Performance-based outcome measures are associated with cadence variability during community ambulation among individuals with a transtibial amputation.

Background: In the United States, Medicare Functional Classification Level (K-level) guidelines require demonstration of cadence variability to justify higher-level prosthetic componentry prescription; however, clinical assessment of cadence variability is subjective. Currently, no clinical outcome measures are associated with cadence variability during community ambulation.

Objectives: Evaluate whether physical performance, i.e. 10-meter Walk Test (10mWT)-based walking speeds, L-Test, and Figure-of-8 Walk Test scores, is associated with community-based cadence variability among individuals with a transtibial amputation.

Study Design: Cross-sectional.

Methods: Forty-nine participants, aged 18-85 years, with a unilateral transtibial amputation were included. Linear regression models were conducted to determine whether physical performance was associated with cadence variability (a unitless calculation from FitBit® One minute-by-minute step counts), while controlling for sex, age, and time since amputation ( ⩽ .013).

Results: Beyond covariates, self-selected gait speed explained the greatest amount of variance in cadence variability (19.2%,  < .001). Other outcome measures explained smaller, but significant, amounts of the variance (11.1-17.1%,  = .001-.008). For each 0.1 m/s-increase in self-selected and fast gait speeds, or each 1-s decrease in L-Test and F8WT time, community-based cadence variability increased by 1.76, 1.07, 0.39, and 0.79, respectively ( < .013).

Conclusions: In clinical settings, faster self-selected gait speed best predicted increased cadence variability during community ambulation.

Clinical Relevance: The 10-meter Walk Test may be prioritized during prosthetic evaluations to provide objective self-selected walking speed data, which informs the assessment of cadence variability potential outside of clinical settings.