Improvements in gait speed following various training paradigms applied to patients post-stroke does not always lead to changes in walking performance, defined as gains in daily stepping activity. We hypothesized that testing conditions, specifically the presence of an observer, influences patient behaviors and resultant outcomes may overestimate their true walking capacity. This potential Hawthorne effect on spatiotemporal and biomechanical measures of locomotor function in individuals post-stroke has not been assessed previously. Fifteen ambulatory individuals with chronic stroke wore instrumented insoles and performed two separate normal-pace walking assessments, including unobserved conditions during which participants were unattended and unaware of data collection, and observed conditions with an investigator present. Gait analysis was conducted outside of a laboratory setting using instrumented insoles equipped with a 3D accelerometer and pressure sensors which captured the spatiotemporal kinematics, vertical ground reaction forces and foot acceleration. Data were compared using paired comparisons, with subsequent correlation and stepwise regression analyses to explore potential associations between Hawthorne-induced changes in walking strategies, gait speed and locomotor performance (daily stepping). Except for cadence, other measures of spatiotemporal parameters and swing kinematics (acceleration) were not significantly different between observed vs unobserved conditions. However, analyses of ground reaction forces revealed significantly greater paretic limb loading (Δ1st peak = 1.5 ± 1.6 N/kg Δ2nd peak = 1.4 ± 1.8 N/kg; p < 0.01) and increases in weight bearing symmetry (11-24%, p < 0.01) during observed vs unobserved conditions. This potential Hawthorne effect was greater in those with slower walking speeds and shorter stride lengths but was not related to daily stepping. The present findings suggest that biomechanical parameters of walking function may be related to the presence of an observer and highlight the need to separately measure locomotor capacity (gait speed) and performance (daily stepping).

译文

:针对中风后患者进行各种训练范例后,步态速度的提高并不总是导致步行性能的改变,步行能力的提高被定义为每日踩踏活动的增加。我们假设测试条件(特别是观察者的在场)会影响患者的行为,而产生的结果可能会高估他们的真实步行能力。之前尚未评估过这种霍桑对中风后个体运动功能的时空和生物力学测量的潜在影响。 15名患有中风的非卧床患者穿着仪器鞋垫,并进行了两次单独的正常步态步行评估,包括未观察到的参与者无人值守和不知道数据收集的状况,以及观察者在场的情况。使用配备3D加速度计和压力传感器的仪器化鞋垫在实验室环境之外进行步态分析,该鞋垫可捕获时空运动学,垂直地面反作用力和脚加速度。使用配对比较对数据进行比较,随后进行相关性和逐步回归分析,以探讨霍索恩(Hawthorne)诱发的步行策略变化,步态速度和运动能力(每日踏步)之间的潜在关联。除了节奏以外,观察到的和未观察到的条件之间的其他时空参数和摆动运动学(加速度)测量也没有显着差异。但是,对地面反作用力的分析表明,肢体肢体负荷显着增加(Δ1st峰= 1.5±1.6 N / kgΔ2nd峰= 1.4±1.8 N / kg; p <0.01),负重对称性增加(11-24%,p <0.01)。在步行速度较慢,步幅较短的人中,这种潜在的霍桑效应更大,但与日常踏步无关。本研究结果表明,步行功能的生物力学参数可能与观察者的存在有关,并强调需要分别测量运动能力(步态速度)和性能(每日踏步)。

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