How Many Trials Are Needed for Consistent Clinical Gait Assessment?

Background: Clinical assessment of gait typically consists of patients walking a few trials at various speeds while the clinician assesses performance. Unfortunately, there is no clear guidance on how gait changes across trials, leaving clinicians uncertain about the optimal number of trials needed to observe consistent (non-variable) performance. To address this issue, we examined gait performance from a large dataset of older adults who participated in a community-based comprehensive fall risk assessment. Methods: Community-dwelling, older adults (n = 340; 70.8 ± 7.4 years; 120 men, 220 women) performed gait trials under two conditions: preferred and maximum walking speed. Individuals were encouraged to complete five trials for both conditions. Consistency between gait trials within each condition was calculated using intraclass correlation (ICC) and standard error of measurement (SEM) analysis. Results: Our data showed the middle three trials had the most consistency compared to the average of 2–5 trials. Conclusions: When performing a clinical gait analysis, the first trial should be used to acclimate the participant to the protocol and not used for analysis. Data should be recorded from the next three trials, which is when gait appears to stabilize. Data from a fifth trial differs from the second trial, potentially indicating fatigue and/or motivation changes, so it is recommended that the gait analysis conclude after the fourth trial.