Associations Between Foot Placement Asymmetries and Metabolic Cost of Transport in Hemiparetic Gait.
James M Finley, Amy J Bastian
PMID 27798378WHAT IT FOUND
In stroke survivors, how far feet are placed ahead of the trunk predicts metabolic cost better than overall step length asymmetry.
Targeting foot placement symmetry, not just step length, may improve walking economy.
Key findings
01Stroke survivors had a significantly higher metabolic cost of transport than healthy controls matched for speed.
02The step position contribution to step length asymmetry was a significant predictor of metabolic cost, whereas step time asymmetry was not.
03Walking speed and the step position contribution together explained 89% of the variance in metabolic cost.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The sample size was small (15 stroke survivors), which limits generalizability. All participants held onto a handrail during walking, which may have altered natural gait mechanics and reduced metabolic cost compared to unsupported walking. The study was cross-sectional, so it cannot determine if changing foot placement asymmetry will actually reduce metabolic cost. Two participants were excluded from the primary regression analysis as outliers, which could influence the results. The sample included individuals with varying levels of impairment, but the findings may not apply to those who walk much faster or slower than this cohort. Cardiorespiratory fitness and balance ability were not measured, yet these factors likely influence both walking speed and metabolic cost.
Declared interests
The authors declared no potential conflicts of interest. The study was supported by the National Institutes of Health (N.I.H., Extramural).
The easy way to misread this
Do not conclude that correcting overall step length asymmetry will improve walking economy. The study found that the specific component of asymmetry related to foot placement relative to the trunk was the significant predictor, while general step length asymmetry and step time asymmetry were not.