The association between fear of falling and gait variability in both leg and trunk movements
Introduction
Fear of falling (FoF) refers to a lack of self-confidence that normal activities can be performed without falling [1]. The prevalence of FoF ranges up to 60% in the community-dwelling elderly [2], [3], [4] and is even higher in given populations—especially in women or men with a previous history of falls [3]. Factors associated with FoF are psychological problems [5] and poor physical performance [6], [7]. Moreover, FoF results in limitations in activities of daily living (ADL) and decreased quality of life [8].
Most falls among older adults occur during movement, such as walking, and it is therefore important to assess the relationship between FoF and gait. Changes in gait that are associated with FoF in the elderly and have been reported consistently in previous studies are reduction in gait velocity [9], [10], [11], shortening of stride length [10], [11], [12], and increase in step width and prolongation of double-support time [10], [11]. Gait variability, a measure of the consistency of movement [13], may provide a more sensitive measure of the risk of falls [14], functional decline, and various adverse health outcomes than do routine spatiotemporal measures such as gait velocity [15]. Gait variability is therefore used as a clinical index of gait stability [16]. The results of studies of the relationship between FoF and gait variability have been inconsistent. Reelick et al. [9] found that gait variability did not differ significantly between those with and without FoF. On the other hand, Rochat et al. [17] reported that FoF was associated with gait variability. The former conducted an analysis adjusted for gait velocity, whereas the latter did not. Gait variability was linked with gait velocity [18]. Beauchet et al. showed that walking at slow velocity increases stride-time variability [18]. The variability in these findings indicates that there is a need to clarify the association between FoF and gait variability, with adjustment for gait velocity.
To assess gait variability in the clinical setting, the body can be divided functionally into two units, namely “passenger” (head, neck, trunk, and arms) and “locomotor” (the two lower limbs and the pelvis) [19]. The trunk—a component of the passenger unit—sits upon the locomotor unit and acts mainly to help to maintain body equilibrium spatially during gait [20]. Propulsion of the body during gait is the primary role of the locomotor unit. Because the locomotor unit shifts constantly during gait, the trunk must maintain body equilibrium in these relatively unstable positions; therefore, the trunk movement during gait should be assessed. Moreover, the trunk, being the largest segment of the body, is easily influenced by inertial force from the movement of the locomotor unit and is itself unstable during gait. For these reasons, when gait variability is evaluated it is important to assess not only leg movements but also trunk movement during gait. However, few studies have explored the association between FoF and trunk movement during gait [9].
The aim of this study was to explore the cross-sectional association between FoF and gait variability, including both the temporal and spatial aspects of trunk movement, during gait in the community-dwelling elderly. Our hypothesis was that both lower leg and trunk movements during gait would be associated with FoF, independent of gait velocity.
Section snippets
Participants
We recruited elderly subjects who were community-dwelling and independent in ADL (n = 120). Inclusion criteria were age ≥65 years and the ability to walk independently without an assistive device; 119 participants met these criteria. Participants were excluded if they had a history of neuromuscular disease that affected gait or scored less than 8 on the Rapid Dementia Screening Test (RDST) [21]. In addition, participants who did not complete our assessment were excluded. There were 93
Characteristics of participants
There were 21 participants (23%) in the Fear group and 72 (77%) in the No-Fear group. Participant characteristics for the two groups are summarized in Table 1. Age, number of comorbidities, number of medications, number of years of education, experience of at least one fall in the past 12 months, RDST score, GDS score, and 5CS score had no significant difference. The Fear group had a significantly higher proportion of females and was characterized by shorter height and lower weight than the
Discussion
The prevalence rate of FoF in this study was 22.3%. The Fear group had a higher proportion of females, who were shorter in stature and weighed less than those in the No-Fear group. There were no significant differences in age, number of comorbidities, number of medications, experience of at least one fall in the past 12 months, years of education, RDST score, GDS score, and 5CS score. Participants in the Fear group had significantly shorter stride length, and all parameters representing
Acknowledgments
We acknowledge all the subjects who participated in this study, and we thank Hiroshi Ando and Soichiro Hirata for their advice.
Conflict of interest statement
There is no conflict of interest.
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