Stride Length Predicts Adverse Clinical Events in Older Adults: A Systematic Review and Meta-Analysis

Ibadete Bytyçi, Michael Y Henein, Ibadete Bytyçi, Michael Y Henein

Abstract

Background: This meta-analysis aims to estimate the power of walking stride length as a predictor of adverse clinical events in older adults.

Methods: We searched all electronic databases until April 2021 for studies reporting stride length and other spatial gait parameters, including stride velocity, stride width, step width and stride variability, and compared them with clinical outcomes in the elderly. Meta-analyses of odds ratios (ORs) of effects of stride length on clinical outcomes used the generic inverse variance method and random model effects. Clinical outcomes were major adverse events (MAEs), physical disability and mortality.

Results: Eleven cohort studies with 14,167 patients (mean age 75.4 ± 5.6 years, 55.8% female) were included in the analysis. At 33.05 months follow up, 3839 (27%) patients had clinical adverse events. Baseline stride length was shorter, WMD -0.15 (-0.19 to -0.11, p < 0.001), and stride length variability was higher, WMD 0.67 (0.33 to 1.01, p < 0.001), in fallers compared to non-fallers. Other gait parameters were not different between the two groups (p > 0.05 for all). Short stride length predicted MAE OR 1.36 (95% CI; 1.19 to 1.55, p < 0.001), physical disability OR 1.26 (95% CI; 1.11 to 1.44, p = 0.004) and mortality OR 1.69 (95% CI; 1.41 to 2.02, p < 0.001). A baseline normalized stride length ≤ 0.64 m was more accurate in predicting adverse clinical events, with summary sensitivity 65% (58-71%), specificity 72% (69-75%) and accuracy 75.5% (74.2-76.7%) compared to stride length variability 5.7%, with summary sensitivity 66% (61-70%), specificity 56% (54-58%) and accuracy 57.1% (55.5-58.6%).

Conclusion: The results of this meta-analyses support the significant value of stride length for predicting life-threatening clinical events in older adults. A short stride length of ≤0.64 m accurately predicted clinical events, over and above other gait measures.

Keywords: adverse clinical events; older adult; stride length.

Conflict of interest statement

No authors have any conflict of interest to declare.

Figures

Figure 1
Figure 1
Illustration of spatial parameters of gait.
Figure 2
Figure 2
Gait parameters in fallers compared to non-fallers: (A) stride length; (B) stride variability; (C) stride width; (D) stride velocity; (E) step width.
Figure 3
Figure 3
Shorter stride length in predicting adverse clinical events: (A) major adverse event (MAE); (B) physical disability; (C) mortality.
Figure 4
Figure 4
Interaction of age and gender with major adverse events (MAE).
Figure 5
Figure 5
Diagnostic accuracy of stride length in predicting major adverse events (MAE).

References

    1. Kennedy B.K., Pennypacker J.K. Drugs that modulate aging: The promising yet difficult path ahead. Transl. Res. 2014;163:456–465. doi: 10.1016/j.trsl.2013.11.007.
    1. Sonntag W.E., Ungvari Z. GeroScience: Understanding the interaction of processes of aging and chronic diseases. AGE. 2016;38:377–378. doi: 10.1007/s11357-016-9953-7.
    1. Motl R.W., McAuley E. Physical activity, disability, and quality of life in older adults. Phys. Med. Rehabil. Clin. N. Am. 2010;21:299–308. doi: 10.1016/j.pmr.2009.12.006.
    1. Battalio S.L., Jensen M.P., Molton I.R. Secondary health conditions and social role satisfaction in adults with long-term physical disability. Health Psychol. 2019;38:445–454. doi: 10.1037/hea0000671.
    1. Ashok L., Shetty B., Mayya S., Chandrasekaran V., Kuvalekar K., Kamath R. Quality of life among persons with physical disability in udupi taluk: A cross sectional study. J. Fam. Med. Prim. Care. 2015;4:69–73. doi: 10.4103/2249-4863.152258.
    1. Simning A., Kittel J., Conwell Y. Late-life depressive and anxiety symptoms following rehabilitation services in medicare beneficiaries. Am. J. Geriatr. Psychiatry. 2019;27:381–390. doi: 10.1016/j.jagp.2018.12.012.
    1. Chodzko-Zajko W.J., Proctor D.N., Fiatarone Singh M.A., Minson C.T., Nigg C.R., Salem G.J., Skinner S.J. American college of sports medicine position stand. Exercise and physical activity for older adults. Med. Sci. Sports Exerc. 2009;41:1510–1530. doi: 10.1249/MSS.0b013e3181a0c95c.
    1. Zbrońska I., Mędrela-Kuder E. The level of physical activity in elderly persons with overweight and obesity. Roczniki Państwowego Zakładu Higieny. 2018;69:369–373. doi: 10.32394/rpzh.2018.0042.
    1. Studenski S. Gait speed and survival in older adults. JAMA. 2011;305:50–58. doi: 10.1001/jama.2010.1923.
    1. Hall W.J. Update in geriatrics. Ann. Intern. Med. 2006;145:538–543. doi: 10.7326/0003-4819-145-7-200610030-00012.
    1. Moher D., Liberati A., Tetzlaff J., Altman D.G., Group P. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. BMJ. 2009;339:b2535. doi: 10.1136/bmj.b2535.
    1. Herrero-Larrea A., Miñarro A., Narvaiza L., Gálvez-Barrón C., León N.G., Valldosera E., Felipe E., Valverde R.A., Kruse L., Sabater J.B., et al. Normal limits of home measured spatial gait parameters of the elderly population and their association with health variables. Sci. Rep. 2018;8:13193. doi: 10.1038/s41598-018-31507-1.
    1. Hof A.L. Scaling gait data to body size. Gait Posture. 1996;4:222–223. doi: 10.1016/0966-6362(95)01057-2.
    1. Zeng X.-T., Zhang Y., Kwong J.S., Zhang C., Li S., Sun F., Niu Y., Du L. The methodological quality assessment tools for preclinical and clinical studies, systematic review and meta-analysis, and clinical practice guideline: A systematic review. J. Evid. Based Med. 2015;8:2–10. doi: 10.1111/jebm.12141.
    1. Hozo S.P., Djulbegovic B., Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med. Res. Methodol. 2005;5:13. doi: 10.1186/1471-2288-5-13.
    1. Higgins J.P.T., Thompson S.G., Deeks J.J., Altman D.G. Measuring inconsistency in meta-analyses. BMJ. 2003;327:557–560. doi: 10.1136/bmj.327.7414.557.
    1. Rutter C.M., Gatsonis C.A. A hierarchical regression approach to meta-analysis of diagnostic test accuracy evaluations. Stat. Med. 2001;20:2865–2884. doi: 10.1002/sim.942.
    1. Der Simonian R., Laird N. Meta-analysis in clinical trials. Control Clin. Trials. 1986;7:177–188. doi: 10.1016/0197-2456(86)90046-2.
    1. Wolfson L., Whipple R., Amerman P., Tobin J.N. Gait assessment in the elderly: A gait abnormality rating scale and its relation to falls. J. Gerontol. 1990;45:M12–M19. doi: 10.1093/geronj/45.1.M12.
    1. Maki B.E. Gait changes in older adults: Predictors of falls or indicators of fear? J. Am. Geriatr. Soc. 1997;45:313–320. doi: 10.1111/j.1532-5415.1997.tb00946.x.
    1. Woo J., Ho S.C., Yu A.L.M. Walking speed and stride length predicts 36 months dependency, mortality, and institutionalization in Chinese aged 70 and older. J. Am. Geriatr. Soc. 1999;47:1257–1260. doi: 10.1111/j.1532-5415.1999.tb05209.x.
    1. Verghese J., Holtzer R., Lipton R.B., Wang C. Quantitative gait markers and incident fall risk in older adults. J. Gerontol. A Biol. Sci. Med. Sci. 2009;64:896–901. doi: 10.1093/gerona/glp033.
    1. Blain H., Carriere I., Sourial N., Berard C., Favier F., Colvez A., Bergman H. Balance and walking speed predict subsequent 8-year mortality independently of current and intermediate events in well-functioning women aged 75 years and older. J. Nutr. Health Aging. 2010;14:595–600. doi: 10.1007/s12603-010-0111-0.
    1. Reelick M.F., Kessels R.P.C., Faes M.C., Weerdesteyn V., Esselink R.A.J., Rikkert M.G.M.O. Increased intra-individual variability in stride length and reaction time in recurrent older fallers. Aging Clin. Exp. Res. 2011;23:393–399. doi: 10.1007/BF03337764.
    1. Hirsch C.H., Bůžková P., Robbins J.A., Patel K.V., Newman A.B. Predicting late-life disability and death by the rate of decline in physical performance measures. Age Ageing. 2011;41:155–161. doi: 10.1093/ageing/afr151.
    1. Johansson J., Nordström A., Nordström P. Greater fall risk in elderly women than in men is associated with increased gait variability during multitasking. J. Am. Med. Dir. Assoc. 2016;17:535–540. doi: 10.1016/j.jamda.2016.02.009.
    1. Rodríguez-Molinero A., Herrero-Larrea A., Miñarro A., Narvaiza L., Gálvez-Barrón C., León N.G., Valldosera E., De Mingo E., Macho O., Aivar D., et al. The spatial parameters of gait and their association with falls, functional decline and death in older adults: A prospective study. Sci. Rep. 2019;9:1–9. doi: 10.1038/s41598-019-45113-2.
    1. Gillain S., Boutaayamou M., Schwartz C., Dardenne N., Bruyère O., Brüls O., Croisier J.L., Salmon E., Reginster Y.E., Garrauxet G., et al. Gait symmetry in the dual task condition as a predictor of future falls among independent older adults: A 2-year longi-tudinal study. Aging Clin. Exp. Res. 2019;31:1057–1067. doi: 10.1007/s40520-019-01210-w.
    1. Doi T., Nakakubo S., Tsutsumimoto K., Kim M.-J., Kurita S., Ishii H., Shimada H. Spatio-temporal gait variables predicted incident disability. J. Neuroeng. Rehabil. 2020;17:1–7. doi: 10.1186/s12984-020-0643-4.
    1. Inzitari M., Newman A.B., Yaffe K., Boudreau R., De Rekeneire N., Shorr R., Harris T.B., Rosano C. Gait speed predicts decline in attention and psychomotor speed in older adults: The health aging and body composition study. Neuroepidemiology. 2007;29:156–162. doi: 10.1159/000111577.
    1. Van Kan G.A., Rolland Y., Andrieu S., Bauer J., Beauchet O., Bonnefoy M., Vellas B. Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people. J. Nutr. Health Aging. 2009;13:881–889. doi: 10.1007/s12603-009-0246-z.
    1. Mortaza N., Abu Osman N.A., Mehdikhani N. Are the spatio-temporal parameters of gait capable of distinguishing a faller from a non-faller elderly? Eur. J. Phys. Rehabil. Med. 2014;50:677–691.
    1. Waite L.M., Grayson D.A., Piguet O., Creasey H., Bennett H.P., Broe G.A. Gait slowing as a predictor of incident dementia: 6-year longitudinal data from the Sydney Older Persons Study. J. Neurol. Sci. 2005;229–230:89–93. doi: 10.1016/j.jns.2004.11.009.
    1. Hausdorff J.M., Rios D.A., Edelberg H.K. Gait variability and fall risk in community-living older adults: A 1-year prospective study. Arch. Phys. Med. Rehabil. 2001;82:1050–1056. doi: 10.1053/apmr.2001.24893.
    1. Verghese J., Wang C., Lipton R.B., Holtzer R., Xue X. Quantitative gait dysfunction and risk of cognitive decline and dementia. J. Neurol. Neurosurg. Psychiatry. 2007;78:929–935. doi: 10.1136/jnnp.2006.106914.

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