title: Gait Efficiency on an Uneven Surface Is Associated with Falls and Injury in Older Subjects with a Spectrum of Lower Limb Neuromuscular Function: A Prospective Study.
abstract: OBJECTIVE
  The objective of this study was to determine which gait measures on smooth and uneven surfaces predict falls and fall-related injuries in older subjects with diabetic peripheral neuropathy.
  
  
  METHODS
  Twenty-seven subjects (12 women) with a spectrum of peripheral nerve function ranging from normal to moderately severe diabetic peripheral neuropathy walked on smooth and uneven surfaces, with gait parameters determined by optoelectronic kinematic techniques. Falls and injuries were then determined prospectively over the following year.
  
  
  RESULTS
  Seventeen subjects (62.9%) fell and 12 (44.4%) sustained a fall-related injury. As compared with nonfallers, the subject group reporting any fall, as well as the subject group reporting fall-related injury, demonstrated decreased speed, greater step width (SW), shorter step length (SL), and greater SW-to-SL ratio (SW:SL) on both surfaces. Uneven surface SW:SL was the strongest predictor of falls (pseudo-r = 0.65; P = 0.012) and remained so with inclusion of other relevant variables into the model. Post hoc analysis comparing injured with noninjured fallers showed no difference in any gait parameter.
  
  
  CONCLUSIONS
  SW:SL on an uneven surface is the strongest predictor of falls and injuries in older subjects with a spectrum of peripheral neurologic function. Given the relationship between SW:SL and efficiency, older neuropathic patients at increased fall risk appear to sacrifice efficiency for stability on uneven surfaces.
authors.affiliation: From the Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, Michigan (KZ, TKD, JKR); Department of Physiotherapy, University of Applied Sciences of Western Switzerland, Geneva, Switzerland (LA); and Department of Mechanical Engineering, Biomechanics Research Laboratory, University of Michigan, Ann Arbor, Michigan (HK, JAA-M).
authors.forename: Katie
authors.initials: K
authors.lastname: Zurales
authors.forename: Trina K
authors.initials: TK
authors.lastname: DeMott
authors.forename: Hogene
authors.initials: H
authors.lastname: Kim
authors.forename: Lara
authors.initials: L
authors.lastname: Allet
authors.forename: James A
authors.initials: JA
authors.lastname: Ashton-Miller
authors.forename: James K
authors.initials: JK
authors.lastname: Richardson
mesh_terms: D000058:Accidental Falls; D000368:Aged; D003929:Diabetic Neuropathies / Q000150:complications* / Q000503:physiopathology*; D004779:Environment Design; D005260:Female; D005430:Floors and Floorcoverings; D005500:Follow-Up Studies; D005684:Gait / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D004856:Postural Balance; D011446:Prospective Studies; D012307:Risk Factors; D013499:Surface Properties; D014947:Wounds and Injuries / Q000453:epidemiology* / Q000503:physiopathology*