Measuring walking-related performance fatigability in clinical practice: a systematic review

Abstract

BACKGROUND: Fatigability, a change in performance according to tasks and circumstances, can contribute to walking limitations in daily life. Walking-related fatigability (WF) has been assessed subjectively, but current knowledge on best objective measurement methods is limited. OBJECTIVE: To provide an overview of objective clinical measurement methods assessing WF in different populations. DATA SOURCES: Articles were searched in Pubmed and Web Of Science by two independent raters. STUDY ELIGIBILITY CRITERIA AND SYNTHESIS METHODS: Studies were included when meeting inclusion criteria of measuring WF objectively in a clinical setting, with no exclusion towards any population. Case studies and reviews were not included in the review (systematic review registration number: PROSPERO - CRD42017074121). PARTICIPANTS: In total, 28 articles were included. The study populations were older adults (n=7), multiple sclerosis (n=14), spinal muscle atrophy (n=3), osteoarthritis (n=3), interstitial lung diseases (n=1), and myasthenia gravis (n=1). STUDY APPRAISAL: Data about patient characteristics, walking task, WF formula and interpretation (cut-off values and/or psychometric properties) got extracted from included literature. Every included article got checked for quality and risk of bias. RESULTS: WF was mostly measured during longer walking test such as six minute walking test (6MWT) and 500 or 400-m walking test, by comparing the first and last minute or lap for spatiotemporal or kinematic changes in well-defined formulas. LIMITATIONS: No gold standard is however available yet given different tasks or outcome measures across study populations. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS: Longer walking test were most often used, with a preference towards the 6MWT, thereby comparing the changes over the last and first part of the test. Psychometric properties need more documentation before inclusion as experimental outcome.