specific reference equations for each population and /or ethnic group . Accordingly , these equations developed in Brazil are probably the most appropriate for interpreting 6MWT performance in Brazilian patients with chronic diseases affecting the exercise capacity . Future studies are necessary with larger sample sizes ( e.g. multicentric ones ) and r and omized design for the reference values of the 6MWD to be considered reliable Asthma is the most common chronic disease of childhood and a leading cause of morbidity in adults . Despite significant advances in medical therapy , asthma morbidity and mortality rates have risen dramatically over the past two decades , especially in minority and socioeconomically disadvantaged population s. Numerous intervention programs have been design ed in an attempt to reduce asthma morbidity but few have targeted poor or minority population s. The purpose of this study was to assess whether an outpatient intervention program specifically targeted at a high-minority population in East Harlem , in New York City , was successful in reducing asthma morbidity . A retrospective chart review of 84 patient records was conducted . The patients were divided into two groups , an intervention group ( n = 45 ) , who were followed by an asthma specialist ( allergist/immunologist ) , and a nonintervention group , followed by a general internist or pediatrician . Outcome variables including clinic walk-in visits , emergency room visits , and hospitalizations were determined and compared in the pre- and postintervention period in both groups . Patients in the intervention group had reduced total walk-in visits ( 73 vs. 27 , p < 0.001 ) , emergency room visits ( 30 vs. 5 , p < 0.001 ) , and hospitalizations ( 16 vs. 2 , p < 0.001 ) . In contrast , patients in the nonintervention group had no change in total walk-in visits ( 88 vs. 72 ) , increased emergency visits ( 7 vs. 22 , p < 0.05 ) , and no change in hospitalizations ( 5 vs. 2 ) , respectively . The outpatient intervention program has been successful in reducing  asthma morbidity in the high-risk minority community of East Harlem . Future larger studies are warranted to extend this pilot program to other high-risk minority population R and omised controlled trials ( RCTs ) must be internally valid ( i.e. , design and conduct must eliminate the possibility of bias ) , but to be clinical ly useful , the result must also be relevant to a definable group of patients in a particular clinical setting ( i.e. , they must be externally valid ) . Lack of external validity is the most frequent criticism by clinicians of RCTs , systematic review s , and guidelines , and is one explanation for the widespread underuse in routine practice of many treatments that have been shown to be beneficial in trials and are recommended in guidelines [ 1 ] . Yet medical journals , funding agencies , ethics committees , the pharmaceutical industry , and governmental regulators seem to give external validity a low priority . Admittedly , whereas the determinants of internal validity are intuitive and can generally be worked out from first principles , underst and ing of the determinants of the external validity of an RCT requires clinical rather than statistical expertise , and often depends on a detailed underst and ing of the particular clinical condition under study and its management in routine clinical practice . However , reliable judgments about the external validity of RCTs are essential if treatments are to be used correctly in as many patients as possible in routine clinical practice . The results of RCTs or systematic review s will never be relevant to all patients and all setting s , but they should be design ed and reported in a way that allows clinicians to judge to whom the results can reasonably be applied . Table 1 lists some of the important potential determinants of external validity , each of which is review ed briefly below . Many of the considerations will only be relevant in certain types of trials , for certain interventions , or in certain clinical setting s , but they can each sometimes undermine external validity . Moreover , the list is not exhaustive and requires more detailed annotation and explanation than is possible in this short review . Table 1 Main Issues That Can Affect External Validity and Should Be Addressed in Reports of the Results of R and omised Controlled Trials or Systematic Review s and Considered by Clinicians Some of the issues that determine external validity are relevant to the distinction between pragmatic trials and explanatory trials [ 2 ] , but it would be wrong to assume that pragmatic trials necessarily have greater external validity than explanatory trials . For example , broad eligibility criteria , limited collection of baseline data , and inclusion of centres with a range of expertise and differing patient population s have many advantages , but they can also make it very difficult to generalise the overall average effect of treatment to a particular clinical setting OBJECTIVE To examine the test-retest reliability , validity , and responsiveness of several outcome measures in the treatment of patellofemoral pain . DESIGN Evaluation of the clinimetric properties of individual outcome measures for patellofemoral pain treatment , using data collected from a previously published r and omized controlled trial ( RCT ) . SETTING General community and private practice . PARTICIPANTS The data from 71 persons enrolled in an RCT of a conservative intervention for patellofemoral pain were used to evaluate the measures ' validity and responsiveness . A subset of this cohort ( n=20 ) was used to assess reliability . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Three  10-cm visual analog scales ( VASs ) for usual pain ( VAS-U ) , worst pain ( VAS-W ) , and pain on 6 aggravating activities ( walking , running , squatting , sitting , ascending and descending stairs ) ( VAS-activity ) ; the Functional Index Question naire ( FIQ ) ; the Anterior Knee Pain Scale ( AKPS ) ; and the global rating of change . RESULTS The test-retest reliability ranged from poor ( intraclass correlation coefficient [ICC]=.49 ) to good ( ICC=.83 ) , and the measures correlated moderately with each other ( r range,.56-.72 ) . Median change scores differed significantly between improved and unimproved persons for all measures . The effect sizes for VAS-U ( .79 ) , VAS-W ( .88 ) , and the AKPS ( .98 ) were large , indicating greater responsiveness than the FIQ ( .37 ) and VAS-activity ( .66 ) . Similarly , the AKPS and VAS-W were the most efficient measures for detecting a treatment effect when compared with a reference measure ( VAS-U , which was assigned a value of 1 ) . The minimal difference that patients or clinicians consider clinical ly important for the AKPS is 10 ( out of 100 ) points and for the VAS it is 2 cm ( out of 10 cm ) . CONCLUSIONS The AKPS and VAS for usual or worst pain are reliable , valid , and responsive and are therefore recommended for future clinical trials or clinical practice in assessing treatment outcome in persons with patellofemoral pain Background : Studies of the maximal oxygen uptake ( VO2max ) of transfemoral amputees have mostly used protocol s that activate a relatively small muscle mass . Consequently , transfemoral amputee VO2max may be systematic ally underestimated , and the validity of these test protocol s is question able . Objectives : ( 1 ) Investigate validity and reliability of a VO2max walking protocol and ( 2 ) compare the VO2max of a transfemoral amputee group with a group of matching controls . Study design : ( 1 ) R and omized crossover study : walking versus running VO2max for the control group and ( 2 ) case-control study : transfemoral amputees versus control group VO2max . Methods : Twelve transfemoral amputees and control participants performed a walking VO2max test with increasing treadmill inclinations to voluntary exhaustion . The control group also completed a running ( “ gold-st and ard ” ) VO2max test . Results : Mean ( st and ard deviation ) control group VO2max following walking and running was similar , that is , 2.99 ( 0.6 ) L min−1 and 3.09 ( 0.7 ) L min−1 , respectively . Mean ( st and ard deviation ) transfemoral amputee walking VO2max was 2.14 ( 0.8 ) L min−1 ( compared to CON ; p < 0.01 ) . Mean intraclass correlation coefficient of repeated VO2 measurements was 0.97 , and within-subjects st and ard deviation was 60 mL min−1 . Conclusions : The walk protocol is valid . Walking VO2max of transfemoral amputees was 40 % lower compared to control group . Reliability of the walking protocol is comparable to other walking protocol s. Clinical relevance The design , alignment , and material s of prostheses are important for effective ambulation . Cardio-respiratory fitness is , however , also important in this regard , and a low fitness may compromise health and independent living . Hence , transfemoral amputees with low physical fitness should engage in regular physical activity to improve health , gait capacity , and independency BACKGROUND AND PURPOSE To facilitate optimal stroke rehabilitation , valid interpretation of observed functional recovery is required . The purpose of this study was to examine the longitudinal relationship between comfortable walking speed and  Functional Ambulation Categories ( FAC ) scores for physically independent gait . SUBJECTS This study was a prospect i ve cohort study with 73 subjects who were severely affected by acute stroke . METHODS Functional Ambulation Categories classification and walking speed were measured between weeks 4 and 26 after stroke . The responsiveness of walking speed  measurements for detecting clinical ly important speed changes was determined , and the longitudinal association between walking speed and FAC scores and its time dependency were established . This relationship subsequently was scrutinized for possible speed changes occurring within specific FAC scores . Responsiveness ratios , r and om coefficient analysis , paired Student t tests , and the Cohen kappa statistic were used for statistical analyses . RESULTS Responsiveness ratios exceeded the smallest detectable differences . R and om coefficient analysis demonstrated a significant between- and within-subject coefficient and a significant negative interaction between timing of measurements and FAC scores . Paired Student t tests revealed mostly significant pretest-posttest differences in walking speeds , and all kappa values for pretest-posttest FAC scores were significant . DISCUSSION AND CONCLUSION Walking speed measurements are sensitive for detecting clinical ly important changes . Functional Ambulation Categories scores are dependent on the timing of comfortable walking speed measurements after stroke . Moreover , there are indications that , in this relationship , repeated FAC appraisal s are not only based on steady walking speeds , but that the walking speeds related to a specific FAC appraisal also change and , over time , may shift gradually from higher to lower speeds OBJECTIVE To examine the reliability and validity of the Medication Adherence Individual Review -Screening Tool ( MedAdhIR-ST ) for assessing medication adherence in a community-dwelling elderly population . DESIGN A prospect i ve , observational pilot study comparing the reliability and validity of the MedAdhIR-ST and the Medication Adherence Question naire ( MAQ ) . SETTING Independent senior-housing apartments and senior centers in Wake County , North Carolina . PARTICIPANTS Eligible subjects included individuals 60 years of age or older who were living in the community and managing their own medication regimens . INTERVENTIONS Each subject was asked to participate in two assessment visits , two weeks ( + /- 3 days ) apart , in which the questions of the MedAdhIR-ST and MAQ were administered . MAIN OUTCOME MEASURE Medication adherence . RESULTS Both tools showed moderate-to-high test/retest reliability in the study population ( correlation coefficient of 0.632 for MAQ , and 0.699 for MedAdhIR-ST ) , and moderate internal consistency ( Cronbach 's a of 0.551 and 0.584 , respectively ) . Moderate concordance in the ability to assess adherence was observed between MedAdhIR-ST and MAQ ( positive correlation coefficient of 0.450 ) . When compared with refill records , MedAdhIR-ST was slightly more sensitive ( 67 % vs. 43 % ) and specific ( 60 % vs. 50 % ) for detecting adherence and nonadherence , respectively , compared with MAQ . Exploratory factor analysis indicated that MedAdhIR-ST is multidimensional . CONCLUSION MedAdhIR-ST appears to be a reliable and valid tool for screening nonadherence in a community-dwelling elderly population The aim of this study was to analyse in particular dependence in instrumental daily life activities ( I-ADLs ) and its association with physical impairments and functional limitations in the elderly . The study was based on cross-sectional data on 70-year-olds ( n = 602 ) and longitudinal data on subjects followed up to the age of 76 ( n = 371 ) . Persons dependent in ADL  had lower values in maximum walking speed , grip strength , knee extensor strength , stair climbing capacity and in forward reach , compared with those who were independent in ADL .  Walking speed in both women and men and sight impairment in men had the greatest influence on dependence in ADL . Possible critical levels for disability in ADL are discussed , as persons who developed dependence between 70 and 76 already had a lower capacity in walking speed and knee extensor strength at age 70 than persons who retained their independence in ADL Abstract Objective The criteria for inappropriate drug use developed by Beers have been widely used in drug utilization review s to assess the quality of prescribing , but there is still inconclusive evidence that these criteria can impact on patient outcomes . The aim of the present study was to evaluate the relationship between the use of inappropriate drugs and measures of physical performance , muscle strength and functional status in an elderly population ( 80 + years ) . Methods Data are from the baseline evaluation of 364 subjects enrolled in the ilSIRENTE study , a prospect i ve cohort study performed in a mountain community living in the Sirente geographic area ( L’Aquila , Abruzzo ) in Central Italy .  Physical performance was assessed using the  physical performance battery score ( SPPB )  , which is based on three timed tests : 4-m walking speed , balance and chair st and tests . Muscle strength was measured by h and grip strength . Inappropriate drug use was defined by the 2003 Beers criteria . Analyses of covariance were performed to evaluate the relationship of inappropriate drugs with physical function . Results In the unadjusted model , all of the physical performance , muscle strength and functional measures showed significant associations with inappropriate drug use . Following adjustment for potential confounders , which included age , gender , physical activity level , cognitive performance scale , comorbidity , lung diseases and diabetes , these associations were still statistically significant for the physical performance battery score [ non-users inappropriate drugs : 7.0 ; st and ard error ( SE ) : 0.1 ; users inappropriate drugs : 6.1 ; SE : 0.2 ; p = 0.007 ] The 4-m walking speed , physical performance battery score and Total Activities of Daily Living ( ADL ) scale score showed worsening results among subjects using two inappropriate medications compared with subjects using one inappropriate drug or none at all . Conclusions The use of inappropriate medication ( as defined by Beers 2003 criteria ) was found to be common among the elderly Italian study cohort living in the community . Our results suggest that among old – old subjects the use of inappropriate drugs is associated with impaired physical performance OBJECTIVE Scant attention has been paid to the risk factors for recurrent falls among the home-dwelling elderly , although there are remarkable age and sex differences according to whether or not the falls recur . In this report we describe and analyse the risk factors for recurrent falls by selected clinical variables and the history of falling during the previous year . DESIGN A community-based prospect i ve study covering two years . SETTING All home-dwelling persons ( N = 1016 ) aged 70 years or older living in five municipalities in northern Finl and . OUTCOME MEASURES The risk factors of recurrent falling by selected clinical variables using cross-tabulations and multivariate analyses . RESULTS Previous falls , peripheral neuropathy , use of psychotropic medication and slow walking speed were independent risk factors for recurrent falling . The risk of recurrent falling increased with an increasing number of previous falls . CONCLUSIONS Early preventive measures should be taken among the elderly persons who are prone to falling . In order to reduce the risk of recurrent falls among the elderly , the attending physician should take a critical view of the use of psychotropic medications , and attempts should be made to treat conditions underlying peripheral neuropathies and abnormal gait & NA ; The physical performance of chronic pain patients is of major concern both for their assessment and for treatment evaluation . However , there are few widely used physical tests , a shortage of reliability and validity data on published tests , and an over‐reliance on self‐report or on clinical measures of dubious generalisability . A set of tests was design ed to cover speed and endurance in walking , stair climbing , st and ing up from a chair , sit‐ups , arm endurance , grip strength , and peak flow . St and ard instructions and testing conditions were used by a trained tester on a population of chronic pain patients before and after a cognitive‐behavioural chronic pain management programme .  Reliability , validity , and acceptability of each test was examined , and recommendations made for their relative utility Background and Purpose — We compared the test-retest reliability , validity , and responsiveness of the Dynamic Gait Index , the 4-item Dynamic Gait Index , and the Functional Gait Assessment for assessment of walking in patients with stroke . Methods — Forty-five out patients participating in the validity and responsiveness study were tested using the 3 walking measures as well as the 10-m walk test , Barthel Index , and Postural Assessment Scale for Stroke Patients .  We tested them during the first week , then again after 2 months and 5 months of therapy .  Another 48 chronic patients completed the 3 measures twice , 1 week apart , in the test-retest reliability study . Results — Thirty-five participants completed 3 time-point assessment s. The Functional Gait Assessment showed the least floor and ceiling effects , indicating it has the best discriminative ability for patients with stroke with high walking function . We found the 3 measures were highly correlated with each other , indicating excellent concurrent validity , and all measures at the first week of therapy were moderately to highly correlated with the Barthel Index scores at 5 months , indicating good predictive validity . Responsiveness of the 3 measures was moderate during a 5-month period , and all showed good test-retest reliability . The minimal detectable changes between tests indicate acceptable r and om error . Conclusions — All 3 measures showed sufficient validity , responsiveness , and reliability for assessment of walking function in patients with stroke undergoing rehabilitation , but the Functional Gait Assessment is recommended for its psychometric properties Background Physical performance tests are important for assessing the effect of physical activity interventions in older people with dementia , but their psychometric properties have not been systematic ally established within this specific population . Objective The purpose of this study was to determine the relative and absolute test-retest reliability of the  6-m walk test  , the  Figure-of-Eight Walk Test ( F8W ) , the  Timed “ Up & Go ” Test ( TUG )  , the  Frailty and Injuries : Cooperative Studies of Intervention Techniques–4  ( FICSIT–4 ) Balance Test , the  Chair Rise Test ( CRT )  , and the  Jamar dynamometer .  These tests are used to assess gait speed , dynamic balance , functional mobility , static balance , lower-limb strength , and grip strength , respectively . Design This investigation was a prospect i ve , nonexperimental study . Methods Older people with dementia ( n=58 , age range=70–92 years ) performed each test at baseline and again after 1 week . Intraclass correlation coefficients ( ICC ) , st and ard error of measurement ( SEM ) , minimal detectable change ( MDC ) , and log-transferred limits of agreement of Bl and -Altman plots were calculated . Results The relative reliability of the F8W , TUG , and Jamar dynamometer was excellent ( ICC=.90–.95 ) and good for the 6-m walk test , FICSIT–4 , and CRT ( ICC=.79–.86 ) . The SEMs and MDCs were large for all tests . The absolute reliability of the TUG and CRT was significantly influenced by the level of cognitive functioning ( as assessed with the Mini-Mental State Examination [ MMSE ] ) . Limitations The specific etiology of dementia was not obtained . Conclusions The physical performance tests evaluated are useful for detecting differences in performance between older people with mild to moderate dementia and , therefore , are suitable for cross-sectional or controlled intervention studies . They appear less suitable to monitor clinical ly relevant intra-individual performance changes . Future studies should focus on the development of more sensitive tests and the identification of criteria for clinical ly relevant changes in this rapidly growing population OBJECTIVE to investigate and compare the predictive values of four physical performance measures for the onset of functional dependence in older Japanese people living at home . DESIGN a population -based prospect i ve cohort study . SETTING Nangai village , Akita Prefecture , Japan . METHODS out of the population aged 65 years and older living in Nangai ( n = 940 ) in 1992 , we measured h and grip-strength , one-leg st and ing , and usual and maximum walking speeds  in 736 subjects who were independent in the five basic activities of daily living . Their functional status was assessed each year for the subsequent 6 years . The outcome event was the onset of functional dependence , defined as a new disability in one or more of the five basic activities of daily living , or death of a subject who had shown no disability at the previous follow-up . RESULTS even after controlling for age , sex and a number of chronic conditions , lower scores on each baseline performance measure showed increased risk for the onset of functional dependence . Maximum walking speed  was most sensitive in predicting future dependence for those aged 65 - 74 years , while usual walking speed was most sensitive for people aged > or = 75 years . CONCLUSION  walking speed  was the best physical performance measure for predicting the onset of functional dependence in a Japanese rural older population OBJECTIVE To evaluate the internal and absolute reliability and construct validity of the Activities-Specific Balance Confidence ( ABC ) scale and a new Canadian French version ( ABC-CF ) of it among people with stroke . DESIGN Cross-sectional data from a r and omized controlled trial . SETTING Community . PARTICIPANTS Ninety-one people with a residual walking deficit between 57 and 386 days poststroke . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES The ABC and ABC-CF scales , Berg Balance Scale ( BBS ) , comfortable and maximum gait speeds , Timed Up & Go ( TUG ) test , 6-minute walk test ( 6MWT ) , Barthel Index , physical function scale of the Medical Outcomes Study 36-Item Short-Form Health Survey , Geriatric Depression Scale ( GDS ) , and the EQ-5D visual analog scale ( EQ VAS ) . RESULTS Internal consistency ( Cronbach alpha ) was .94 and .93 and the st and ard error of measurement was 5.05 and 5.13 for the ABC ( n=51 ) and the ABC-CF ( n=35 ) scales , respectively . Spearman rho values ranged from .30 to .60 for the ABC scale and from .45 to .68 on the ABC-CF scale for associations with scores on the BBS , comfortable and maximum gait speeds , TUG , 6MWT , Barthel Index , physical function scale , GDS , and EQ VAS . CONCLUSIONS Evidence of internal and absolute reliability and of construct validity of the ABC and the ABC-CF scales supports their use for cross-sectional measurements of balance self-efficacy among community-dwelling people in the first year poststroke BACKGROUND Functional assessment is an important part of the evaluation of elderly persons . We conducted this study to determine whether objective measures of physical function can predict subsequent disability in older persons . METHODS This prospect i ve cohort study included men and women 71 years of age or older who were living in the community , who reported no disability in the activities of daily living , and who reported that they were able to walk one-half mile ( 0.8 km ) and climb stairs without assistance . The subjects completed a short battery of physical-performance tests and participated in a follow-up interview four years later . The tests included an assessment of st and ing balance  , a  timed 8-ft ( 2.4-m ) walk at a normal pace  , and a  timed test of five repetitions of rising from a chair and sitting down .  RESULTS Among the 1122 subjects who were not disabled at base line and who participated in the four-year follow-up , lower scores on the base-line performance tests were associated with a statistically significant , graduated increase in the frequency of disability in the activities of daily living and mobility-related disability at follow-up . After adjustment for age , sex , and the presence of chronic disease , those with the lowest scores on the performance tests were 4.2 to 4.9 times as likely to have disability at four years as those with the highest performance scores , and those with intermediate performance scores were 1.6 to 1.8 times as likely to have disability . CONCLUSIONS Among nondisabled older persons living in the community , objective measures of lower-extremity function were highly predictive of subsequent disability . Measures of physical performance may identify older persons with a pre clinical stage of disability who may benefit from interventions to prevent the development of frank disability OBJECTIVE To evaluate the effectiveness of a treadmill and overground walking program in reducing the disability and h and icap associated with poor walking performance after stroke . DESIGN R and omized , placebo-controlled clinical trial with a 3-month follow-up . SETTING General community . PARTICIPANTS A volunteer sample of 29 ambulatory individuals ( less 2 dropouts ) who were living in the community after having suffered a stroke more than 6 months previously . INTERVENTIONS The experimental group participated in a 30-minute treadmill and overground walking program , 3 times a week for 4 weeks . The control group received a placebo consisting of a low-intensity , home exercise program and regular telephone contact . MAIN OUTCOME MEASURES Walking speed ( over 10 m ) , walking capacity ( distance over 6 min ) , and h and icap ( stroke-adapted 30-item version of the Sickness Impact Profile ) measured by a blinded assessor . RESULTS The 4-week treadmill and overground walking program significantly increased walking speed ( P=.02 ) and walking capacity ( P<.001 ) , but did not decrease h and icap ( P=.85 ) compared with the placebo program . These gains were largely maintained 3 months after the cessation of training ( P</=.05 ) . CONCLUSIONS The treadmill and overground walking program was effective in improving walking in persons residing in the community after stroke . This suggests that the routine provision of accessible , long-term , community-based walking programs would be beneficial in reducing disability after stroke OBJECTIVE To establish the test-retest reliability and concurrent validity with maximum oxygen consumption ( VO2max ) for 3 submaximal exercise tests in persons with chronic stroke : ( 1 ) submaximal treadmill test , ( 2 ) submaximal cycle ergometer test , and ( 3 ) 6-minute walk test ( 6MWT ) . DESIGN Prospect i ve study using a convenience sample . SETTING Free-st and ing tertiary rehabilitation center . PARTICIPANTS A volunteer sample of 12 community-dwelling individuals who had a stroke with moderate motor deficits . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Heart rate , blood pressure , and oxygen consumption ( VO2 ) were assessed during the exercise tests . RESULTS Test-retest reliability was good to excellent for the exercise tests ( maximal and submaximal tests ) . VO2 for all submaximal measures related to VO2max ( r range , .66-.80 ) . Neither the 6MWT distance , self-selected gait speed , nor hemodynamic measures related to VO2max . CONCLUSION The VO2 measures of the submaximal exercise tests had excellent reliability and good concurrent validity with VO2max . Submaximal exercise tests may be a method by which to monitor the effects of interventions after a screening test ( eg , symptom-limited grade d exercise test , dobutamine stress echocardiograph ) OBJECTIVES To compare the practicality , reliability , validity , and responsiveness of the timed up and go ( TUG ) , one-leg st and ( OLS ) , functional reach ( FR ) , and Tinetti balance ( TB ) performance measures in people aged 65 and older . DESIGN A prospect i ve study . SETTING Shin-Sher Township of Taichung County , west- central Taiwan . PARTICIPANTS Twelve hundred community-dwelling older people . MEASUREMENTS During an initial assessment at their residences , participants were interviewed for demographics , cognition , fall history , use of a walking aid , and activities of daily living ( ADLs )  , in addition to completing the four balance tests . Falls were ascertained by telephone every 3 months for a 1-year follow-up ; the four balance measures and ADLs were also reassessed at the end of the follow-up year . RESULTS Of the four balance measures , the OLS had the lowest participation rate , and participation of people who were cognitively impaired had fallen in the previous year , used a walking aid , or suffered from an ADL disability was lower than for their counterparts . The time to complete the tests ranged from 58 seconds for OLS , to 160 seconds for the TB . All four balance measures exhibited excellent test-retest reliability and discriminant validity but poor responsiveness to fall status . The TB showed better discriminant , convergent , and predictive validities and responsiveness to ADL changes than the other three tests . CONCLUSION According to psychometric properties , the most suitable performance measure for evaluating balance in community-dwelling older people was the TB , followed by the TUG CONTEXT Preventing the development of disability in activities of daily living is an important goal in older adults , yet relatively little is known about the disabling process . OBJECTIVES To evaluate the relationship between 2 types of intervening events ( hospitalization and restricted activity ) and the development of disability and to determine whether this relationship is modified by the presence of physical frailty . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve cohort study , conducted in the general community in greater New Haven , Conn , from March 1998 to March 2003 , of 754 persons aged 70 years or older , who were not disabled ( ie , required no personal assistance ) in 4 essential activities of daily living :  bathing , dressing , walking inside the house , and transferring from a chair . Participants were categorized into 2 groups according to the presence of physical frailty ( defined on the basis of slow gait speed ) and were followed up with monthly telephone interviews for up to 5 years to ascertain exposure to intervening events and determine the occurrence of disability . MAIN OUTCOME MEASURE Disability , defined as the need for personal assistance in bathing , dressing , walking inside the house , or transferring from a chair . RESULTS During the 5-year follow-up period , disability developed among 417 ( 55.3 % ) participants , 372 ( 49.3 % ) were hospitalized and 600 ( 79.6 % ) had at least 1 episode of restricted activity . The multivariable hazard ratios for the development of disability were 61.8 ( 95 % confidence interval [ CI ] , 49.0 - 78.0 ) within a month of hospitalization and 5.54 ( 95 % CI , 4.27 - 7.19 ) within a month of restricted activity . Strong associations were observed for participants who were physically frail and those who were not physically frail . Hospital admissions for falls were most likely to lead to disability . Intervening events occurring more than a month prior to disability onset were not associated with the development of disability . The population -attributable fractions associated with new exposure to hospitalization and restricted activity , respectively , were 0.48 and 0.19 ; 0.40 and 0.20 , respectively , for frail participants and 0.61 and 0.16 , respectively , for nonfrail participants . CONCLUSIONS Illnesses and injuries leading to either hospitalization or restricted activity represent important sources of disability for older persons living in the community , regardless of the presence of physical frailty . These intervening events may be suitable targets for the prevention of disability Background and Purpose : Mobility disability is a serious and frequent adverse health outcome associated with aging . Early identification of individuals at risk for mobility disability is important if interventions to prevent disability are to be instituted . The objectives of this prospect i ve study were to ( 1 ) determine the magnitude of stance time variability ( STV ) that discriminates individuals who currently have mobility disability ( prevalent mobility disability ) and ( 2 ) determine the magnitude of STV that predicts a new onset of mobility disability at 1 year ( incident mobility disability ) . Methods : A total of 552 community-dwelling older adults were evaluated as part of the Cardiovascular Health Study , a longitudinal cohort study . Stance time , in milliseconds , was determined from 2 passes on a 4-m computerized walkway at self-selected walking speed , and STV was defined as the st and ard deviation from approximately 12 individual steps . Mobility disability was defined as self-reported difficulty walking a one-half mile . Receiver operating characteristic ( ROC ) curves were plotted to determine an optimal cutoff value for STV for prevalent and incident mobility disability , and the area under the receiver operating characteristic curve ( AUC ) was computed . Results : The optimal cutoff score for STV ( maximizing sensitivity and specificity ) for prevalent mobility disability was 0.037 seconds ( sensitivity = 65 % , specificity = 65 % , AUC = 0.70 ) and for incident 1-year mobility disability was 0.034 seconds ( sensitivity = 61 % , specificity = 60 % , AUC = 0.65 ) . The use of likelihood ratios demonstrated a gradient of risk across values of STV , with mobility risk increasing as values of STV increased . Discussion and Conclusion : Values of STV may be useful in identifying older adults with mobility disability and at risk for future disability . We recommend the more conservative estimate for identifying risk , STV = 0.034 seconds , which maximizes the sensitivity and minimizes false negatives . The relatively modest values on the validity indices could possibly be improved by increasing the reliability of the measurement of STV . Clinicians should interpret the cutoff values liberally and use STV in conjunction with other measures until further work is completed to vali date STV as an indicator of mobility disability AIM To develop and vali date a  bronchiolitis severity scoring instrument  for use by nurses and other healthcare professions . BACKGROUND Bronchiolitis is a viral lower respiratory tract infection of infancy . In industrialized countries , admission rates have increased over the last decade with up to 3 % of all infants born being admitted to hospital . A small number of these hospitalized infants will require admission to critical care for either invasive or non-invasive ventilation . During the seasonal epidemic , the number of unplanned admissions to critical care with bronchiolitis substantially increases . DESIGN We will use a mixed methods study design . METHODS We will use scale development and psychometric methods to develop a scoring instrument and to test the instrument for content , construct and criterion validity and reliability in several different clinical locations . This study protocol has been review ed and approved by the NHS National Research Ethics Service , January 2011 . DISCUSSION There is an urgent need to develop a valid and reliable severity scoring instrument sensitive to clinical changes in the infant , to facilitate clinical decision-making and help st and ardize patient care . Furthermore , a valid and reliable scoring instrument could also be used as a proxy patient-reported outcome measure to evaluate the efficacy of clinical interventions in r and omized controlled trials OBJECTIVES To vali date self-reported pre clinical mobility limitation concept and self-report assessment method against muscle power and walking speed , and to study the predictive validity of pre clinical mobility limitation with respect to future risk of manifest mobility limitation . DESIGN Observational prospect i ve cohort study and cross-sectional analysis . SETTING Research laboratory and community . PARTICIPANTS A total of 632 community-living ( age range , 75 - 81 y ) women and men took part in the baseline assessment s and 302 persons in the semi-annual interviews on mobility limitation over 2 years . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Walking speed , muscle power , and self-reported pre clinical and manifest mobility limitation . Pre clinical mobility limitation was defined as self-reported tiredness or modification of task performance without task difficulty . At baseline , 4 subgroups were created according to self-reported pre clinical mobility limitation in any of 3 mobility tasks ( walking 2 km , walking 0.5 km , climbing up stairs ) : no limitation , pre clinical limitation , and minor and major manifest limitation . RESULTS At baseline , participants with pre clinical mobility limitation showed intermediate levels of walking speed and muscle power , compared with those with no limitation or manifest mobility limitation . Participants reporting baseline pre clinical mobility limitation had 3- to 6-fold higher age- and sex-adjusted risk of progressing to major manifest mobility limitation during the 2-year follow-up compared with participants with no limitation at baseline , whereas the risk among those with minor limitation at baseline was 14- to 18-fold higher compared with those with no limitation . CONCLUSIONS The self-report assessment tool proved to be a valid measure to capture the early signs of disability and may serve as an inexpensive tool for identifying those nondisabled persons at high risk for future disability
Walking speed is a highly valid test , both at habitual and maximum speed .
Both habitual and maximum walking speeds are valid instruments , and they predict death , hospitalization/institutionalization , and decline in mobility
The number of available walking tests has increased dramatically over the past decades .
Therefore , it is highly important to help clinicians choose the most appropriate walking test for a specific setting .
This systematic review aim ed to critically evaluate the reliability , validity , and responsiveness of clinical walking speed in a broad population of elderly persons living in the community , sheltered housing , or institutions .