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Gait dynamics to optimize fall risk assessment in geriatric patients admitted to an outpatient diagnostic clinic
- Source :
- PLoS ONE, Vol 12, Iss 6, p e0178615 (2017), PLoS ONE, PLoS ONE, 12(5):e0178615. PUBLIC LIBRARY SCIENCE, PLoS One, 12(6). Public Library of Science
- Publication Year :
- 2017
- Publisher :
- PUBLIC LIBRARY SCIENCE, 2017.
-
Abstract
- Fall prediction in geriatric patients remains challenging because the increased fall risk involves multiple, interrelated factors caused by natural aging and/or pathology. Therefore, we used a multi-factorial statistical approach to model categories of modifiable fall risk factors among geriatric patients to identify fallers with highest sensitivity and specificity with a focus on gait performance. Patients (n = 61, age = 79; 41% fallers) underwent extensive screening in three categories: (1) patient characteristics (e.g., handgrip strength, medication use, osteoporosis-related factors) (2) cognitive function (global cognition, memory, executive function), and (3) gait performance (speed-related and dynamic outcomes assessed by tri-axial trunk accelerometry). Falls were registered prospectively (mean follow-up 8.6 months) and one year retrospectively. Principal Component Analysis (PCA) on 11 gait variables was performed to determine underlying gait properties. Three fall-classification models were then built using Partial Least Squares-Discriminant Analysis (PLS-DA), with separate and combined analyses of the fall risk factors. PCA identified 'pace', 'variability', and 'coordination' as key properties of gait. The best PLS-DA model produced a fall classification accuracy of AUC = 0.93. The specificity of the model using patient characteristics was 60% but reached 80% when cognitive and gait outcomes were added. The inclusion of cognition and gait dynamics in fall classification models reduced misclassification. We therefore recommend assessing geriatric patients' fall risk using a multi-factorial approach that incorporates patient characteristics, cognition, and gait dynamics.
- Subjects :
- Male
030506 rehabilitation
Physiology
Entropy
lcsh:Medicine
Walking
Ambulatory Care Facilities
0302 clinical medicine
Gait (human)
Mathematical and Statistical Techniques
Patient Admission
STRENGTH
80 and over
Medicine and Health Sciences
Medicine
Biomechanics
Prospective Studies
Prospective cohort study
lcsh:Science
Gait
Geriatrics
Cognitive Impairment
Aged, 80 and over
Principal Component Analysis
COORDINATION
Multidisciplinary
Hand Strength
Cognitive Neurology
Physics
Cognition
VARIABILITY
Neurology
Physical Sciences
Thermodynamics
Female
0305 other medical science
Risk assessment
Gait Analysis
Factor Analysis
Statistics (Mathematics)
Research Article
medicine.medical_specialty
Cognitive Neuroscience
Research and Analysis Methods
Risk Assessment
VALIDATION
03 medical and health sciences
Physical medicine and rehabilitation
Hand strength
Journal Article
Humans
Statistical Methods
OLDER-ADULTS
Aged
WALKING SPEED
STABILITY
business.industry
Biological Locomotion
lcsh:R
Biology and Life Sciences
POSTURAL CONTROL
PREVENTION
Preferred walking speed
Gait analysis
Multivariate Analysis
Physical therapy
Cognitive Science
COGNITION
lcsh:Q
business
030217 neurology & neurosurgery
Mathematics
Neuroscience
Subjects
Details
- Language :
- English
- ISSN :
- 19326203
- Volume :
- 12
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- PLOS-One
- Accession number :
- edsair.doi.dedup.....07917b23583f5285273a9cdb84099ede