Using Walking Speed in Clinical Practice: Interpreting Age-, Gender-, and Function-Specific Norms

摘要

Physical therapists expend a great deal of effort to assist older persons to regain the ability to walk independently. While we often use descriptors of gait patterns, assistive device use, level of assistance required, and distance traversed as part of our documentation, quantifying self-selected and fast walking speeds may be the most powerful measure to inform clinical decision making and to assess outcomes of intervention. In this article, we will consider why and how physical therapist should incorporate walking speed data into functional screening, development of plans of care (ie, setting appropriate goals), and assessing efficacy of interventions. We will explore the factors that determine an individual's self-selected walking speed and the importance of assessing if, and how much, an older person is able to increase walking speed for safe community function. We will then present current best evidence about how walking speed typically changes in the later years of life, highlight age- and gender-specific "norms" (ie, typical performance). We will review the converging evidence of key threshold values for walking speed, as they relate to community function, risk of frailty and morbidity, and risk of institutionalization and conclude with a discussion of how such information is used to determine physical therapy prognosis, setting measurable functional goals, documenting efficacy of intervention, and determining need for continued physical therapy care across delivery settings. ^g>fast walking speed, functional assessment, older adults, self-selected walking speed