Elsevier

Gait & Posture

Volume 36, Issue 3, July 2012, Pages 532-536
Gait & Posture

Clinically meaningful change in stair negotiation performance in older adults

https://doi.org/10.1016/j.gaitpost.2012.05.015Get rights and content

Abstract

Stair negotiation is a key marker for independence among older adults; however, clinically meaningful change has not been established. Our objective was to establish the values of clinically meaningful change in stair negotiation time using distribution- and anchor-based approaches.

Study participants were 371 community residing older adults (age  70) in the Einstein Aging Study with time to ascend and descend 3 steps measured at baseline and at one-year follow-up. Anchor-based estimates were obtained using functional decline (defined as one-point increment in disability score) and change in self-reported walking ability over the one-year follow-up period. Small, moderate, and large meaningful change estimates were 0.28, 0.71, and 1.15 s for stair ascent time (0.31, 0.78, and 1.25 s for stair descent time) using the distribution-based approach of effect size. The estimates of meaningful decline range from 0.47 to 0.53 s for stair ascent time (0.33–0.53 s for stair descent time) using the anchor-based approach. The estimates of meaningful improvement were smaller (0.13–0.18 s for stair ascent, 0.06–0.15 for stair descent) compared to those for decline. Based on general consistency between distribution- and anchor-based approaches, preliminary criteria suggested for stair negotiation time is 0.5 s for meaningful decline and 0.2 s for meaningful improvement.

Highlights

► We report the values of clinically meaningful change in stair negotiation time over 1 year among older adults. ► Distribution- and anchor-based approaches were used to estimate the clinically meaningful changes. ► Clinically meaningful decline in stair negotiation of 3 steps is estimated as 0.5 s. ► Clinically meaningful improvement in stair negotiation of 3 steps is estimated as 0.2 s

Section snippets

Study population

Six hundred and eighty-five Einstein Aging Study participants were seen between July 2006 and March 2011. Eligibility criteria for Einstein Aging Study include age of 70 and older living in the Bronx County, New York. Exclusion criteria include severe auditory or visual loss, being bedbound, and institutionalization. Of these 685 participants, 42 were disabled (requiring personal assistance or dementia), 58 could not perform stair negotiation due to unsteadiness, pain, or weakness, 40 were not

Sample characteristics

Demographic and clinical characteristics of 371 participants were summarized in Table 1. Mean age was 80.2 with 39.6% of men. Approximately 39% of the participants reported being able to walk more than a mile during an hour. The SNT at baseline was longer in 20 individuals who were not able to perform stair negotiation at follow-up compared to those with 2 consecutive stair assessments (4.22 versus 2.67 s in SAT, 4.34 versus 2.71 s in SDT). However, there was no difference in SNT between those

Discussion

We have previously reported that SNT is a valid measure for predicting decline in ADLs among high functioning older adults without difficulty in stair climbing at baseline [2]. In the current study, we report clinically meaningful change in stair ascent and descent time in non-demented older adults using both distribution-based and anchor-based approaches.

The estimates of change derived from distribution-based approach are based on statistical criteria and these values might vary from one

Conclusion

Preliminary estimates for criteria for clinically meaningful change in SNT of three steps were 0.5 s for decline and 0.2 s for improvement based both on distribution- and anchor-based approaches. Future studies will be necessary to confirm these preliminary estimates and examine whether these magnitudes of meaningful change is achievable with intervention.

Funding

The Einstein Aging Study is supported by National Institutes on Aging Program Project grant (AG03949). M. Oh-Park is an Einstein Men's Division Scholar partially supported through a National Institutes of Health ‘Clinical and Translational Science Award’ (CTSA) grant UL1 RR025750 and KL2RR025749 from the National Center for Research Resources (NCRR). S Perera is supported in part by Pittsburgh Claude D. Pepper Older Americans Independence Center (NIH P30 AG024827). J. Verghese is supported by a

Conflict of interest statement

None.

References (19)

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