The reliability of gait parameters captured via instrumented walkways: a systematic review and meta-analysis

Abstract

Introduction: Electronic pressure-sensitive walkways are commonly available solutions to quantitatively assess gait parameters for clinical and research purposes. Many studies have evaluated their measurement properties in different conditions with variable findings. In order to be informed about the current evidence of their reliability for optimal clinical and scientific decision making, this systematic review provided a quantitative synthesis of the test-retest reliability and minimal detectable change of the captured gait parameters across different test conditions (single and cognitive dual-task conditions) and population groups.

Evidence acquisition: A literature search was conducted in PubMed, Embase, and Scopus until November 2021 to identify articles that examined the test-retest reliability properties of the gait parameters captured by pressure-sensitive walkways (gait speed, cadence, stride length and time, double support time, base of support) in adult healthy individuals or patients. The methodological quality was rated using the Consensus-Based Standards for the Selection of Health Measurement Instruments Checklist. Data were meta-analyzed on intraclass correlation coefficient to examine the test-retest relative reliability. Quantitative synthesis was performed for absolute reliability, examined by the weighted average of minimal detectable change values.

Evidence synthesis: A total of 44 studies were included in this systematic review. The methodological quality was adequate in half of the included studies. The main finding was that pressure-sensitive walkways are reliable tools for objective assessment of spatial and temporal gait parameters both in single-and cognitive dual-task conditions. Despite few exceptions, the review identified intraclass correlation coefficient higher than 0.75 and minimal detectable change lower than 30%, demonstrating satisfactory relative and absolute reliability in all examined populations (healthy adults, elderly, patients with cognitive impairment, spinocerebellar ataxia type 14, Huntington's disease, multiple sclerosis, Parkinson's disease, rheumatoid arthritis, spinal cord injury, stroke or vestibular dysfunction).

Conclusions: Current evidence suggested that, despite different populations and testing protocols used in the included studies, the test-retest reliability of the examined gait parameters was acceptable under single and cognitive dual-task conditions. Further high-quality studies with powered sample sizes are needed to examine the reliability findings of the currently understudied and unexplored pathologies and test conditions.

Figure 1

—Schematic representation of the examined gait parameters and the pressure-sensitive walkway set-up.

Figure 2

—PRISMA flow diagram of selection process in the systematic review.

Figure 3

—Test-retest relative reliability of gait speed. A) Results in single-task condition; and B) in dual-task condition.^{, , , , , -, -} Forest plot displaying intraclass correlation coefficients (ICC) data (and 95% confidence interval) of the gait speed, primary outcome measure of the review. Grey box indicates the area of suboptimal ICC findings.

Figure 4

—Summary of the relative and absolute reliability findings. For each examined outcome measure, the test-retest relative reliability (pooled ICC [95% confidence interval, CI]) findings is presented on the left column and the weighted average of MDC₉₅±standard deviation is shown on the right column. For each graph, the results of relative and absolute reliability in single-task and dual task conditions for the total population sample (TOT) and the subgroups are shown. Grey box indicates suboptimal ICC findings. AH: Healthy adult; EY: elderly; CI: cognitive impairment; VD: vestibular dysfunction; MS: multiple sclerosis; PD: Parkinson’s disease; CA: spinocerebellar ataxia type 14; HD: Huntington’s disease; SK: stroke; SCI: spinal cord injury; RA: rheumatoid arthritis.

Figure 5

—Summary of MDC₉₅% findings. A) Results of MDC₉₅% of the gait parameters in single-task; and B) results in dual-task condition. The analysis was performed for the total population sample (TOT) and the subgroups. Dot size is proportional to the number of participants included in the analyses. MDC₉₅% less than 30% is considered acceptable (light gray-gray dots; green-yellow in the online version), otherwise MDC₉₅% is judged suboptimal (off-white–dark gray dots; orange-red in the online version). AH: Healthy adult; EY: elderly; CI: cognitive impairment; VD: vestibular dysfunction; MS: multiple sclerosis; PD: Parkinson’s disease; CA: spinocerebellar ataxia type 14; HD: Huntington’s disease; SK: stroke; SCI: spinal cord injury; RA: rheumatoid arthritis.