Part 3: The window to actionable insights capable of transforming fall risk care for seniors has been opened

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Refer to our blog for a refresher on Part 1: The reality of a fall requires a response and Part 2: The motivation for independence fuels a desire for connection with therapists.

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Gait assessment and gait training are critical components of fall prevention intervention and, as a result, are recommended in the current fall guidelines. Today, as a result of technologies like OneStep which enable gait and motion assessment via the near-universal availability of a smartphone, therapists are able to secure longitudinal insight into the gait and motion patterns of senior adults. The therapist’s ability to monitor critical, ongoing insight into fall risk is a result of:

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1. Specific gait parameters are supported in current literature to provide meaningful insight into the patient’s risk status for a fall.
2. The increased competency seniors possess with digital technology enables assessment of gait outside the clinic.
3. The universal availability of smartphones enables patients to provide insight into their gait without the need for managing additional technology or wearables during their daily life.
4. The smartphone, when equipped with the OneStep application, provides insight into gait that has been validated by the world’s foremost gait labs.
5. The senior’s desire for connection is impacted by their independence, which is related to their gait and motion status.

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The above factors create a fertile field for the deployment of a “tech plus touch” strategy to manage fall risk.

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Research indicates that a decline in gait speed is the primary clinical indicator for an increase in fall risk, with double support time, stance asymmetry, step asymmetry, and consistency providing valuable secondary indicators of increased risk. Numerous studies point to the higher risk of falls associated with a reduction in gait speed. The quote below from 2019 research conducted by Van Shooten et al. is representative of the consensus view.

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“Higher levels of concern about falling were associated with slower gait speed. Following adjustment for age, history of falls, and female sex, and further adjustment for physical and cognitive function, the association between concern about falling and walking speed remained significant, with a considerable effect size (standardized β = 0.18 ± 0.08; P = .037).”

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The excerpt below from the OneStep position paper on the mitigation of fall risk provides insight into the incremental power that can be found in longitudinal assessment of gait for dynamic change.

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“Fall risk has been shown to increase when gait speed trends consistently fall below 1.0 m/sec. Some studies have concluded that step length variability, stride time, and an increase in double support time are associated with an increase in the risk of falls in certain populations. However, no study has defined the normal values of variability for each of these parameters.”

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Still, it is fair to ask, why is monitoring longitudinal changes in gait important? The answer is a function of the risk status common to seniors who are at high risk for falls. Because many seniors using OneStep may initially fall above the threshold gait speed to qualify as “high risk”, it is necessary to monitor for incremental changes to fall risk by securing routine (daily) insight into gait parameters. The evaluation is explained below by the team at OneStep.

“At OneStep, we look at the asymmetries of step length and stance as the percent difference between right and left over the gait cycle. Considering the error of margin for these parameters varies by about 4% points, we become alerted when these asymmetries consistently exceed 8%. Considering a single point in time is not reflective of overall performance, we hypothesize that certain trends should trigger some concern of fall risk."

OneStep further noted that they "have found that a combination of multiple factors over time may further increase the probability of falls. Our ability to track gait in a person’s natural environment using only a smartphone allows us to remotely monitor gait and perform immediate outreach if we see a trend as depicted here. The ability to track and see changes before they become a medical event is a critical step towards upstream healthcare and prevention which has the potential to save money and lives.”

Part 3: Key Takeaways

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• Dynamic change assessment, achieved only via routine, longitudinal tracking of gait and motion, becomes a leading indicator for an increase in fall risk. 
• It is the dynamic change in these gait parameters that permits OneStep physical therapists and their colleagues in physical therapy that they support to turn increased attention to those patients who have expressed a significant change in their gait parameters.
• Assessing dynamic change requires engagement with seniors across their journey in motion... anywhere and at any time.
• Today, more than ever, seniors are equipped and motivated to participate in a longitudinal conversation with their therapists, based on meaningful insight into gait and motion patterns, to reduce their risk of a fall.

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Series Summary

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Therapists must ignite and sustain a conversation on gait and motion outside the walls of the clinic.

For therapists, the time is now to "own" the longitudinal understanding of motion health in patients challenged with musculoskeletal and neurological conditions. For therapists, technologies such as OneStep can be to gait and motion what A1C, blood pressure, and oxygen level monitoring are to nephrology, cardiology, and respiratory specialties. Clinicians seeing patients at risk for falls and adverse events related to musculoskeletal conditions must "own" the understanding of gait metrics much like the cardiologist and internist own metrics specific to cardiovascular risk (blood pressure and heart rate, for example). Physical therapists are poised to benefit from the insight that can be gained outside the clinic. Innovative therapists are moving quickly to leverage digital platforms such as OneStep to secure an increased understanding of the health status of the senior and to deliver increased value to the conversation with seniors by leveraging personal gait and motion insight – improving productivity through digital health technology that extends their reach across their patient population.

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How can enterprise healthcare deploy a “tech plus touch” approach in motion health?

The process begins with asking the right questions. Assessing and determining the appropriate digital complement to clinical practice requires clinicians and therapists to evaluate the digital health platform across a range of clinical and operational competencies. When considering a digital partner for priorities focused on caring for seniors, it is important that the technology utilized to capture insight is easy to integrate into the senior’s lifestyle and is supported by a user interface that is easy for the senior to launch and navigate. Below, a list of qualifying questions is provided to help practitioners in their assessment of digital gait and motion platforms.

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Clinical Focus

• Are the gait metrics secured by the platform consistent with established research on fall risk?
• Are the gait metrics validated?
• Does the volume of data support ongoing analysis into the implications of dynamic
• changes to gait and motion in the senior population?

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User Interface Focus

• Can the gait and motion platform be easily integrated into the lives of seniors to permit both adoption and ongoing adherence to gait and motion assessment?
• Do the user interface and the reminders bring forward the metrics specific to motion that serve to motivate the senior to routinely assess gait and motion?

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