Relationship of backward walking to clinical outcome measures used to predict falls in the older population: A factor analysis

Abstract

Background: Backward walking has been found to be a more sensitive measure to detect fallers than forward walking. It involves greater reliance on neuromuscular control to make up for the lack of vision. In fact, backward walking speed has been determined to more accurately identify fallers in the older population than forward walking. This study examined if backward walking measures more than one underlying factor while also examining the relationship between it and other clinical measures used to identify falls risk. Methods: A convenience sample of 57 older adults (10 males and 47 females) with a mean age of 78.8 years (SD 8.9 years) participated in this cross-sectional study. Subjects walked backward on the GAITRite ® computerized walkway system recording gait velocity, stride and step length, stance and swing time, single and double support. Additionally, subjects were tested on clinical measures commonly used to assess falls risk which included the Timed up and go test, Four square step test, Activity-specific balance confidence scale, single heel rise test and the 30-second chair stand test. An exploratory factor analysis with Maximum Likelihood extraction and Varimax rotation was performed on various aspects of backward walking. The relationship between the backwards walking factor scores and selected clinical measures was tested using Spearman correlations and regression. Results: Results revealed that there are two factors associated with backward walking: cadence and velocity. Cadence was only mildly correlated to 30-second chair stand test, r=0.29; whereas velocity was highly correlated with each of the known predictors of falls used, all r>0.44. Conclusion: Given theses findings, a clinician could quickly measure backward walking velocity and count the number of steps an individual takes in order to screen those at-risk for falls.

Backward Walking and Dual-Task Assessment Improve Identification of Gait Impairments and Fall Risk in Individuals with MS

“…These findings reflect the sensitivity of backward walking and its potential to supplement the current clinical dual-task and fall risk assessments. Additionally, these findings agree with previous studies in the elderly [ 24 , 25 ] and other neurodegenerative disease populations [ 26 , 27 ] in which backward walking better identified fallers compared to forward walking. These findings also build upon our previous work in MS in which backward walking velocity exhibited the highest effect magnitude and specificity in differentiating fallers from nonfallers in individuals with MS [ 31 ].…”

“…We a priori chose to evaluate a limited number of gait variables, including velocity, stride length, and double support time. These variables were chosen because stride length and double support time have been linked to balance in MS [ 33 ], elderly [ 25 ], and other neurodegenerative populations [ 34 ], and backward walking velocity has specifically been linked to falls in older adults [ 24 ].…”

“…Recently, backward walking has been recognized as a sensitive clinical measure of mobility and fall risk in the elderly [ 24 , 25 ] and other neurodegenerative disease populations [ 26 ]. Similar to dual-task walking, backward walking requires increased cognitive demands and postural control [ 27 , 28 ] than forward walking.…”

Concurrent Validity and Test–Retest Reliability of the 3-Meter Backward Walk Test in Stroke Survivors

“…Backward walking has been found to demand higher levels of neuromuscular control, proprioception, and protective reflexes than forward walking, due to its greater complexity in motor planning and coordination [16]. Consequently, backward walking has been proposed as a more sensitive measure of balance and mobility [17,18]. Incorporating backward walking into balance assessment tools may offer a more comprehensive evaluation of balance in stroke patients.…”

A backward cycling programme for people with Parkinson’s disease: a feasibility and preliminary results study

“…Most falls that occur while walking tend to happen in a forward direction, possibly due to deficits in terminating gait (3). People with PD also demonstrate difficulty step ping and walking in a backward direction, and deficits in backward walking have been correlated with known predictors of falling in older adults (4)(5)(6). In standing, people with PD have a preponderance for backward falls (7)(8)(9).…”