Key result
The Walk Test smartphone application accurately measured walking cadence during usual-paced walks compared to an in-clinic accelerometer (CCC 0.97; 95% CI 0.96-0.99; p<0.001).
Why the study?
Preoperative physical functional assessments are not routinely performed in-clinic before surgery, though smartphone-measured walking cadence may remotely identify high-risk older patients.
Does the Walk Test smartphone application accurately and feasibly measure walking cadence compared to an in-clinic accelerometer in older adults prior to abdominal surgery?
Cohort (n=41)
Does the Walk Test smartphone application accurately and feasibly measure walking cadence compared to an in-clinic accelerometer in older adults prior to abdominal surgery?
The Walk Test smartphone application is a feasible, acceptable, and accurate tool for measuring walking cadence in older adults prior to abdominal surgery.
Supports smartphone Walk Test accuracy for preoperative cadence in older adults; extends digital biomarker validation but leaves outcome trials open.
Introduction: Preoperative physical functional assessments (i.e., assessments that measure capability to perform physical activity) are integral to estimate perioperative risk for older adults. However, these assessments are not routinely performed in-clinic prior to surgery. Walking cadence, or the number of steps walked in a specified amount of time (i.e., steps/min), measures activity intensity and may be able to identify high-risk patients prior to surgery. Smartphones can measure walking characteristics and guide patients through remote functional assessments. Here, we assess feasibility, acceptability, and accuracy of Walk Test, a smartphone application designed to measure walking cadence. Methods: We performed a prospective cohort study of older adults prior to abdominal surgery and enrolled them remotely to perform at-home usual- and fast-paced walks with subsequent validation in-clinic. Each walk (usual- and fast-paced) was 2 min in duration. Feasibility was assessed if 80% of patients could perform all study procedures; acceptability was measured using the Post-Study Survey Usability Questionnaire (PSSUQ); accuracy of our approach was assessed with Lin’s concordance coefficient (CCC). activPAL thigh worn accelerometer worn during the in-clinic walk served as a gold standard comparison. We used the CCC to compare the at-home and in-clinic walks as performed by Walk Test. Results: We enrolled 41 participants (mean age 69 ± 5 years, 26 (63%) female); 88% (36/41) successfully completed entire study protocol including independent installation of the application, walk tests (at-home and in-clinic) and questionnaires. Median (interquartile range) overall score of PSSUQ was 1 (1, 1) indicating strong acceptability and usability. The Lin’s CCC between the in-clinic activPAL and Walk Test for usual-paced walk was 0.97 (95% CI: 0.96, 0.99, p < 0.001) and for fast-paced walks 0.96 (95% CI: 0.93, 0.98, p < 0.001). The CCC between the at-home and in-clinic walks for usual-paced walks was 0.70 (95% CI: 0.53, 0.86) and for fast-paced walks was 0.46 (95% CI: 0.21, 0.72). Conclusion: We successfully demonstrated the feasibility, acceptability and accuracy of Walk Test to measure walking cadence. Future work is needed to standardize walk test performance at-home to ensure consistency between in-clinic and at-home measures.
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Rubin et al. (2025) conducted a cohort in older adults prior to abdominal surgery (n=41). Walk Test smartphone application vs. in-clinic activPAL accelerometer was evaluated on Accuracy of Walk Test for usual-paced walk (Lin's concordance coefficient) (CCC 0.97, 95% CI 0.96, 0.99, p=< 0.001). The Walk Test smartphone application accurately measured walking cadence during usual-paced walks compared to an in-clinic accelerometer (CCC 0.97; 95% CI 0.96-0.99; p<0.001).
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