Reliability of 4-meter and 10-meter walk tests after lower extremity surgery

Purpose: To investigate the test–retest reliability of the 4-meter walk test (4 MWT) and 10-meter walk test (10 MWT) in patients undergoing lower extremity surgery during inpatient rehabilitation.

Method: In all, 102 patients with total hip arthroplasty (THA), total knee arthroplasty (TKA), lower extremity fracture (LEF) and soft tissue operation were recruited. Patients performed two 4 MWT and two 10 MWT trials on the same day. The same researcher performed all the measurements to avoid inter-rater variability.

Results: The 4 MWT and 10 MWT were shown to have excellent test–retest reliability. The ICCs for the 4 MWT and 10 MWT were found as 0.94 and 0.95, respectively. The SEMs for the 4 MWT and 10 MWT were 2.0 and 5.5?seconds, respectively. The smallest real difference at the 95% confidence level (SRD95) was 5.5?seconds for the 4 MWT and 12.2?seconds for 10 MWT and SRD95 percentage was 31.2 for the 4 MWT and 28.5 for the 10 MWT.

Conclusion: Both the 4 MWT and the 10 MWT have excellent reliability in patients undergoing lower extremity surgery such as TKA, THA, LEF and soft tissue operation during inpatient rehabilitation. Clinicians and researchers can be confident that changes above the SRD95s for the different patient groups, for both sexes and with regard to weight-bearing status, represent a real clinical change in rehabilitation process.

• Implications for Rehabilitation

• The 4 MWT and the 10 MWT are simple methods and were also shown to be reliable measurement methods in many patient groups.

• This study illustrates that the test–retest reliability of the 4 MWT and 10 MWT are excellent in patients undergoing lower extremity surgery during inpatient rehabilitation (ICC: 0.94 for 4 MWT, ICC: 0.95 for 10 MWT).

• Clinicians and researchers can be confident that changes above the SRD95s for the different patient groups, for both sexes and with regard to weight-bearing status represent a real clinical change in rehabilitation process.

     

Nordic walking for geriatric rehabilitation: a randomized pilot trial

Purpose: There is a need to identify effective interventions to promote walking capacity in seniors. This study compares nordic walking (NW) and usual overground walking (OW) and estimates the relative efficacy in improving walking capacity (endurance and gait speed) of the elderly. Method: Single blind, site-stratified, randomized, pilot trial designed to estimate the amount of change with NW and OW. Main outcomes were distance walked measured by 6-min walk test (6MWT) and comfortable gait speed measured by 5-meter walk test (5MWT). Explanatory variables were age, sex, number of comorbidities, walking aids, balance, pain, and leg function. Results: NW and OW participants improved, respectively, 45 and 41 m on 6MWT and increased their gait speed by 0.14 and 0.07 m/s, respectively. NW effect sizes were moderate for 6MWT (ES = 0.53) and large for gait speed (effect size (ES) = 0.68). OW demonstrated moderate effect size for 6MWT (ES = 0.53) but a small one for gait speed (ES = 0.33). Relative efficacy, which was obtained from the ratio of NW and OW effects’ sizes, was 1 for 6MWT and 2.06 for gait speed. Conclusions: NW is 106% more effective in improving gait speed among elderly than OW.

Implications for Rehabilitation

• Elderly are the fastest growing segment of the population. With advanced age, greater number of disabilities, and consequently mobility limitations, are observed among this group.

• Nordic walking is a more intensive form of walking, using muscles of upper and lower body. There’s evidence that nordic walking leads to greater cardiorespiratory workload without an increase in the level of exertion.

• In this study, nordic walking was 106% more efficient than regular walking in improving gait speed among the elderly.

• Clinicians specialized in geriatric rehabilitation may contribute to improve gait speed of seniors by adding nordic walking, a non-expensive and feasible option, to their physiotherapy sessions.

     

Building the repertoire of measures of walking in Rett syndrome

Background: The repertoire of measures of walking in Rett syndrome is limited. This study aimed to determine measurement properties of a modified two-minute walk test (2MWT) and a modified Rett syndrome-specific functional mobility scale (FMS-RS) in Rett syndrome.

Methods: Forty-two girls and women with Rett syndrome (median 18.4 years, range 2.4–60.9 years) were assessed for clinical severity, gross motor skills, and mobility. To measure walking capacity, 27 of this group completed a 2MWT twice on two different assessment days. To assess walking performance, the FMS-RS was administered to the total sample of parents (n?=?42) on two occasions approximately one week apart.

Results: There were negative correlations between clinical severity and 2MWT (r?=??0.48) and FMS-RS (r?=??0.60–0.66). There were positive correlations between gross motor skills and mobility and 2MWT (r?=?0.51, 0.43) and FMS-RS (r?=?0.71–0.93, 0.74–0.94), respectively. Test–retest reliability for the 2MWT was good with high intraday and interday correlations (ICC?=?0.86–0.98). For the 2MWT, the standard error of measurement was 13.8 m and we would be 95% confident that changes greater than 38 m would be greater than within subject error. There was good test–retest reliability for all three distances on the FMS-RS (ICC?=?0.94–0.99).

Conclusions: Walking capacity as measured by the 2MWT showed expected but limited relationships with measures of different constructs, providing some support for concurrent validity. Walking performance as measured with the FMS-RS was more strongly consistent with other clinical measures supporting its concurrent validity. Test–retest reliability was good for both the FMS-RS and the 2MWT. Therefore, these measures have the potential to be used in clinical practice and research.

• Implications for Rehabilitation

• Walking is one of the commonest daily physical activities in ambulant girls and women with RTT. Comprehensive knowledge about the walking abilities in this population is limited.

• Evidence of validity and test–retest reliability have been demonstrated for the modified two-minute walk test (2MWT) and the Rett syndrome-specific functional mobility scale (FMS-RS).

• The 2MWT and FMS-RS offer detailed information of the capacity and performance of walking, respectively, in girls and women with RTT

     

A new equation based on the 6-min walking test to predict VO2peak in women with obesity

Objective: The 6-min walking test (6?MWT) is commonly used to assess obese patients’ aerobic fitness, but it has rarely been compared with a direct measurement of maximal aerobic capacities (VO_2max or VO_2peak) in obese adults. The aim of this study was to investigate the relationship between the distance covered during a 6?MWT with objectively measured VO_2peak and to propose a new equation to predict VO_2peak from this walking test in obese patients.

Methods: One hundred and thirty-seven obese patients (45.6?±?12.5?years) admitted to our hospital for a multidisciplinary rehabilitation program were enrolled. After assessment of their body composition, the participants were asked to perform a 6?MWT and their maximal aerobic capacities (VO_2peak) were measured.

Result: There is a significant linear relation between VO_2peak and the distance covered during the 6?MWT (p?r?=?0.349). The determinant of VO_2peak was body mass index, waist-to-hip ratio, fat free mass, leading to the follow prediction equation VO_2peak such as VO_2peak (l/min)?=?(body mass index ×0.0150065)???(waist-to-hip-ratio?×?0.8595088)?+?(fat-free-mass?×?0.0295478)?+?(6-min walk test?×0.0020672)???0.5853372.

Conclusion: The 6-min walk test is a reliable method to reflect obese women’s aerobic capacities and the distance covered can be used to accurately estimate VO_2peak according to our newly proposed equation.

• Implication for rehabilitation

• Obesity is a worldwide disease and physical capacity evaluation is a key point for rehabilitation.

• The six minutes’ walk test is commonly used in obese people to assess aerobic fitness.

• This study proposes a new equation using 6?MWT performance to estimate VO_2peak.

     

Fatigue induced changes to kinematic and kinetic gait parameters following six minutes of walking in people with multiple sclerosis

Purpose: The aim of this study was to examine the effect of 6?min of walking on fatigue, exertion and spatiotemporal, kinematic and kinetic gait parameters in people with multiple sclerosis (MS). Methods: Thirty-four people with MS with moderate levels of disability completed measures of fatigue, exertion and instrumented gait analysis before and after 6-min trials of rest and walking (using a modified 6-min walk test, m6MWT). Ten age- and gender-matched healthy controls completed analysis before and after the m6MWT. Results: The MS group had a significant increase in self-reported fatigue following the m6MWT; however, there was no effect on spatiotemporal gait parameters. During stance on the more affected side ankle dorsiflexion at initial contact decreased, while knee and hip flexor moments and hip power absorption increased. On the less affected side ankle and knee power absorption, and hip extensor moment all increased. Healthy controls showed increases in joint kinetics likely due to increased walking speeds following m6MWT. Conclusion: For people with MS, ankle dorsiflexion angle reduces at initial contact following walking induced fatigue, while increased power absorption at the hip, knee and ankle indicate gait inefficiencies that may contribute to higher levels of fatigue and exertion.

• Implications for Rehabilitation

• The modified 6-min walk test (m6MWT) leads to significant increases in self-reported fatigue and exertion in people with MS.

• Following the m6MWT, there is significantly reduced ankle dorsiflexion angle at initial contact in the more affected leg in people with MS. This reveals an important walking-induced kinematic change that should be the target of future orthotic and strengthening interventions.

• In people with MS, increased power absorption primarily during the stance phase of gait following the m6MWT reveals important walking-induced muscle weakness that should also be monitored in future strengthening and gait retraining interventions.

     

The Figure-of-Eight Walk test: reliability and associations with stroke-specific impairments

Abstract

Objectives: To investigate (1) the intra-rater, inter-rater and test–retest reliabilities of the Figure-of-Eight Walk (F8W) test times; (2) its correlation with other stroke-specific impairments; and (3) the cut-off scores best discriminating patients with stroke from the healthy elderly. Design: Cross-sectional study. Setting: University-based rehabilitation centre. Participants: A convenience sample of 64 subjects: 35 subjects with chronic stroke and 29 healthy elderly. Main Outcome Measures: F8W test times, Fugl–Meyer Motor Assessment for the lower extremities (FMA-LE), hand-held dynamometer measurements of bilateral hip abductor and knee extensor isometric muscle strength, Five times Sit to Stand Test (FTSTST) times, 10-Meter Walk Test (10MWT), Timed Up and Go Test (TUGT) times, Berg Balance Scale (BBS) and Activities-specific Balance Confidence Scale (ABC) scores. Results: Excellent intra-rater, inter-rater and test–retest reliabilities (intra-class correlation coefficient (ICC) range 0.944–0.999) of F8W test times were found. The F8W test times were also found to be significantly associated with FMA-LE, BBS, FTSTST, TUG scores and 10MWT. No significant correlation was found between F8W test times and either leg strength or ABC results. A F8W test time of 8.2?s was found to be the most representative for discriminating between healthy elderly and stroke subjects, with a sensitivity of 100% and a specificity of 89.7%. Conclusions: The F8W test time is a reliable measurement tool, which is able to differentiate the patients with stroke and healthy elderly subjects and correlated well with stroke-specific impairments and walking tests. The F8W is a reliable measurement tool for assessing the advanced walking performance of subjects with chronic stroke.

• Implication for Rehabilitation

• The F8W test times have excellent intra-rater, inter-rater and test–retest reliabilities in patients with chronic stroke.

• The F8W test times were also found to be significantly associated with FMA-LE, BBS, FTSTST, TUG scores and 10MWT.

• A F8W test time of 8.2?s was found to be the most representative for discriminating between healthy elderly and stroke subjects, with a sensitivity of 100% and a specificity of 89.7%.

• The F8W test time is a reliable and valid measure in assessing the advanced walking skill in patients with stroke.

     

Preoperative prediction of inpatient recovery of function after total hip arthroplasty using performance-based tests: a prospective cohort study

Purpose: The aim of this study was to evaluate the value of conventional factors, the Risk Assessment and Predictor Tool (RAPT) and performance-based functional tests as predictors of delayed recovery after total hip arthroplasty (THA). Method: A prospective cohort study in a regional hospital in the Netherlands with 315 patients was attending for THA in 2012. The dependent variable recovery of function was assessed with the Modified Iowa Levels of Assistance scale. Delayed recovery was defined as taking more than 3 days to walk independently. Independent variables were age, sex, BMI, Charnley score, RAPT score and scores for four performance-based tests [2-minute walk test, timed up and go test (TUG), 10-meter walking test (10?mW) and hand grip strength]. Results: Regression analysis with all variables identified older age (>70 years), Charnley score C, slow walking speed (10?mW >10.0 s) and poor functional mobility (TUG >10.5 s) as the best predictors of delayed recovery of function. This model (AUC 0.85, 95% CI 0.79–0.91) performed better than a model with conventional factors and RAPT scores, and significantly better (p = 0.04) than a model with only conventional factors (AUC 0.81, 95% CI 0.74–0.87). Conclusions: The combination of performance-based tests and conventional factors predicted inpatient functional recovery after THA.

• Implications for Rehabilitation

• Two simple functional performance-based tests have a significant added value to a more conventional screening with age and comorbidities to predict recovery of functioning immediately after total hip surgery.

• Patients over 70 years old, with comorbidities, with a TUG score >10.5 s and a walking speed >1.0 m/s are at risk for delayed recovery of functioning.

• Those high risk patients need an accurate discharge plan and could benefit from targeted pre- and postoperative therapeutic exercise programs.

     

The 6-minute walk distance cannot be accurately assessed at home in people with COPD

Abstract

Purpose: The 6-minute walk test (6MWT) is commonly used to measure exercise capacity in COPD, but it is unclear if this test is accurate when performed at home. This study aimed to determine whether exercise capacity can be accurately assessed at home using the 6MWT in COPD. Methods: A total of 19 participants with stable COPD (mean [SD] FEV₁/FVC 52[13]) undertook the 6MWT at home and at the hospital, in random order, with two tests performed on each occasion. Hospital tests were conducted on a 30-metre walking track whilst home tests (indoor or outdoor) were conducted using the longest available track. Agreement for 6-minute walk distance (6MWD) was examined using the Bland and Altman method. Results: The track length at home was mean [SD] of 17[9]?m. The home 6MWD was shorter than the hospital 6MWD (mean 30?m shorter, limits of agreement ?167 to 102?m). For the home tests, a shorter track length was associated with a greater reduction in 6MWD (r_s?=?0.59, p?=?0.01), but not an increased number of turns (r_s?=??0.41, p?=?0.08). Conclusions: The 6MWD underestimates exercise capacity when conducted at home in COPD. Alternative tests suitable for the home environment should be considered if a comprehensive assessment is to be performed at home.

• Implications for Rehabilitation

• The 6-minute walk test is commonly used to assess change in exercise capacity following pulmonary rehabilitation in patients with chronic obstructive pulmonary disease, and may be conducted on varying track lengths, indoors or outdoors.

• When conducted at home, the 6-minute walk test underestimates exercise capacity in chronic obstructive pulmonary disease, due to a shorter track length available in the home environment.

• This suggests that results from 6-minute walk tests performed at home environment cannot be directly compared to results from centre-based tests

     

Knee posture during gait and global functioning post-stroke: a theoretical ICF framework using current measures in stroke rehabilitation

Abstract

Purpose: To characterise the global functioning post-stroke in patients with normal knee posture (NKP) and abnormal knee posture (AKP) during loading-response. Methods: 35 people, 6 months post-stroke. with NKP and AKP were identified and assessed using clinical measures classified into the corresponding International Classification of Functioning, Disability and Health (ICF) domains: weight function (body mass index); muscle power (knee isometric strength); muscle tone (Modified Ashworth Scale); voluntary motor control (Leg sub-score of Fugl–Meyer scale); walking short distances (5-meter walk test; Timed-Up and Go test); walking on different surfaces (Functional Ambulation Categories); moving around (Falls Efficacy Scale); moving using equipment (walking aids) and global assessment of function (WHODAS II). Age, gender, marital status, current occupation and caregivers support characterised personal factors. Results: Patients with AKP had significantly lower knee flexor strength, higher knee flexor and extensor spasticity, more difficulty in maintaining a standing position, walking short and long distances, used walking aids more often and needed more caregiver support. Restriction in activities and participation were correlated with knee flexor strength for AKP and with knee spasticity for NKP group. Conclusions: AKP restricts functioning and participation.

• Implications for Rehabilitation

• Identification of abnormal knee posture in gait can indicate potential assessment and treatment priorities, e.g. knee flexor strength is a major determinant of functioning in patients with abnormal knee posture and should be assessed.

• The identification of an abnormal knee posture post-stroke seems relevant for planning patient’s long-term needs (e.g. amount of caregiver support).

• The interpretation of functional measures based on the ICF framework can enhance clinical-reasoning in rehabilitation post-stroke.

     

The immediate and long-term effects of a walking-skill program compared to usual physiotherapy care in patients who have undergone total knee arthroplasty (TKA): a randomized controlled trial

Abstract

Purpose: To examine the immediate and long-term effects of a walking-skill program compared with usual physiotherapy on physical function, pain and perceived self-efficacy in patients after total knee arthroplasty (TKA). Method: A single blind randomized controlled trial design was applied. Fifty-seven patients with primary TKA, mean age of 69 years (SD?±?9), were randomly assigned to a walking-skill program emphasizing weight-bearing exercises or usual physiotherapy. Outcomes were assessed before the interventions started at 6 weeks postoperatively (T1), directly after the interventions at 12–14 weeks (T2) and 9 months after the interventions (T3). Walking was the primary outcome, assessed by the 6?min walk test (6MWT). The secondary outcomes were timed stair climbing, timed stands, Figure-of-eight test, Index of muscle function, active knee range of motion, Knee Injury and Osteoarthritis Outcome Score and self-efficacy score. Results: From T1 to T2, a better 6MWT score was found in favor of the walking-skill program of 39?m (2–76), p?=?0.04. The difference between the groups in 6MWT persisted at T3, 44?m (8–80), p?=?0.02. No differences in other outcome measures were found. Conclusion: The walking-skill program had better effect on walking than usual physiotherapy. Weight bearing was tolerated.

• Implications for Rehabilitation

• Weight-bearing exercises are tolerated by the patients in the early stage after TKA.

• Physiotherapy that focuses on learning different ways of walking through practice may be a plausible way to train patients after TKA.

     

Does size matter? Examining the effect of obesity on inpatient amputation rehabilitation outcomes

Purpose This study investigated whether obesity impacted clinical outcomes of patients at discharge from inpatient amputation rehabilitation. Method This was a retrospective chart review examining admissions for lower extremity amputation rehabilitation at a Canadian Regional Amputee Rehabilitation Programme between December 2011 and June 2014. Discharge outcomes were predefined as the two-minute walk test (2MWT), the L-test of functional mobility and the SIGAM score. These were compared between each body mass index (BMI) group (underweight 2, normal between 18.5 and 24.9?kg/m², overweight between 25.0 and 29.9?kg/m² and obese greater or equal to 30?kg/m²) as a whole and within transtibial, transfemoral and bilateral amputation groups. Results Of the 289 admissions meeting inclusion criteria, only underweight patients walked significantly less distance on the 2MWT than normal weight patients. There were group differences in the L-test, but post hoc testing was unable to qualify the differences. No significant difference was found in the SIGAM score. There were no significant differences found in the 2MWT, L-test or SIGAM when patients were grouped by amputation level. Conclusions Obesity does not appear to significantly impact inpatient amputation rehabilitation outcomes such as the 2MWT, L-test or SIGAM score. As such, obesity should not be a deciding factor as to whether a patient is offered rehabilitation.

• Implications for Rehabilitation

• Obesity is increasing in prevalence and is comorbid with peripheral vascular disease and diabetes, the leading causes of lower extremity amputation.

• Function is compromised in the obese general population when compared to non-obese individuals.

• Obesity does not seem to confer a disadvantage with regards to validated outcomes, such as the 2-min walk test, L-test or SIGAM score at discharge after inpatient amputation rehabilitation.

• Obesity should not be a barrier to offering inpatient rehabilitation to amputation patients.

     

Nordic pole walking improves walking capacity in patients with intermittent claudication: a randomized controlled trial

Purpose: The aim of the study was to compare the efficacy of Nordic pole walking (NPW) training with traditional treadmill training (TT) on a claudication (CD) and maximum walking distance (MWD) in patients with peripheral arterial disease (PAD). Method: Patients with intermittent claudication (IC) (n?=?70; age=68.27) in the Fontaine class II were randomized into a two three-month rehabilitation programs performed three times per week. TT were finished by 31 patients, NPW by 21. Walking capacity was measured by an exercise treadmill test (ETT) with the Gardner–Skinner protocol (before and after the program) and six minute walk test (6MWT) (before, during and after the program). Results: In an ETT both groups reached significant increase in CD and MWD (p?≤?0.005). In 6MWT NPW group reached significant increase in both CD (p?=?0.001) and MWD (p?=?0.001), whereas the TT group only in MWD (p?=?0.001). Conclusions: NPW has been shown to be as effective as the standard TT and is much less expensive. It should be the preferred method of exercise for PAD patients with IC.

• Implications for Rehabilitation

• Nordic walking training is a valuable form of rehabilitation for peripheral arterial disease (PAD) patients with intermittent claudication (IC).

• Nordic walking has been shown to be as efficient as traditional treadmill training. It is however more cost-effective method of rehabilitation in PAD patients.

     

Are cardiovascular and metabolic responses to field walking tests interchangeable and obesity-dependent?

Purpose: To investigate if cardiovascular and metabolic responses to the six-minute walk test (6MWT) and incremental shuttle walking test (ISWT) are in agreement with cardiopulmonary exercise testing (CPX) and determine if both submaximal tests are interchangeable in obese and eutrophic individuals.

Method: Observational and cross-sectional study included 51 obese women (ObG) and 21 controls (CG) (20–45 years old). Subjects underwent clinical evaluation, CPX, the 6MWT and ISWT. We applied Bland–Altman plots to assess agreement between walking tests and CPX. Correlation analysis assessed relationships between key variables.

Results: There was an agreement between CPX and both the 6MWT [oxygen uptake (VO₂ mL?kg^?1?min^?1)?=?6.9 (CI: 5.7–8.1), and heart rate (bpm)?=?37.0 (CI: 33.3–40.7)] and ISWT [VO₂ (mL?kg^?1?min^?1)?=?6.1 (CI: 4.9–7.3), and heart rate (bpm)?=?36.2 (CI: 32.1–40.3)]. We found similar cardiovascular and metabolic responses to both tests in the ObG but not in the CG. Strong correlations were demonstrated between 6MWT and ISWT variables: VO₂ ( r?=?0.70); dyspnoea (r?=?0.80); and leg fatigue (r?=?0.70).

Conclusions: 6MWT and ISWT may both hold interchangeable clinical value when contrasted with CPX in obese women and may be a viable alternative in the clinical setting when resources and staffing are limited.

• Implications for Rehabilitation

• Obesity is a worldwide epidemic, with high prevalence in women, and it is associated to impaired cardiorespiratory fitness and functional capacity as well as high mortality risk.

• Assessing oxygen uptake by means of cardiopulmonary exercise testing is the gold standard method for evaluating and stratifying cardiorespiratory fitness, however it is not ever applied due to costs and staffing.

• Walking field tests may be a cost-effective approach that provides valuable information regarding the functional capacity in agreement to metabolic and cardiovascular responses of cardiopulmonary exercise testing.

     

The functional exercise capacity and its correlates in obese treatment-seeking people with binge eating disorder: an exploratory study

Abstract

Purpose: The primary aim was to compare the functional exercise capacity between obese treatment-seeking people with and without binge eating disorder (BED) and non-obese controls. The secondary aim was to identify clinical variables including eating and physical activity behaviour, physical complaints, psychopathology and physical self-perception variables in obese people with BED that could explain the variability in functional exercise capacity. Methods: Forty people with BED were compared with 20 age-, gender- and body mass index (BMI)-matched obese persons without BED and 40 age and gender matched non-obese volunteers. A 6-minute walk test (6MWT), the Baecke physical activity questionnaire, the Symptom Checklist-90, the Physical Self-Perception Profile and the Eating Disorder Inventory were administered. Physical complaints before and after the 6MWT were also documented. Results: The distance achieved on the 6MWT was significantly lower in obese participants with BED (512.1?±?75.8?m versus 682.7?±?98.4, p?<?0.05) compared to non-obese controls. No significant differences were found between obese participants with and without BED. Participants with BED reported significantly (p?<?0.05) more musculoskeletal pain and fatigue after the walk test than obese and non-obese controls. A forward stepwise regression analysis demonstrated that sports participation and perceived physical strength explained 41.7% of the variance on the 6MWT in obese participants with BED. Conclusion: Physical activity participation, physical self-perception and perceived physical discomfort during walking should be considered when developing rehabilitation programs for obese people with BED.

• Implications for Rehabilitation

• Rehabilitation programmes in people with binge eating disorder should incorporate a functional exercise capacity assessment.

• Clinicians involved in the rehabilitation of people with binge eating disorder should consider depression and lower self-esteem as potential barriers.

• Clinicians should take into account the frequently observed physical discomfort when developing rehabilitation programmes for people with binge eating disorder.

     

Reliability,validity, and norms of the 2-min walk test in children with and without neuromuscular disorders aged 6–12

Purpose: The 2-min walk test may be more appropriate functional exercise test for young children. This study aimed to examine the 2-min walk test’s reliability; validity; and minimal clinically important difference; and to establish norms for children aged 6–12.

Methods: Sixty-one healthy children were recruited to examine the 2-min walk test’s reliability. Forty-six children with neuromuscular disorders (63% cerebral palsy) were recruited to test the validity. The normative study involved 716 healthy children without neuromuscular disorders (male?=?51%, female?=?49%). They walked at a self-selected speed for 2?min along a smooth, flat path 15 m in length.

Results: The mean distance covered in the 2-min walk test was 152.8 m (SD?=27.5). No significant difference was found in the children’s test-retest results (p?>?0.05). The intra- and inter-rater reliability were high (all intra-class correlation coefficients >0.8). All children, except one with neuromuscular disorders, completed the 2-min walk test, of which the minimal clinically important difference at 95% confidence interval was 23.2 m for the entire group, 15.7 m for children walking with aids, and 16.6 m for those walking independently.

Conclusions: The 2-min walk test is a feasible, reliable, and valid exercise test for children with and without neuromuscular disorders aged 6–12. The first normative references and minimal clinically important difference for children with neuromuscular disorders were established for children of this age group.

• Implications for rehabilitation

• The 2-min walk test is a feasible, safe, reliable, and valid time-based walk test for children aged 6–12 years.

• Normative references have been established for healthy children aged 6–12 years.

• Minimal clinically important difference at 95% confidence interval were calculated for children with neuromuscular disorders who walked without aids (i.e., independent and stand-by supervision) and those who walked with aids equal to 16.6 and 15.7 m, respectively.

• Distance covered by the healthy children in the 2?min did not correlate with age, gender, height, and weight of the children.

     

Effects of 12-week supervised treadmill training on spatio-temporal gait parameters in patients with claudication

The purpose of the study was to evaluate selected temporal and spatial gait parameters in patients with intermittent claudication after completion of 12-week supervised treadmill walking training. The study included 36 patients (26 males and 10 females) aged: mean 64 (SD 7.7) with intermittent claudication. All patients were tested on treadmill (Gait Trainer, Biodex). Before the programme and after its completion, the following gait biomechanical parameters were tested: step length (cm), step cycle (cycle/s), leg support time (%), coefficient of step variation (%) as well as pain-free walking time (PFWT) and maximal walking time (MWT) were measured. Training was conducted in accordance with the current TASC II guidelines. After 12 weeks of training, patients showed significant change in gait biomechanics consisting in decreased frequency of step cycle (p?p?p?p?p?p?>?0.05).

• Implications for Rehabilitation

• Twelve-week treadmill walking training programme may lead to significant improvement of temporal and spatial gait parameters in patients with intermittent claudication.

• Twelve-week treadmill walking training programme may lead to significant improvement of pain-free walking time and maximum walking time in patients with intermittent claudication.

     

Is walking symmetry important for ambulatory patients with spinal cord injury?

Purpose: To assess and compare the levels of walking symmetry in ambulatory participants with spinal cord injury (SCI) who had different degrees of lesion severity, levels of walking ability, and fall history. In addition, the study explored the relationship between the levels of walking symmetry and variables related to the ability of well-controlled walking of the participants.

Study design: Cross-sectional study.

Methods: Sixty-six eligible participants were assessed and interviewed for levels of walking symmetry, walking speed, functional endurance, symmetrical lower limb support ability, balance control, and fall history over the last 6 months.

Results: Participants walked asymmetrically (85%) similar to those with unilateral impairments (i.e., patients with stroke and amputee, 79–93%). The levels of walking symmetry were significantly correlated to walking speed, functional endurance and balance ability of the participants (p?r?=?0.613–0.765, p?Conclusions: The findings confirm problems of asymmetrical walking and the importance of walking symmetry for the ability of well-controlled walking and a risk of multiple falls in ambulatory participants with SCI. Therefore, apart from the levels of independence, the improvement of walking symmetry is crucial for these individuals.

• Implications for Rehabilitation:

• Ambulatory individuals with spinal cord injury walked asymmetrically at the same level as those with unilateral impairments such as patients with stroke and amputee.

• Their levels of walking symmetry were significantly related to the ability of well-controlled walking, particularly in those with the history of multiple falls.

• The finding confirmed the importance of walking symmetry as a crucial parameter to detect walking improvement and fall risk reduction.

• Apart from the levels of independence, rehabilitation professionals also need to emphasize on the improvement of symmetrical walking for these patients.

     

Over-ground and robotic-assisted locomotor training in adults with chronic stroke: a blinded randomized clinical trial

Purpose: The purpose was to compare the effectiveness of robotic-assisted body weight supported treadmill training using the Lokomat^® to over-ground gait training (OGT) in adults with chronic stroke. Methods: Participants were randomly assigned to the Lokomat^® or OGT interventions. Both protocols included 40 sessions over 8 weeks. Primary outcome measures were the 10-meter walk test and 6-minute walk distance. Secondary measures included the Functional Independence Measure^TM locomotion score, Fugl-Meyer Lower Extremity Motor Score (FM-LE), Barthel Index, and Stroke Impact Scale. Blinded assessors tested the participants at baseline, post-intervention, and 3-month follow-up. Results: Eleven Lokomat^® and nine OGT participants completed the study. Within group differences in the FM-LE score and Barthel Index occurred over time from baseline to post-intervention and baseline to 3-month follow-up. No other within group differences and no between group differences were observed. Conclusions: Although walking measures did not show significant changes between groups, LE motor function and physical functional levels improved over time within both groups. The Lokomat^® may allow aggressive locomotor training, particularly for the lower functioning patients who wish to improve walking ability due to apparent eased therapist physical burden, when compared to OGT, although an increased risk of skin breakdown is present.

Implications for Rehabilitation

• Survivors of chronic stroke can continue to improve in motor recovery and functional ability after intensive over-ground or robotic-assisted locomotor training.

• Over-ground and robotic-assisted locomotor training appear to equivalently enhance motor recovery and functional ability in low functioning survivors of chronic stroke.

• Risk of skin breakdown is significant with roboticassisted locomotor training.

     

Six-minute walking test in children

• Implications for Rehabilitation

• Six-minute walking test.

• The six-minute walking test is safe and widely performed in the world because of its easy implementation and low cost.

• Many countries have established normal values to the six-minute walking test in healthy children.

• However, the applicability of this test also gains popularity among children with other disease conditions.

     

A novel mechanotronic orthosis enables symmetrical gait kinematics in a patient with a femoral nerve palsy – a case study

The usage of stance- and swing-phase control orthoses (SSCOs) is a good option in patients with neuromuscular insufficiency of the quadriceps muscle in a broad range of musculo-skeletal disorders. The subjective sensation of improved mobility in daily life and walking comfort could be objectively confirmed by the ability to walk without crutches and by harmonization of the gait patterns in hip and knee. They could also be a considered mobility device after limb salvage surgery, which may even have an impact on preoperative decision making.

• IMPLICATIONS FOR REHABILITATION

• Symmetric gate in spite of femoral nerve palsy.

• Early gate improvements even after hours.

• High patient?s motivation to use the device.