Revealing the optimal thresholds for movement performance: A systematic review and meta-analysis to benchmark pathological walking behaviour

Deepak K Ravi, Michelle Gwerder, Niklas König Ignasiak, Christian R Baumann, Mechtild Uhl, Jaap H van Dieën, William R Taylor, Navrag B Singh

Research output: Contribution to JournalReview article


In order to address whether increased levels of movement output variability indicate pathological performance, we systematically reviewed and synthesized meta-analysis data on healthy and pathological motor behavior. After screening up to 24'000 reports from four databases, 85 studies were included containing 2409 patients and 2523 healthy asymptomatic controls. The optimal thresholds of variability with uncertainty boundaries (in % Coefficient of Variation ± Standard Error) were estimated in 7 parameters: stride time (2.34 ± 0.21), stride length (2.99 ± 0.37), step length (3.34 ± 0.84), swing time (2.94 ± 0.60), step time (3.35 ± 0.23), step width (15.87 ± 1.86), and dual-limb support time (6.08 ± 2.83). All spatio-temporal parameters exhibited a positive effect size (pathology led to increased variability) except step width variability (Effect Size = -0.21). By objectively benchmarking thresholds for pathological motor variability also presented through a case-study, this review provides access to movement signatures to understand neurological changes in an individual that are apparent in movement variability. The comprehensive evidence presented now qualifies stride time variability as a movement biomarker, endorsing its applicability as a viable outcome measure in clinical trials.

Original languageEnglish
Pages (from-to)24-33
Number of pages10
JournalNeuroscience and Biobehavioral Reviews
Early online date19 Oct 2019
Publication statusPublished - Jan 2020


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Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.

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