Factors associated with walking activity in adults with cerebral palsy

Background: This prospective study used instrumented gait analysis, patient-reported outcomes, and portable accelerometers to examine walking activity in adults with cerebral palsy (CP). Research question: This study aimed to provide objective data and evaluate factors associated with walking activity in adults with CP. Methods: Participants with CP (ages 25-45 years) completed instrumented gait analysis and patient-reported outcomes, including the Patient Reported Outcome Measurement Information System (PROMIS) and Satisfaction with Life Score (SWLS), and wore a StepWatch for 8 days. Average strides per day, stratified by Gross Motor Function Classification System (GMFCS), were compared with nondisabled adults ages 30-39 years utilizing Welch's t-tests with Bonferroni corrections. Correlation coefficients and stepwise multiple linear regression analyses examined relationships between walking activity and GMFCS, gait deviation index (GDI), gait velocity, PROMIS physical function, SWLS, body mass index (BMI), and employment. Results: Participants included 109 adults with CP, ages 29 +/- 4 years, classified at GMFCS levels I/II (73 %) and III/IV (27 %). Compared with nondisabled adults, daily stride count was significantly lower in both groups of adults with CP (p < 0.00025), with a progressive decline according to GMFCS level. Walking activity correlated with PROMIS physical function (r=.42), GDI (r=.48), and gait velocity (r=.58). Association for employment was lower (r= 0.27) but significant, while age, SWLS, and BMI were not individually correlated with walking activity. Stepwise, multiple linear regression modeled with Akaike information criterion explained 40.9 % of the observed variability in walking activity in this cohort of adults with CP. Significance: Physical function, as classified by GMFCS or measured by PROMIS and self-selected walking velocity, has the strongest association with and is the most significant predictor of walking activity in adults with CP. After accounting for physical function, a small amount of the variation in walking activity can be explained by GDI, employment, and age.

Automated summary

This study used instrumented gait analysis, patient-reported outcomes, and accelerometers to investigate walking activity in adults with cerebral palsy (CP). The results showed that physical function, as measured by GMFCS and PROMIS, and self-selected walking velocity were the strongest predictors of walking activity in adults with CP. Factors such as employment and age also influenced walking activity to a certain extent.