Relationship between test methodology and mean velocity in timed walk tests: a review

Abstract

Objective: To assess the degree to which test methodology affects outcomes in clinical evaluations of walking speed.

Data sources: Medline database and reference lists from relevant articles.

Study selection: We conducted electronic searches by using various combinations of terms related to clinical evaluations of walking speed. Resultant abstracts were then reviewed, and the methods and results section of promising full-text articles were searched for detailed descriptions of walk-test methodologies and results. Ultimately, articles were limited to the most common participant groups, older adults (aged) and individuals with neurologic conditions (neuro). The final sample included 46 studies.

Data extraction: Three aspects of test methodology (pace, starting protocol, distance timed) were extracted for use as independent variables. Group mean age was extracted for use as a covariate. Group mean velocity was extracted for use as the dependent variable. Data were extracted by a single investigator.

Data synthesis: Usual and/or comfortable pace was reported nearly twice as often as fast pace in both groups. Static-start protocols were more frequently used in aged studies, whereas dynamic (ie, rolling) starts were more common in neuro studies. Distances of 6 and 10m were most common in aged and neuro studies, respectively. Multivariate analyses (analysis of covariance) showed that only pace was significantly related to the mean velocity in both groups (aged: pace, P<.01; starting protocol, P=.21; distance, P=.05; neuro: pace, P=.01; starting protocol, P=.63; distance, P=.49). However, methodology-related differences in the distribution (95% confidence intervals) of performance scores across certain clinical standards were noted within all 3 methodology variables.

Conclusions: Clinical assessments of walking velocity are not conducted uniformly. Common methodologic factors may influence the clinical interpretation of walk performances. Universal walk-test methodology is warranted to improve intergroup comparisons and the development of useful clinical criteria and consensus norms.

Figures

Fig 1

Schematic of literature search and results of study selection process. *Studies included in analysis are: Dobkin, Baer and Smith, Kuo et al, Ostchega et al, Rantanen et al, Rolland et al, van Hedel et al, van Loo et al, Salbach et al, Tyson and DeSouza, Moseley et al, Galvão and Taaffe, Henwood and Taaffe, Salbach et al, Wang et al, van Herk et al, Arnadottir and Mercer, Bischoff-Ferrari et al, Brill et al, Cesari et al, Chang et al, English et al, Gajdosik et al, Gold et al, Goldie et al, Herman et al, Kadanka et al, Kollen et al, Kressig et al, Meeuwsen et al, Miyai et al, Miyai et al, Morey and Zhu, Nelson et al, Nieuwenhuis et al, Pellecchia et al, Romberg et al, Taaffe et al, Tiedemann et al, Vos-Vromans et al, Webster et al, White and Petajan, Winchester et al, Witte and Carlsson, Wolf et al, and Yanagita et al.

Fig 2

Age-adjusted and weighted estimates of mean velocities (SEs) and 95% confidence intervals by methodology in the aged group. The dashed vertical lines represent usual- and fast-paced standards cited in the implications section of the discussion.

Fig 3

Age-adjusted and weighted estimates of mean velocities (SEs) and 95% confidence intervals by methodology in the neuro group. The dashed vertical lines represent usual- and fast-paced standards cited in the implications section of the discussion.