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RehabMeasures Instrument

Gait Speed

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Purpose

A test of gait speed assesses an individual's functional mobility. It is simple to perform, and it requires minimal space, equipment, and time. Gait Speed can be performed with populations of varying abilities and diagnoses.  Gait speed has been used as a predictor of decline in functional mobility.

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Instrument Details

Acronym  GS

Area of Assessment

Balance – Non-vestibular
Balance – Vestibular
Coordination
Functional Mobility

Cost

Free

Key Descriptions

  • Gait speed is the time one takes to walk a specified distance on level surfaces over a short distance. This is not a measure of endurance.
  • A distance of 3-10 meters is measured over a level surface with 2 meters for acceleration and 2 meters for deceleration.
  • Examinees walk at their comfortable (normal/natural) speed over the entire distance (referred to as comfortable speed).
  • Examinees walk as fast as they can (without running) over the same distance (referred to as maximum speed).
  • Examinees are timed once the first foot passes the acceleration path; the time is stopped once the first foot enters the deceleration path.
  • Two trials are given for each, with the average comfortable speed calculated and the average maximum speed calculated.
  • Gait speed is measured by the predetermined distance/time to walk that distance (e.g., 5m/__sec)
  • Similar assessments include the 10-meter walk test and the 6-minute walk test.

Equipment Required

  • Stop watch
  • Distance measure of 3 to 10 meters
  • Measuring tape
  • Tape, cone, or object to mark distances
  • Empty hallway/space

Time to Administer

5 minutes

<5 minutes

Required Training

No Training

Age Ranges

Adult

18 - 64

years

Elderly adult

65 +

years

Instrument Reviewers

Reviewed by Jill Heitzman, PT, DPT, GCS, NCS, CWS, CEEAA, FACCWS in November 2013; Updated by Jessica Donovan, MOTS & OTD Student.

ICF Domain

Activity

Measurement Domain

Activities of Daily Living
Motor

Considerations

  • Gait speed is the most valid and reliable among older adults (aged 65+)

  • Gait speed is a reliable predictor of potential for hospitalization and decline in function

  • Gait speed is more commonly assessed using the 10-meter walk test or the 6-minute walk test

  • Women have an overall slower gait speed than men, especially among older adults

Joint Pain and Fractures

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Minimal Detectable Change (MDC)

Hip Fracture:
 
(Hollman et al., 2008; n = 16; during acute care rehabilitation)
  • MDC = 0.082m/sec

(Palombaro, Craik, Mangione, & Tomlinson, 2006; n = 92; 6 months post fracture)

  • MDC = 0.08m/sec

Minimally Clinically Important Difference (MCID)

Hip Fracture:
 
(Palombaro, Craik, Mangione, Tomlinson, 2006)
  • MCID = 0.1m/sec

Test/Retest Reliability

Hip Fracture: (Hollman et al., 2008)

  • Excellent test-retest reliability (ICC = 0.823)

Stroke

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Minimally Clinically Important Difference (MCID)

Stroke:

(Perera, Mody, Woodman, & Studenski, 2006; n = 692)

  • MCID = 0.1m/sec

Non-Specific Patient Population

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Normative Data

Community-Dwellers:

(Montero-Odasso et al., 2005)

  • Low gait speed (at risk for falls/admissions/adverse events): <0.7m/sec

  • Mean gait speed: 0.7-1.0m/sec

  • High functioning gait speed: >1.1m/sec

(Bohannon et al., 2008)

Gait Speed: m/sec

 

     

Gender

Age

3M

6M

Female

50-59

1.1 (0.24)

1.109 (0.22)

 

60-69

0.99 (0.24)

1.0 (0.23)

 

70-79

0.917 (0.24)

0.929 (0.24)

 

80+

0.762 (0.216)

0.783 (0.219)

Male

50-59

1.115 (0.235)

1.122 (0.20)

 

60-69

1.03 (0.23)

1.033 (0.20)

 

70-79

0.954 (0.244)

0.957 (0.23)

 

80+

0.844 (0.24)

0.832 (0.22)

Interrater/Intrarater Reliability

Community Dwellers:

(Bohannon et al., 1997; n = 230)

  • Excellent reliability: ICC = 0.903 (comfortable)

  • Excellent reliability: ICC = 0.910 (maximum)

(Steffen, Hacker, & Mollinger, 2002; n = 96)

  • Excellent interrater reliability, intrarater reliability, and test-retest reliability: ICC = 0.90 - 0.96, = 0.89-1.00

Criterion Validity (Predictive/Concurrent)

Community Dwellers:

(Bohannon et al., 1997; n = 230)
  • Correlation with age, height and LE muscle strength

    • r = .190 to .251 (comfortable gait speed)

    • r = .292 to .558 (maximum gait speed)

(Bohannon et al., 2008)

  • Correlation with shorter (3m) distances to longer (6 m) distances

    • r = .933

  • BMI has a higher correlation to the longer gait speed:

    • r = -.081 for 6M walk

    • r = -.78 for 3M walk

(Steffen, Hacker, & Mollinger, 2002)

  • Correlation with Balance Master weight shift tasks: r = -.49 to -.72

  • Correlation with Berg Balance Scale: r = .81

  • Correlation with TUG: = -.75

  • Predictor of independent physical function:

    • Sensitivity 80%

    • Specificity 89%

Pulmonary Diseases

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Standard Error of Measurement (SEM)

COPD: (Kon et al., 2013; n = 586)

Test

SEM

SEM%

Usual 4MGS (stopwatch)

0.05

4.4

Usual 4MGS (timer)

0.05

4.4

Usual 10MGS (timer)

0.04

3.3

Maximal 4MGS (stopwatch)

0.08

4.8

Maximal 4MGS (timer)

0.08

4.8

Maximal 10MGS (timer)

0.07

4.0

 
  • Interobserver SEM: 1.14%

  • Test-retest reliability SEM: 1.5%

Minimal Detectable Change (MDC)

COPD: (Kon et al., 2014; n = 586)
  • MDC with pulmonary rehabilitation: 0.11m/s (95% CI)

Minimally Clinically Important Difference (MCID)

COPD: (Kon et al., 2014)

  • 0.11m/s (anchored against ISW)

  • 0.08 m/s (anchored against self-reported improvement)

Cut-Off Scores

COPD: (Kon et al., 2013)

  • Slow: <0.8 m/s

  • Normal: ≥0.8 m/s

Normative Data

COPD: (Liston & Brouwer, 1996)

Walking Speed Protocol

Mean Speed ± SD (m/s)

Minimum-Maximum (m/s)

Usual 4MGS (stopwatch)

1.13 ± 0.23

0.68-1.74

Usual 4MGS (timer)

1.14 ± 0.24

0.68-1.82

Usual 10MGS (timer)

1.27 ± 0.24

0.87-2.00

Maximal 4MGS (stopwatch)

1.68 ± 0.37

0.98-2.50

Maximal 4MGS (timer)

1.69 ± 0.38

0.93-2.67

Maximal 10MGS (timer)

1.77 ± 0.39

1.05-2.78

(4MGS= 4-meter gait speed; 10MGS= 10 meter gait speed)

COPD: (Kon et al., 2013)

  • Significant increase in mean 4GMS with pulmonary rehabilitation = 0.08 m/s

Test/Retest Reliability

COPD: (Liston & Brouwer, 1996)

  • Excellent test-retest reliability at usual and maximal pace for 4MGS (ICC ≥ .95)

Test

ICC (95% CI)

Mean Difference (95% CI)

Usual 4MGS (stopwatch)

0.95 (0.92-0.97)

0.01 (-0.03- 0.01)

Usual 4MGS (timer)

0.95 (0.91-0.97)

<0.01 (-0.02- 0.02)

Usual 10MGS (timer)

0.95 (0.95-0.98)

<0.01 (-0.02- 0.01)

Maximal 4MGS (stopwatch)

0.95 (0.93-0.97)

0.02 (-0.04- 0.01)

Maximal 4MGS (timer)

0.95 (0.92-0.97)

0.02 (-0.05- 0.01)

Maximal 10MGS (timer)

0.95 (0.96-0.98)

0.03 (-0.05- <0.01)

  • Excellent test-retest reliability (ICC = 0.97, 95% CI, 0.95-0.98)

Interrater/Intrarater Reliability

COPD: (Kon et al., 2013)

  • Excellent inter-rater reliability: (ICC = 0.99, 95% CI, 0.98-0.99)

Construct Validity

COPD: (Kon et al., 2013)

Convergent:

  • Excellent correlations with 4MGS and ISAW (p = 0.78, p < 0.001)

Discriminant:

  • Negative correlation with MRC dyspnea scale (p = -0.55, p < 0.001)

  • Negative correlation with SGRQ (p = -0.44, p < 0.001)

Floor/Ceiling Effects

COPD: (Kon et al., 2013)

  • Effect size with pulmonary rehabilitation = 0.4

Responsiveness

COPD: (Kon et al., 2013)

  • 4MGS is responsive to intervention and declines with time

  • Smallest real change = 0.02 m/s

  • Substantial real change = 0.11 m/s

Older Adults and Geriatric Care

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Minimal Detectable Change (MDC)

Older Adults: (Pulignano et al., 2016; n = 331; mean age = 78 years (6); 43% women; community-dwelling with history of chronic heart failure)

  • MDC: 0.05 m/s

Minimally Clinically Important Difference (MCID)

Older Adults: (Pulignano et al., 2016)

  • MCID: 0.05 m/s and 0.12 m/s

Cut-Off Scores

Aged 65 and Older: (Studenski et al., 2003)

  • Clinically Valid Cut Point: 0.6 m/s to 1.0 m/s

Aged 70 and above: (Peel, Kuys, & Klein, 2013)

  • Age 70-79 comfortable gait speed:

    • Men: 1.13 m/s

    • Women: 1.26 m/s

  • Age 80-99 comfortable gait speed:

    • Men: 0.94 m/s

    • Women: 0.97 m/s

  • Predictor of poor clinical outcomes: 0.8 m/s

  • Predictor of further functional decline in already impaired individuals: 0.6 m/s

Adults 75 and above: (Montero-Odasso et al., 2005).

Gait Velocity (GS) Category

Gait Velocity

High

1.1 m/s

Median

0.7-1.1 m/s

Low

<0.7 m/s

  • >1 m/s= “normal” in older adults without disability

  • <0.7 m/s= predictor of adverse events

Older Adults with Heart Failure: (Pulignano et al., 2016)

  • Slow: gait speed < or = to 0.65 m/s

  • Intermediate: gait speed = 0.66-0.99 m/s

  • Fast: gait speed > or = to 1.0 m/s

Normative Data

Age 70 and above: (Peel, Kuys, & Klein, 2013)

  • Usual pace gait speed estimate= 0.58 m/s (95% CI: 0.001-0.006)

  • Maximal pace= 0.89 m/s (95% CI: 0.75-1.02)

  • Gate speed increased per year: mean 0.013 m/s (95% CI: 0.003-0.023)

Usual and Maximal Pace Gait Speed in Clinical Settings

Pace

Location

Gait Speed Estimates (m/s)

SE

95% CI

Usual

Acute

0.455

0.057

0.344-0.567

 

Subacute

0.529

0.046

0.438-0.619

 

Ambulatory

0.739

0.046

0.648-0.831

Maximal

Acute

0.749

0.080

0.592-0.905

 

Subacute

0.822

0.057

0.711-0.933

 

Ambulatory

1.033

0.063

0.910-1.156

Adults Aged 75 and above: (Montero-Odasso et al., 2005).

Results 2 years post-test (8m/usual speed):

Gait Velocity

High: >1.1 m/s (n=34)

Median: 0.7-1.0 m/s (n=42)

Low: <0.7 m/s (n=25)

Relative Risk

P value

Subjects with adverse events

20%

34%

72%

High-Low GV: 3.5 (1.7-7.0)

Intermediate-Low GV: 2.1 (1.3–3.4

.002

 

.001

New falls

12%

24%

60%

High-Low GV: 5.4 (2.0-14.3)

Intermediate-Low GV: 2..6 (1.4-4.9)

<.0005

Hospitalization

8.8%

17%

52%

High-Low GV: 5.9 (1.9–18.5

 

Intermediate-Low: 3.0 (1.4–3.6)

 

<.005

Need for caregiver

3%

17%

28%

High-Low GV: 9.5 (1.3–72.5)

 

Intermediate-Low: 1.64 (0.7–4.1)

 

<.007

Nursing home placement

0%

0%

12%

N/A

 

Fracture

3%

10%

8%

High-Low GV: 2.7 (0.3-28.4)

 

Intermediate-Low: 0.8 (0.8-4.2)

 

 

Death

0%

10%

8%

N/A

 

  • Relative Risk between high and low GV (95% CI) = 3.5 (1.7-7.0), p < .002)

  • RR between intermediate and low GV= 2.1 (1.3-3.4), p < .001

Older Adults with Heart Failure: (Pulignano et al., 2016)

  • Slow: gait speed < or = to 0.65 m/s

  • Intermediate: gait speed = 0.66-0.99 m/s

  • Fast: gait speed > or = to 1.0 m/s

Test/Retest Reliability

Aged 65 and older: (Studenski et al., 2003)

  • Over 2 weeks:

    • Excellent test-retest reliability (ICC > .90)

Aged 70 and older: (Verghese et al., 2011; Verghese & Xue, 2011)

  • Excellent test-retest reliability (r = .96)

Interrater/Intrarater Reliability

Aged 65 and Older: (Studenski et al., 2003)

  • Over 2 weeks:
    • Excellent interrater reliability (ICC > .90)

Aged 70 and Older: (Verghese et al., 2011; Verghese & Xue, 2011)

  • Excellent interrater reliability (ICC > .96)

Internal Consistency

Adults Aged 70 and Older: (Verghese et al., 2011; Verghese & Xue, 2011)

  • Excellent internal consistency (Pearson r = .94)

Criterion Validity (Predictive/Concurrent)

Concurrent Validity

Adults Aged 65 and Older: (Studenski et al., 2003)

  • Excellent correlation with GS and Pra score at 1 year in HMO population (r = 0.686)

Predictive Validity:

Adults Aged 65 and Older: (Studenski et al., 2003)

  • Excellent predictive validity of GS at 1 year in HMO population (r = 0.677)

  • Adequate predictive validity of GS at 1 year in VA population (r = 0.532)

Construct Validity

Aged 65 and Older: (Studenski et al., 2003)

   

Area Under ROC curve for major outcomes:

Outcome

Gait Speed

Gait Speed and Self-report

Pra score*

HMO

VA

Pooled

 

0.677

0.578

0.644

 

0.686

0.580

0.656

Physician risk assessment

HMO

VA

Pooled

 

0.683

0.506

0.630

 

0.690

0.603

0.657

Pra score* and physician risk assessment

HMO

VA

Pooled

 

0.683

0.506

0.630

 

0.701

0.602

0.673

Global health change

HMO

VA

Pooled

0.625

0.743

0.691

0.701

0.820

0.741

Eroquel score

HMO

VA

Pooled

 

0.578

0.631

0.587

 

0.662

0.672

0.653

Functional Status

HMO

VA

Pooled

 

0.690

0.748

0.721

 

0.773

0.830

0.798

*Pra= hospitalization risk by probability of repeated admission

Content Validity

Adults Aged 65 and Older: (Studenski et al., 2003)

Not statistically assessed, however:

  • Out of 32 staff:

    • > 50% felt assessment was very acceptable

    • Remaining felt assessment was acceptable

  • Out of 60 participants:

    • 58 felt assessment was acceptable or very acceptable

    • 2 felt assessment was less than acceptable

Face Validity

"An expert working group recently identified the 4MGS as the most appropriate functional test for interventional trials in frail older adults" (Kon et al., 2013).

Bibliography

Bohannon, R. W. (1997). Comfortable and maximum walking speed of adults aged 20-79 years: reference values and determinants. Age and Ageing, 26, 15-19. Find it on PubMed

Bohannon, R. W. (2008). Population representative gait speed and its determinants. Journal of Geriatric Physical Therapy, 31, 49-52. Find it on PubMed

Hollman, J. H., Beckman, B. A., Brandt, R. A., Merriwether, E. N., Williams, R. T., Nordrum, J. T. (2008). Minimum detectable change in gait velocity during acute rehabilitation following hip fracture. Journal of Geriatric Physical Therapy, 31, 53-56. Find it on PubMed

Kon, S., Patel, M., Canavan, J., Clark, A., Jones, S., Nolan, C., Cullinan, P., Polkey, M. and Man, W. (2013). Reliability and validity of 4-metre gait speed in COPD. European Respiratory Journal, 42(2), 333-340. Find it on PubMed

Kon, S., Patel, M., Canavan, J., Clark, A., Jones, S., Nolan, C., Cullinan, P., Polkey, M. and Man, W. (2014). The 4-metre gait speed in COPD: responsiveness and minimal clinically important difference. The European Respiratory Journal, 43(5), 1298-1305. Find it on PubMed

Montero-Odasso, M., Schapira, M., Soriano, E. R., Varela, M., Kaplan, R., Camera, L. A., Mayorga, L. M. (2005). Gait velocity as a single predictor of adverse events in healthy seniors aged 75 years and older. Journal of Gerontology: Biological Sciences, 60, 1304-1309. Find it on PubMed

Palombaro, K. M., Craik, R. L., Mangione, K .K., Tomlinson, J. D. (2006). Determining meaningful changes in gait speed after hip fracture."Journal of Geriatric Physical Therapy, 31, 53-56. Find it on PubMed

Peel, N., Kuys, S., Klein, K. (2013). Gait speed as a measure in geriatric assessment in clinical settings: A systematic review. Journals of Gerontology Series A: Biological Sciences and Medical Sciences68(1), 39-46. Find it on PubMed

Perera, S., Mody, S. H., Woodman, R. C., Studenski, S. A. (2006). Meaningful change and responsiveness in common physical performance measures in older adults. Journal of American Geriatric Society, 54, 743-749. Find it on PubMed

Pulignano, G., Del Sindaco, D., Di Lenarda, D., Alunni, G., Senni, M., Tarantini, L., Cioffi, G., Denitza Tinti, M., Barbati, G., Minardi, G., & Uguccioni, M. (2016). Incremental value of gait speed in predicting prognosis of older adults with heart failure: Insights from the IMAGE-IF study. JACC: Heart Failure, 4(4), 289-298. Find it on PubMed

Steffen, T. M., Hacker, T. A., Mollinger, L. (2002). Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Physical Therapy, 82, 128-137. Find it on PubMed

Studenski, S., Perera, S., Wallace, D., Chandler, J. M., Duncan, P. W., Rooney, E., Fox, M., Guralnik, J. M. (2003). Physical performance measures in the clinical setting. Journal of the American Geriatrics Society, 51(3), 314–322. Find it on PubMed

Verghese, J., & Xue, X. (2011). Predisability and gait patterns in older adults. Gait & Posture, 33(1), 98-101. Find it on PubMed

Verghese, J., Holtzer, R., Oh-Park, M., Derby, C., Lipton, R., Wang, C. (2011) Inflammatory markers in gait speed decline in older adults. Journal of Gerontology: Series A, Volume 66A(10), 1083-1089. Find it on PubMed

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