Gait Speed as an Objective Measure

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Original Editor - User:Justin Bryan Top Contributors - Justin Bryan, Shaimaa Eldib, Kim Jackson and Nupur Smit Shah

Objective

The speed at which a person walks can be influenced by a number of factors, both voluntary and involuntary, and marks a functional skill that underpins a majority of the tasks that are essential to a person’s ability to function on a daily basis.  Given this, walking speed, which is more commonly referred to as gait speed in the clinical setting, is a metric that is extremely valuable for practitioners when examining aspects of functional mobility in their patients.  Additionally, given its ability to be influenced by multiple body systems (i.e. central nervous system, musculoskeletal system), gait speed is often used a predictor of overall health and function, especially in older adults.

Gait speed has been considered by some to be a "Vital Sign" like blood pressure and heart rate, and it's predictive ability has been linked with a myriad of common outcomes including hospitalization, fall risk, cognitive decline, disability, and mortality.

The objective of this page is to provide an overview of the gait speed as an outcome measure and it implications for clinical practice. Please note that this page pertains specifically to gait speed as a measure and not tests such as the 10-Meter Walk Test, whose results are recorded as a gait speed.

Intended Population

Gait speed can be measured in pretty much any population, but it is most commonly used as a predictive measure in the older adult population.

Method of Use

Gait speed at it's simplest form is a measure of how much long it takes a person to travel a given distance (speed).

Speed (s) = distance (d) ÷ time (t)

As such, there are many variations of how it can be measured, and no one set methods that is used across the board.

That being said, certain parameters can be of interest when looking at specifically how gait speed in measured, and there have been many suggestions regarding the standardization of procedures. Mehmet, Robinson, and Yang performed a systematic review of approximately 50 studies looking specifically at the methods of measuring gait speed between investigators. Below are components that looked at the the variations they found:

• Timing device / Measuring tool - Digital stopwatch, analog stopwatch, accelerometer, photocell triggered computer stopwatch, walking system (i.e. GAITRite)
• Measurement distance - Ranging from 2.4 meters to 15 meters; 3, 4 , and 6 meters were the most commonly used distances
• Timing points - Acceleration and deceleration zones are sometimes used with timing measured the two middle points of a four point course
• Use of walking aids - Walking aids are generally allowed, but in some cases they were not permitted
• Number of trials - Two trials were performed most commonly
• Walking pace - Pace is commonly normal or self-selected, although fast pace is sometimes measured

Given the wide variation in protocol and measurement methods, Mehmet, Robinson, and Yang suggest the following standard procedure for determining gait speed:

• Patient walks at a comfortable pace with appropriate walking aid
• Straight path and flat surface
• 9 meter total distance with the first and last 2.5 meters used for acceleration and deceleration
  • Time recorded for the middle 4 meters
• Handheld stopwatch
• Fastest of 2 trials is recorded
• Gait Speed = 4 meters ÷ Time (seconds)

Normative and Predictive Data

Typical gait speeds across various settings:

• Normal
  • Acute care (hospital): o.455 m/s
  • Subacute / rehab facility: 0.529 m/s
  • Outpatient: 0.739 m/s
• Maximal
  • Acute care (hospital): care 0.749 m/s
  • Subacute / rehab facility: 0.822 m/s
  • Outpatient: 1.033 m/s

Typical gait speeds based on age:

• Woman age 70-79 comfortable pace: 1.13 m/s
• Men age 70-79 comfortable pace: 1.26 m/s
• Woman age 80-99 comfortable pace: 0.94 m/s
• Men age 80-99 comfortable pace: 0.97 m/s

Predictive values for community dwelling older adults:

• <0.8 m/s - predictive of poor clinical outcomes

• < 0.6 m/s - predictive of continued decline is individuals already experiencing poor outcomes

Predictive values for the post stroke population based on gait speed:

• Household ambulator: <0.4 m/s
• Limited community ambulator: 0.4 - 0.8 m/s
• Unlimited community ambulator: >0.8 m/s

Reliability

Given the variability in procedure and applicable populations, data regarding reliability is often determined with regard to specific populations or modes of determining gait speed.

Normal gait speed in adults measured using 4-meter distance:

• Test-retest reliability (Inter-class correlation): 0.406 (Low reliability)
• Minimal detectable change w/ 95% confidence (MDC_95%): 0.5 m/s

Normal gait speed in health older adults comparing 4 meter and 10 meter distances:

• Test-retest reliability (Inter-class correlation) between 4 meter and 10 meter distances: 0.93 (High reliability)

Gait speed in adults w/ hemiparesis following stroke using 10 meter distance:

• Test-retest reliability (Inter-class correlation) for normal gait speed: 0.94 (excellent reliability)
• Test-retest reliability (Inter-class correlation) for fast gait speed: 0.97 (excellent reliability)

Validity

Similar to reliability, validity is also quite specific to particular populations and the given testing parameters examined.

Criterion validity for community dwelling older adults using 8 feet and 20 feet distances:

• Age, gender, knee extension force, waist circumference, and stature as predictors of gait speed
  • 8 feet distance: Multiple correlation R = 0.459
  • 20 feet distance: Multiple correlation R = 0.506