Significance of Walking Speed. Maggie Benson Virginia Commonwealth University Department of Physical Therapy

Transcription

1 Significance of Walking Speed Maggie Benson Virginia Commonwealth University Department of Physical Therapy

2 The 6 th Vital Sign Walking speed is considered the 6 th vital sign A valid and reliable measure to assess and monitor functional status Can predict rehabilitation response, length of stay, functional dependence, frailty, cognitive decline, falls, hospitalization, cardio-vascular events, and mortality Indicates an individuals functional capacity and health status

3 Walking Speed Improvements An increase in usual speed over 1 year predicts survival through 8 years Improvement in walking speed over time may indicate improved physiological health due to medical interventions Increasing walking speed predicts subsequent independent mobility Improved health status, physical function, fewer disabilities, and lower healthcare costs

4 Walking Speed as a Measurement Can be used in a variety of settings with different diagnoses Helps monitor patients over time Explains an individual s walking behavior, fear of falling, functional decline, as well as home and community ambulation Appropriate for patients where using 6MWT may not be due to a patient s cardiopulmonary compromise

5 Interventions to Improve Walking Speed Multifactorial approaches targeting improvement of underlying impairments Age-related walking problems contribute to an inefficient gait Altered biomechanics (Ex: flexed trunk) Disrupted movement control (Ex: reduced stride length) Walking becomes slow, less stable, inefficient, and timing is poor

6 Interventions to Improve Walking Speed Try to fix impairments of lower extremity weakness, flexibility and endurance Therapeutic exercises to enhance strength, range of motion, and aerobic conditioning Resistance exercise and stretching Progressive ambulation training Break down tasks of walking: propulsion, weight shifting, toe clearance, weight acceptance of heel Practice each individually with cueing

7 Assessing Walking Speed Takes less time than other measurement tools such as Berg Balance Score, Tinetti Performance Oriented Mobility Assessment, and Timed Up and GO Reflects body response to physical activity demands Incorporates physiological response with physical performance and overall fitness status Can identify those at risk of adverse outcomes or in need of intervention

8 Recommendations for Assessing Walking Speed No standard protocols developed Use of 10 m or less for walkway to be clinically feasible Studies show walkways between 5 to 10 m produce similar results Use of acceleration and deceleration phases to decrease variability Distance ranges 2.17 m to 2.5 m

9 Recommendations Straight path should be used to capture steady walking speed compared to including a turn Can use thin rope of distance compared to tape Using real-life examples or demonstration may result in greater walking speed Walk like you need to reach a bus vs. walk as fast as possible and safely but without running

10 Middleton et al. 2015

11 Minimal Detectable Changes (MDC) by Diagnosis Diagnosis Community-dwelling older adults SS MDC (m/s) Max MDC (m/s) Timed Distance (m) 0.14 N/A 4 2 Chronic stroke Accelerated distance (m) Incomplete SCI 0.17 N/A to 0.9 Hip fracture 0.08 N/A 10 1 Multiple Sclerosis NR Parkinson s Dementia 0.27 N/A 6 NR SS= self-selected walking speed Max= maximal walking speed Middleton et al. 2015

12 Minimal Detectable Changes (MDC) by Setting Diagnosis SS MDC (m/s) Max MDC (m/s) Timed Distance (m) Accelerated distance (m) Short term rehabilitation 0.13 N/A Acute care 0.18 N/A 3 15 Cardiac rehabilitation 0.16 N/A 4 1 Residential care unit N/A SS= self-selected walking speed Max= maximal walking speed Middleton et al. 2015

13 Utilizing Walking Speed in Acute Care Study investigated use of measuring walking speed to assess change during hospitalization Included subjects of 60 years or older who were able to walk at least 20 ft Subjects walked at self-selected speeds over 20 ft/6.09 m course (included 5 ft zone for acceleration, central 10 ft as steady zone, and 5 ft for deceleration) Subjects typically seen 30 minutes/day for bed mobility and transfer practice followed by ambulation at initial and pre-discharge Most common admitting diagnoses of subjects: orthopedic, cardio-pulmonary, gastro-intestinal, central nervous system, trauma and infections

14 Walking Speed in Acute Care Typical Walking Speed (60 to 69 y/o) Male Female 1.3 m/s 1.24 m/s Community-living 70 to 79 y/o 80 to 90 y/o 1.26 m/s 0.97 m/s 1.13 m/s 0.94 m/s Average walking speed on admission: 0.33 m/s Average walking speed at discharge: 0.37 m/s Significant increase in walking speed from admission to discharge: 0.04 m/s Conclusion: walking can improve even over short course of therapy

15 Walking speed differences following open heart surgery vary with discharge destination Albany et al Journal of Acute Care Physical Therapy

16 Albany et al. Purpose: investigate whether gait speed can be used to determine discharge disposition recommendations from acute care Methods Telemetry, cardiac surgery step-down unit Inclusion criteria: median sternotomy open heart coronary artery bypass with or without valve surgery without bypass Exclusion criteria: alternative approach open heart surgery or combined procedures Assessed gait speed at initial visit following chest tube removal

17 Prior studies

18 Albany et al. Walkway of 2.4 m (8 ft) with acceleration and deceleration area of 1.5 m (5 ft) Permitted to use assistive device Subjects were not informed gait speed was being measured to ensure safety steady walking Command: Walk at a comfortable pace along yellow cord to end No cues or feedback given during measured distance Assessed in single trial to avoid fatigue and eliminate effect of practice or motor learning Timing began at first fall after acceleration area and stopped first fall into deceleration

19 Albany et al. Results 59 subjects included Ages between 44 to 90 y/o (mean 67.3 y/o) 20 subjects discharged to acute rehabilitation, 10 to subacute rehabilitaiton (SAR), 29 to home For the 10 discharged to SAR, acute rehabilitation was recommended Mean gait speed was 0.33 ± 0.17 m/s Mean speed for discharge to rehab: 0.25 m/s, home: 0.42 m/s Subjects using assistive device had slower gait speeds and discharged to rehab

20 Albany et al. Conclusions Gait speed statistically significant in determining discharge disposition in patients who are accurately hospitalized after open heart surgery Subjects with slow speed (<0.4 m/s) likely to discharge to rehab setting (acute or subacute) and subjects with faster speed to home Best predictor of gait speed was use of assistive device Ambulating with rolling walker= highly demanding task May be due to lack of practice with device or sternal pain due to weight bearing of upper extremities

21 Summary Walking speed is a reliable measurement that can be used in multiple settings that represents an individual s functional health and can predict future health status Average walking speed in acute care at discharge: 0.37 m/s Walking speed of <0.4 m/s after open heart surgery most likely to discharge to a rehabilitation setting

22 References 1. Albany, K., Bibi, K. W., and Greenwood, K. C Walking speed differences following open heart surgery vary with discharge destination. Journal of Acute Care Physical Therapy, Brach, J. S. and VanSwearingen, J. M Interventions to improve walking in older adults. Current Translational Geriatrics and Experimental Gerontology Reports, Braden, H. J., et al Gait speed is limited but improves over the course of acute care physical therapy. Journal of Geriatric Physical Therapy, Hardy, S. E. et al Improvements in usual gait speed predicts better survival in older adults. The American Geriatrics Society, Middleton, A., Fritz, S. L., and Lusardl, M Walking speed: The functional vital sign. Journal of Aging and Physical Activity,