October 2020

Gait Speed as Risk Tool for Falls

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Keeping older adults physically active is critical to health maintenance and walking is a key form of exercise for this population. However, foot pain represents a leading cause of mobility limitations and lower quality of life in older individuals. Nearly 25% of adults report foot pain, and those with frequent foot pain are at double the risk of falling.

Walking speed tends to steadily decrease with age and foot pain can add to that decline. Researchers in Croatia and the Czech Republic sought to establish a clinically significant gait speed cut-off value that would predict foot pain and the risk of falls among community dwelling older adults.

They recruited 120 women from Zagreb, Croatia who were living independently, able to ambulate with or without aid for at least 10 minutes, passed a short mental status exam, were free from neurological diseases, and were able to arrange their own means of transportation to the testing site. Mean age of the group was 71.02 years and mean body mass index was 26.79 ± 4.42 kg/m2.

Prevalence of foot pain was assessed by a single question: “On most days do you have pain, aching or stiffness in either of your feet?” Respondents had 6 possible responses broken down by yes/no and by left/right or both. Risk of falls was assessed using the Downtown Fall Risk Index which includes 5 questions about previous falls, medication use, sensory deficits, mental status, and gait characteristics.

For the study, participants walked barefoot back and forth on a 10.5-meter pressure platform at their preferred speed for 4 trials.

More than 50% of participants reported foot pain and one third were at higher risk of falls. Mean gait speed was 0.95 m/s. Gait speed cut-off for foot pain was 0.88 m/s and 0.85 m/s for risk of falls. Participants who walked ≤0.88 m/s and ≤0.85 m/s were nearly 11 times more likely to report foot pain (OR = 10.92, 95% CI 4.28 to 27.89, P < 0.001) and were nearly 13.5 times more likely to have higher risk of falls, and higher risk of falls (OR = 13.59, 95% CI 5.45 to 33.87, P < 0.001). According to the authors, the gait speed cut-off values can predict 20.25% and 24.01% of foot pain and the risk of falls.

While noting that theirs is the first study to define specific gait speed cut-off values for use in predicting foot pain and the risk of falls in older women simultaneously, the authors write that this new gait speed cut-off value of ≤0.88 m/s can be used by health-related professionals as a diagnostic tool in detecting a “risky” group of older women, who may be more vulnerable because they have foot pain.

In their conclusion, they note that by using the proposed cut-off values, individuals who walk slower should be a target population for special interventions that improve foot biomechanics and reducing both foot pain and future risk of falls.

Source: Stefan L, Kasovic M, Zvonar M. Gait speed as a screening tool for foot pain and the risk of falls in community-dwelling older women: a cross-sectional study. Clin Interven Aging. 2020:15 1569–1574.

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