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Dual-Task Tandem Gait and Average Walking Speed in Healthy Collegiate Athletes

Howell, David R. PhD; Oldham, Jessie R. MS; Meehan, William P. III MD; DiFabio, Melissa S. MS; Buckley, Thomas A. EdD
Clinical Journal of Sport Medicine: Post Author Corrections: October 05, 2017
doi: 10.1097/JSM.0000000000000509
Original Research: PDF Only

Objectives:

To (1) examine the association between a commonly used concussion test, tandem gait, in single/dual-task conditions with single-task and dual-task average walking speed, (2) characterize the prevalence of tandem gait false positives, and (3) develop a normative reference range of dual-task tandem gait times.

Design:

Cross-sectional study.

Setting:

Two NCAA collegiate athletic facilities.

Independent Variables:

Athletes completed the tandem gait test and a gait evaluation in single/dual-task conditions during a preseason examination.

Main Outcome Measures:

Associations between tandem gait times and average walking speeds were evaluated using multiple linear regression models. Various tandem gait test time pass/fail cutoffs were calculated to examine false-positive rates.

Results:

Among the 171 participants (103 men, 19.8 ± 1.2 years of age), dual-task tandem gait completion times were independently associated with dual-task average walking speed [β = −4.018; 95% confidence interval (CI), −7.153 to −0.883], but single-task associations were not found. Male gender was associated with faster tandem gait times in both single-task (β = −0.880, 95% CI, −1.731 to −0.029) and dual-task conditions (β = −2.225, 95% CI, −3.691 to −0.759). A pass/fail cutoff threshold of 14 seconds resulted in a 2% false-positive rate for single-task tandem gait, while it resulted in a 29% false-positive rate during dual-task tandem gait.

Conclusions:

Average walking speed and dual-task tandem gait represent objective measures that are useful in concussion management. While a single-task tandem gait cutoff of 14 seconds seems appropriate for males, adjustments may be necessary based on sex and alternate pass/fail criteria may be appropriate for dual-task tandem gait.

Corresponding Author: David R. Howell, PhD, Division of Sports Medicine, Department of Orthopaedics, The Micheli Center for Sports Injury Prevention, Boston Children's Hospital, 9 Hope Ave, Waltham, MA 02453 (David.Howell2@childrens.harvard.edu).

D. R. Howell has received research support through a research contract between Boston Children's Hospital, Cincinnati Children's Hospital Medical Center, and ElMinda Ltd. W. P. Meehan receives royalties from (1) ABC-Clio publishing for the sale of his books, Kids, Sports, and Concussion: A guide for coaches and parents, and Concussions; (2) Springer International for the book Head and Neck Injuries in Young Athlete; and (3) Wolters Kluwer for working as an author for UpToDate. His research is funded, in part, by philanthropic support from the National Hockey League Alumni Association through the Corey C. Griffin Pro-Am Tournament and by a grant from the Football Players Health Study at Harvard University, which is funded by the NFL Players Association. T. A. Buckley's research is funded, in part, by a grant from the National Collegiate Athletic Association and the Department of Defense. The remaining authors have no conflicts of interest to report.

Received February 07, 2017

Accepted June 16, 2017

Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved.