The association between fear of falling and smoothness of lower trunk oscillation in gait varies according to gait speed in community-dwelling older adults
Asai et al. Journal of NeuroEngineering and Rehabilitation
The association between fear of falling and smoothness of lower trunk oscillation in gait varies according to gait speed in community-dwelling older adults
0 Department of Physical Therapy, Faculty of Rehabilitation, Kobe Gakuin University , 518 Ikawadanicho, Arise, Nishi-ku, Kobe, Hyogo 651-2180 , Japan
Background: Fear of falling (FoF) is common in community-dwelling older adults. FoF and increased walking speed are associated with lower trunk oscillation during gait in older adults. We hypothesized that older adults with FoF would struggle to walk safely when instructed to walk faster than usual. Methods: Participants included 260 community-dwelling older adults aged over 65 years (mean age = 71.9 ± 3.9 years) who were able to walk independently without an assistive device. Participants were instructed to walk along a 15-m smooth horizontal walkway at self-selected normal and fast gait speeds. During the middle 10 m of the walk, oscillation of the lower trunk and stride times were measured with two accelerometers. We examined associations between gait variables, including harmonic ratio (HR) in vertical, mediolateral (HR-ML) and anteroposterior (HR-AP) directions as indicators of smoothness of lower trunk oscillation, as well as stride time variability (STV) and FoF. Results: Gait-speed- and STV- adjusted models showed that FoF was significantly associated with HR-ML in the normal-gait condition (HR-ML: β = - .135, p = .040), while FoF was significantly associated with HR-AP in the fast-gait condition (HR-AP: β = - .154, p = .017). Conclusions: FoF-related changes in gait vary with gait speed. In older adults with FoF, lower trunk oscillation was less smooth in the lateral direction when they walked at their usual pace. In addition, lower trunk oscillation was also less smooth in the direction of travel when they walked at a faster pace than their usual walking speed.
Fear of falling; Gait; Accelerometer; Community-dwelling older adults
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Background
Fear of falling (FoF) is common among older adults,
exhibited as a lack of self-confidence in performing normal
activities without falling [1]. The prevalence of FoF
increases with age, ranging from 21 to 85% in
communitydwelling older adults [2]. FoF is an important risk factor
for falling [1, 3] and for limitations in activities of daily
living [4]. Additionally, FoF is associated with
psychological problems [5] and poor physical performance [6, 7].
FoF-related issues have a serious impact on health and
quality of life for older people. Thus, FoF is an important
community health issue to address [8].
Unimpaired gait is an important factor influencing
older adults’ ability to live independently in the
community. In normal gait, trunk stability contributes, in part,
to successful locomotion. During walking, the control of
trunk oscillation is prioritized and the trunk plays an
important role in providing a stable platform for vision and
head control [9]. Importantly, some reports have shown
that FoF is associated with the control of trunk
oscillation while walking. Specifically, it has been reported that
the acceleration waveforms of the trunk are less smooth
and the trunk has greater amplitude in dual-task
conditions among older adults with FoF, compared with those
without FoF [10, 11]. Such gait changes contribute to
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the risk of falling among older adults [12, 13]. Thus,
examining the association between FoF and the control of
trunk oscillation during walking is of clinical importance.
Gait speed is one of the essential factors influencing
the control of trunk oscillation. Several studies have
investigated the relationship between gait speed and the
control of trunk oscillation, revealing that walking faster
than one’s normal speed affects trunk control [14, 15].
There are many occasions in daily life in which
community-dwelling older adults are required to walk
faster than normal (e.g., crossing roads). Therefore,
physical assessment of older adults should include
measurements of gait in various gait-speed conditions,
especially in fast-gait conditions. However, previous studies
have only observed FoF-related gait changes when
participants were instructed to walk at their normal walking
pace [10, 11, 16–18]. To our knowledge, no studies have
investigated FoF-related gait changes when particip (...truncated)