Date Published: June 6, 2016
Publisher: Public Library of Science
Author(s): Danique Vervoort, Nicolas Vuillerme, Nienke Kosse, Tibor Hortobágyi, Claudine J. C. Lamoth, Kewei Chen.
Many tests can crudely quantify age-related mobility decrease but instrumented versions of mobility tests could increase their specificity and sensitivity. The Timed-up-and-Go (TUG) test includes several elements that people use in daily life. The test has different transition phases: rise from a chair, walk, 180° turn, walk back, turn, and sit-down on a chair. For this reason the TUG is an often used test to evaluate in a standardized way possible decline in balance and walking ability due to age and or pathology. Using inertial sensors, qualitative information about the performance of the sub-phases can provide more specific information about a decline in balance and walking ability. The first aim of our study was to identify variables extracted from the instrumented timed-up-and-go (iTUG) that most effectively distinguished performance differences across age (age 18–75). Second, we determined the discriminative ability of those identified variables to classify a younger (age 18–45) and older age group (age 46–75). From healthy adults (n = 59), trunk accelerations and angular velocities were recorded during iTUG performance. iTUG phases were detected with wavelet-analysis. Using a Partial Least Square (PLS) model, from the 72-iTUG variables calculated across phases, those that explained most of the covariance between variables and age were extracted. Subsequently, a PLS-discriminant analysis (DA) assessed classification power of the identified iTUG variables to discriminate the age groups. 27 variables, related to turning, walking and the stand-to-sit movement explained 71% of the variation in age. The PLS-DA with these 27 variables showed a sensitivity and specificity of 90% and 85%. Based on this model, the iTUG can accurately distinguish young and older adults. Such data can serve as a reference for pathological aging with respect to a widely used mobility test. Mobility tests like the TUG supplemented with smart technology could be used in clinical practice.
There is a growing interest in identifying an array of measurements that can assess relevant processes associated with healthy ageing (e.g., [1–5]. Such “biomarkers” can concurrently change with age but can also predict ageing-related phenotypes or subsequent health outcomes including morbidity, mortality, quality of life and health span. Measurements of biomarkers should be easy to administer and still provide clinically meaningful information as surrogate endpoints in interventions specifically designed to extend health span. Beyond interventions, population studies should also benefit from valid, reliable, low-cost indices of healthy ageing . In general, biomarkers comprise key bodily functions, which are known to decline during ageing. Biomarkers should thus target physical capability and cognitive, physiological, musculoskeletal, endocrine and immune functions. Within the domain of motor function in aging, thanks to its high construct and convergent validity, reliability, and standardization the Timed-Up-and-Go (TUG) test has recently been proposed  and recommended as a potentially useful biomarker of healthy ageing . The TUG is routinely used as a composite test to assess leg strength (sit-to-stand), gait, and balance (180° turn; sit-to-stand, stand-to-sit). Constituent elements of TUG represent activities of daily living linked to quality of life in healthy aging. Unsurprisingly, TUG has hence become a popular and informative mobility test that provides age-, gender-, and pathology-specific data on old adults’ balance and gait function [6, 7]. Even though a stopwatch is sufficient to assess TUG performance , total time as a summary measure cannot characterize the execution quality of its sub-phases. Such an omission is unfortunate considering that the postures and the transitions between phases of TUG are frequently administered as individual tests for the quantification of dynamic balance, walking ability , the capacity to sequence tasks , and even to assess fall risks . Miniaturization, low weight, inconspicuousness, validity, reliability low cost, and versatility of automated algorithms to analyse a variety of motor tasks have made such devices the tool of choice for an objective quantification of motor function aging. Such sensor features make it possible to use wearable technology not only in a research setting but also in a clinical setting where individuals execute motor tasks in their natural environment [12, 13].
The present study addressed two main objectives: 1) which variables of the iTUG are most sensitive to distinguish age effects and 2) what is the classification power of a model based on the variables detected by the first objective. These two objectives were addressed using a multivariate analysis, namely the Partial Least Squares (PLS) analysis. We identified 27 variables of iTUG that predicted age. The subsequent PLS-DA analysis using the 27 identified iTUG variables classified young and old adults with a power of 0.95 and sensitivity and specificity of 90% and 85%. We discuss these results with a perspective on how technology can enrich a widely used clinical test for the purpose of stratifying age groups and patients with high sensitivity and specificity.
The current analysis shows that iTUG variables can accurately distinguish healthy young and older adults. A combination of 27 variables, from primarily the turns, walking and stand-to-sit phase was effective to identify iTUG performance in relation to age. The data revealed that young versus older adults executed the TUG with faster and smoother turns and more variable gait cycles and trunk sway during gait. Older adults compared to young adults had a larger angular velocity pattern during the transitions, stand-to-sit and sit-to-stand. Future research should implement the current iTUG analyses for the classification of old adults aging normally and those aging with pathologies. Combined with smart technology, the model could then be used to stratify patients with a high sensitivity and specificity in clinical practice.