Emma Haldane Beisheim1, Elisa Sarah Arch2, John Robert Horne3, Jaclyn Megan Sions1. 1. Department of Physical Therapy, University of Delaware, Newark, DE, USA. 2. Department of Kinesiology and Applied Physiology, University of Delaware, Newark, DE, USA. 3. Independence Prosthetics-Orthotics, Inc., Newark, DE, USA.
Abstract
BACKGROUND: In the United States, Medicare Functional Classification Level (K-level) guidelines require demonstration of cadence variability to justify higher-level prosthetic componentry prescription; however, clinical assessment of cadence variability is subjective. Currently, no clinical outcome measures are associated with cadence variability during community ambulation. OBJECTIVES: Evaluate whether physical performance, i.e. 10-meter Walk Test (10mWT)-based walking speeds, L-Test, and Figure-of-8 Walk Test scores, is associated with community-based cadence variability among individuals with a transtibial amputation. STUDY DESIGN: Cross-sectional. METHODS: Forty-nine participants, aged 18-85 years, with a unilateral transtibial amputation were included. Linear regression models were conducted to determine whether physical performance was associated with cadence variability (a unitless calculation from FitBit® OneTM minute-by-minute step counts), while controlling for sex, age, and time since amputation (p ⩽ .013). RESULTS: Beyond covariates, self-selected gait speed explained the greatest amount of variance in cadence variability (19.2%, p < .001). Other outcome measures explained smaller, but significant, amounts of the variance (11.1-17.1%, p = .001-.008). For each 0.1 m/s-increase in self-selected and fast gait speeds, or each 1-s decrease in L-Test and F8WT time, community-based cadence variability increased by 1.76, 1.07, 0.39, and 0.79, respectively (p < .013). CONCLUSIONS: In clinical settings, faster self-selected gait speed best predicted increased cadence variability during community ambulation. CLINICAL RELEVANCE: The 10-meter Walk Test may be prioritized during prosthetic evaluations to provide objective self-selected walking speed data, which informs the assessment of cadence variability potential outside of clinical settings.
BACKGROUND: In the United States, Medicare Functional Classification Level (K-level) guidelines require demonstration of cadence variability to justify higher-level prosthetic componentry prescription; however, clinical assessment of cadence variability is subjective. Currently, no clinical outcome measures are associated with cadence variability during community ambulation. OBJECTIVES: Evaluate whether physical performance, i.e. 10-meter Walk Test (10mWT)-based walking speeds, L-Test, and Figure-of-8 Walk Test scores, is associated with community-based cadence variability among individuals with a transtibial amputation. STUDY DESIGN: Cross-sectional. METHODS: Forty-nine participants, aged 18-85 years, with a unilateral transtibial amputation were included. Linear regression models were conducted to determine whether physical performance was associated with cadence variability (a unitless calculation from FitBit® OneTM minute-by-minute step counts), while controlling for sex, age, and time since amputation (p ⩽ .013). RESULTS: Beyond covariates, self-selected gait speed explained the greatest amount of variance in cadence variability (19.2%, p < .001). Other outcome measures explained smaller, but significant, amounts of the variance (11.1-17.1%, p = .001-.008). For each 0.1 m/s-increase in self-selected and fast gait speeds, or each 1-s decrease in L-Test and F8WT time, community-based cadence variability increased by 1.76, 1.07, 0.39, and 0.79, respectively (p < .013). CONCLUSIONS: In clinical settings, faster self-selected gait speed best predicted increased cadence variability during community ambulation. CLINICAL RELEVANCE: The 10-meter Walk Test may be prioritized during prosthetic evaluations to provide objective self-selected walking speed data, which informs the assessment of cadence variability potential outside of clinical settings.
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