Clinic vs. daily life gait characteristics in patients with spinocerebellar ataxia

Background Recent findings suggest that a single gait assessment in a clinic may not reflect everyday mobility. Objective We compared gait measures that best differentiated individuals with spinocerebellar ataxia (SCA) from age-matched healthy controls (HC) during a supervised gait test in the clinic vs. a week of unsupervised gait during daily life. Methods Twenty-six individuals with SCA types 1, 2, 3, and 6, and 13 (HC) wore three Opal inertial sensors (on both feet and lower back) during a 2-minute walk in the clinic and for seven days in daily life. Seventeen gait measures were analyzed to investigate the group differences using Mann–Whitney U -tests and area under the curve (AUC). Results Ten gait measures were significantly worse in SCA than HC for the clinic test ( p < 0.003), but only 3 were worse in daily life ( p < 0.003). Only a few gait measures consistently discriminated groups in both environments. Specifically, variability in Swing Time and Double Support Time had AUCs of 0.99 ( p < 0.0001) and 0.96 ( p < 0.0001) in the clinic, and 0.84 ( p < 0.0003) and 0.80 ( p < 0.002) in daily life, respectively. Clinical gait measures showed stronger correlations with clinical outcomes (ie, SARA and FARS-ADL; r = 0.50–0.77 ) than between daily life gait measures ( r = 0.31–0.49 ). Gait activity in daily life was not statistically significant between the SCA and HC groups ( p > 0.06 ). Conclusions Digital gait measures discriminate SCA in both environments. In-clinic measures are more sensitive, while daily life measures provide ecological validity, highlighting a trade-off and offering complementary insights.