Walking speed is "almost the perfect measure." 1 A reliable, valid, 2,3 sensitive 4 and specific 5 measure, self-selected walking speed (WS), also termed gait velocity, correlates with functional ability, 6 and balance confidence. 7 It has the potential to predict future health status, 8,9 and functional decline 10 including hospitalization, 11 discharge location, 12,13 and mortality. 14 Walking speed reflects both functional and physiological changes, 6 is a discriminating factor in determining potential for rehabilitation, 15 and aids in prediction of falls 16 and fear of falling.

Walking speed (WS) is a valid, reliable, sensitive measure appropriate for assessing and monitoring functional status and overall health in a wide range of populations. These capabilities have led to its designation as the “6th vital sign”. By synthesizing the available evidence on WS, this scholarly review article provides clinicians with a reference tool regarding this robust measure. Recommendations on testing procedures for assessing WS, including optimal distance, inclusion of acceleration/deceleration phases, instructions, and instrumentation are given. After assessing an individual’s WS, clinicians need to know what this value represents. Therefore, WS cut-off values and the corresponding predicted outcomes, as well as minimal detectable change values for specific populations and settings are provided.

Background:Falls and their consequences are significant concerns for older adults, caregivers, and health care providers. Identification of fall risk is crucial for appropriate referral to preventive interventions. Falls are multifactorial; no single measure is an accurate diagnostic tool. There is limited information on which history question, self-report measure, or performance-based measure, or combination of measures, best predicts future falls.Purpose:First, to evaluate the predictive ability of history questions, self-report measures, and performance-based measures for assessing fall risk of community-dwelling older adults by calculating and comparing posttest probability (PoTP) values for individual test/measures. Second, to evaluate usefulness of cumulative PoTP for measures in combination.Data Sources:To be included, a study must have used fall status as an outcome or classification variable, have a sample size of at least 30 ambulatory community-living older adults (≥65 years), and track falls occurrence for a minimum of 6 months. Studies in acute or long-term care settings, as well as those including participants with significant cognitive or neuromuscular conditions related to increased fall risk, were excluded. Searches of Medline/PubMED and Cumulative Index of Nursing and Allied Health (CINAHL) from January 1990 through September 2013 identified 2294 abstracts concerned with fall risk assessment in community-dwelling older adults.Study Selection:Because the number of prospective studies of fall risk assessment was limited, retrospective studies that classified participants (faller/nonfallers) were also included. Ninety-five full-text articles met inclusion criteria; 59 contained necessary data for calculation of PoTP. The Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS) was used to assess each study's methodological quality.Data Extraction:Study design and QUADAS score determined the level of evidence. Data for calculation of sensitivity (Sn), specificity (Sp), likelihood ratios (LR), and PoTP values were available for 21 of 46 measures used as search terms. An additional 73 history questions, self-report measures, and performance-based measures were used in included articles; PoTP values could be calculated for 35.Data Synthesis:Evidence tables including PoTP values were constructed for 15 history questions, 15 self-report measures, and 26 performance-based measures. Recommendations for clinical practice were based on consensus.Limitations:Variations in study quality, procedures, and statistical analyses challenged data extraction, interpretation, and synthesis. There was insufficient data for calculation of PoTP values for 63 of 119 tests.Conclusions:No single test/measure demonstrated strong PoTP values. Five history questions, 2 self-report measures, and 5 performance-based measures may have clinical usefulness in assessing risk of falling on the basis of cumulative PoTP. Berg Balance Scale score (≤50 points), Timed Up and Go times (≥12 seconds), and 5 times sit-to-stand times (≥...

No abstract

Context: Organizational effectiveness and the continuity of patient care can be affected by certain levels of attrition. However, little is known about the retention and attrition of female certified athletic trainers (ATs) in certain settings.Objective: To gain insight and understanding into the factors and circumstances affecting female ATs' decisions to persist in or leave the National Collegiate Athletic Association Division I Football Bowl Subdivision (NCAA D-I FBS) setting.Design: Qualitative study. Setting: The 12 NCAA D-I FBS institutions within the Southeastern Conference.Patients or Other Participants: A total of 23 women who were current full-time ATs (n 5 12) or former full-time ATs (n 5 11) at Southeastern Conference institutions participated.Data Collection and Analysis: Data were collected via indepth, semistructured interviews, transcribed verbatim, and analyzed via a grounded theory approach. Peer review and member checking methods were performed to establish trustworthiness.Results: The decision to persist involved 4 main factors:(1) increased autonomy, (2) increased social support, (3) enjoyment of job/fitting the NCAA D-I mold, and (4) kinship responsibility. Two subfactors of persistence, the NCAA D-I atmosphere and positive athlete dynamics, emerged under the main factor of enjoyment of job/fitting the NCAA D-I mold. The decision to leave included 3 main factors: (1) life balance issues, (2) role conflict and role overload, and (3) kinship responsibility. Two subfactors of leaving, supervisory/coach conflict and decreased autonomy, emerged under the main factor of role conflict and role overload.Conclusions: A female AT's decision to persist in or leave the NCAA D-I FBS setting can involve several factors. In order to retain capable ATs long term in the NCAA D-I setting, an individual's attributes and obligations, the setting's cultural issues, and an organization's social support paradigm should be considered.Key Words: job satisfaction, turnover, qualitative research Key PointsN Although a certain amount of employee turnover is expected and necessary, high levels of turnover can negatively affect organizations.N A female athletic trainer's decision to persist in or leave the Division I Football Bowl Subdivision setting can involve a number of factors, including enjoyment of the atmosphere and student-athletes; ''fit'' with the job; social support and autonomy; responsibility to family members; life balance issues; and role conflict and role overload.N To promote the retention of qualified female athletic trainers in the Division I setting, an individual's attributes, personal obligations, and perceived life balance should be considered in conjunction with the organization's social support structure and cultural issues.