The effects of textured materials on static balance in healthy young and older adults: A systematic review with meta-analysis

Abstract

Background:
Standing on textured materials can improve static balance, potentially by modulating somatosensory inputs from the soles of the feet.

Research question:
To synthesise and quantify the immediate effects of textured materials on static balance in healthy young and older adults.

Methods:
Primary outcomes were the centre of pressure (COP) displacement and velocity, during eyes open and eyes closed conditions. Ten crossover studies (n = 318, 58% female) met the inclusion criteria. A random effects meta-analysis model derived pooled standardised mean differences (SMD; Hedges g) to quantify the effects of textured materials. Heterogeneity was quantified with the tau-statistic (τ). A 95% prediction interval quantified the likely range of true effects on COP outcomes in similar future studies.

Results:
There was a small to moderate beneficial effect for textured materials vs control conditions in: COP displacement during both eyes open (SMD: 0.29; 95% CI -0.06 to 0.64; τ = 0.32) and eyes closed (SMD: 0.75; 95% CI 0.18 to 1.33; τ = 0.55). A trivial to small beneficial effect was observed in COP velocity during eyes open (SMD: 0.14; 95% CI -0.14 to 0.43; τ = 0.18) and eyes closed (SMD: 0.20; 95% CI 0.01 to 0.40; τ = 0.18) for textured materials. The 95% prediction intervals showed texture may not consistently provide beneficial results across studies for all outcomes: COP displacement EC (-0.61 to 2.12), EO (-0.54 to 1.12), COP velocity EC (-0.27 to 0.68) and EO (-0.44 to 0.73).

Significance:
Overall, textured materials improved balance, but these effects were heterogeneous. This research may therefore inform applied investigations into balance improvements for healthy populations, for example, in functional movements and sports.

Full text

UNCORRECTED PROOF
!6>I*DHIJG: MMM MMMM MMMMMM
DCI:CIHA>HIH6K6>A67A:6I-8>:C8:>G:8I
!6>I*DHIJG:
?DJGC6A=DB:E6<:LLL:AH:K>:G8DB
.=: :T:8IH D; I:MIJG:9 B6I:G>6AH DC HI6I>8 76A6C8: >C =:6AI=N NDJC< 6C9 DA9:G 69JAIH 
HNHI:B6I>8 G:K>:L L>I= B:I66C6ANH>H
,N6C *1 %:CCN U⁎ !G:< I@>CHDC  6C>:A & 6K:H  :C>H '6GI>C  (6DB> JGC  $D=C >MDC
School of Health and Social Care, Teesside University, Middlesbrough, UK
,.#& #( )
Keywords:
.:MIJG:9 >CHDA:H
':8=6CDG:8:EIDGH
*DHIJG6A HL6N
":6AI=N 69JAIH
*G:9>8I>DC >CI:GK6A
-.,.
Background: -I6C9>C< DC I:MIJG:9 B6I:G>6AH 86C >BEGDK: HI6I>8 76A6C8: EDI:CI>6AAN 7N BD9JA6I>C< HDB6IDH:CHDGN
>CEJIH ;GDB I=: HDA:H D; I=: ;::I
Research question: .D HNCI=:H>H: 6C9 FJ6CI>;N I=: >BB:9>6I: :;;:8IH D; I:MIJG:9 B6I:G>6AH DC HI6I>8 76A6C8: >C
=:6AI=N NDJC< 6C9 DA9:G 69JAIH
Methods: *G>B6GN DJI8DB:H L:G: I=: 8:CIG: D; EG:HHJG: )* 9>HEA68:B:CI 6C9 K:AD8>IN 9JG>C< :N:H DE:C 6C9
:N:H 8ADH:9 8DC9>I>DCH .:C 8GDHHDK:G HIJ9>:H n   ;:B6A: B:I I=: >C8AJH>DC 8G>I:G>6  G6C9DB :;;:8IH
B:I66C6ANH>H BD9:A 9:G>K:9 EDDA:9 HI6C96G9>H:9 B:6C 9>;;:G:C8:H -' ":9<:H g ID FJ6CI>;N I=: :;;:8IH D;
I:MIJG:9 B6I:G>6AH ":I:GD<:C:>IN L6H FJ6CI>R:9 L>I= I=: I6JHI6I>HI>8 τ   EG:9>8I>DC >CI:GK6A FJ6CI>R:9
I=: A>@:AN G6C<: D; IGJ: :;;:8IH DC )* DJI8DB:H >C H>B>A6G ;JIJG: HIJ9>:H
Results: .=:G: L6H 6 HB6AA ID BD9:G6I: 7:C:R8>6A :;;:8I ;DG I:MIJG:9 B6I:G>6AH KH 8DCIGDA 8DC9>I>DCH >C )* 9>H
EA68:B:CI 9JG>C< 7DI= :N:H DE:C -'   #  ID  τ  6C9 :N:H 8ADH:9 -'  
# – τ   IG>K>6A ID HB6AA 7:C:R8>6A :;;:8I L6H D7H:GK:9 >C )* K:AD8>IN 9JG>C< :N:H DE:C -'
  #  ID  τ  6C9 :N:H 8ADH:9 -'   #  ID  τ  ;DG I:MIJG:9
B6I:G>6AH .=:  EG:9>8I>DC >CI:GK6AH H=DL:9 I:MIJG: B6N CDI 8DCH>HI:CIAN EGDK>9: 7:C:R8>6A G:HJAIH 68GDHH
HIJ9>:H ;DG 6AA DJI8DB:H )* 9>HEA68:B:CI   ID  )  ID  )* K:AD8>IN   ID
 6C9 )  ID 
Signi7cance: )K:G6AA I:MIJG:9 B6I:G>6AH >BEGDK:9 76A6C8: 7JI I=:H: :;;:8IH L:G: =:I:GD<:C:DJH .=>H G:H:6G8=
B6N I=:G:;DG: >C;DGB 6EEA>:9 >CK:HI><6I>DCH >CID 76A6C8: >BEGDK:B:CIH ;DG =:6AI=N EDEJA6I>DCH ;DG :M6BEA: >C
;JC8I>DC6A BDK:B:CIH 6C9 HEDGIH
1. Background
'6>CI:C6C8: D; JEG><=I 76A6C8: ;DG =JB6CH 86C 7: 9>;R8JAI 9J: ID
6 =><= 8:CIG: D; B6HH DK:G 6 G:A6I>K:AN HB6AA 76H: D; HJEEDGI 45 K:C
L=:C HI6C9>C< HI6I>86AAN D;I:C I:GB:9 FJ>:I HI6C9>C< I=: 7D9N HI>AA
EGD9J8:H HB6AA 6BDJCIH D; HL6N 45 .=>H EDHIJG6A HL6N >H 6C >C9>86IDG
D; 9>HEA68:B:CI 6C9 BDIDG 8DGG:8I>DCH ID B6>CI6>C I=: 8:CIG: D; <G6K>IN
L>I=>C I=: 76H: D; HJEEDGI 45
*DHIJG6A 8DCIGDA >H 68=>:K:9 K>6 I=: 8:CIG6A C:GKDJH HNHI:B (-
L=>8= 8DAA6I:H 6;;:G:CI >C;DGB6I>DC 6GG>K>C< ;GDB K>HJ6A K:HI>7JA6G 6C9
HDB6IDH:CHDGN HDJG8:H 45 .=: 6;;:G:CI >C;DGB6I>DC G:8:>K:9 ;GDB
I=:H: HDJG8:H 6AADLH ;DG 6C >CI:GC6A G:EG:H:CI6I>DC D; I=: 7D9N’H EDH>
I>DC 6C9 AD86I>DC >C HE68: 1=:C 76A6C8: >H I=G:6I:C:9 7N :>I=:G 6C :M
I:GC6A DG >CI:GC6A E:GIJG76I>DC I=: (- 86C >C>I>6I: 6C 6EEGDEG>6I: BJH
8JA6G G:HEDCH: .=>H >H 688DBEA>H=:9 7N 8DBE6G>C< I=: 8DAA6I:9 6;;:G
:CI >C;DGB6I>DC ID I=: >CI:GC6A BD9:A :ME:8I:9 HI6I: ID :A>8>I 6 BDIDG
G:HEDCH: L=>8= L>AA B6>CI6>C I=: 8:CIG: D; B6HH L>I=>C I=: A>B>IH D;
HI67>A>IN 45 .=:H: H><C6AH 6G: =DL:K:G EA6<J:9 7N CD>H: 45 #I LDJA9
I=:G:;DG: 7: 7:C:R8>6A >; 6C >CI:GK:CI>DC 8DJA9 :C=6C8: I=: 6K6>A67A: >C
;DGB6I>DC 6GG>K>C< ID I=: (- .=>H LDJA9 6AADL ;DG 6 G:9J8I>DC D; I=:
CD>H: ;DG I=: EJGEDH: D; >CI:GC6A BD9:AA>C< 6C9 6AADL ;DG FJ>8@:G :;R
8>:CI 6C9 BDG: 688JG6I: BDIDG G:HEDCH:H L=:C C:8:HH6GN
 @:N HDB6IDH:CHDGN >CEJI ;DG I=: (- >H 9:G>K:9 ;GDB I=: 8JI6
C:DJH B:8=6CDG:8:EIDGH AD86I:9 >C I=: HDA:H D; I=: ;::I 45 .=: 6;
;:G:CI >C;DGB6I>DC G:8:>K:9 ;GDB I=:H: HE:8>6A>H:9 H:CHDGH 6G: E6GI>8J
A6GAN >BEDGI6CI 6H I=:N 8DCI68I I=: HI6C9>C< HJG;68: EGDK>9>C< K>I6A >C
;DGB6I>DC G:<6G9>C< I=: 7D9N >C HE68: 45  G:9J8I>DC >C I=: >C;DGB6
⁎DGG:HEDC9>C< 6JI=DG 6I -8=DDA D; ":6AI= 6C9 -D8>6A 6G: .::HH>9: /C>K:GH>IN '>99A:H7GDJ<= .- 2 /%
Email addresses: ,*1%:CCNI::H68J@ ,*1 %:CCN !G:<I@>CHDCI::H68J@ ! I@>CHDC 6K:HI::H68J@ & 6K:H '6GI>CI::H68J@  '6GI>C (JGCI::H
68J@ ( JGC $D=C>MDCI::H68J@ $ >MDC
=IIEH9D>DG<?<6>IEDHI
,:8:>K:9 :8:B7:G,:8:>K:9>CG:K>H:9;DGB EG>A88:EI:9 EG>A
K6>A67A:DCA>C: MMM
 Q 
,:K>:L

UNCORRECTED PROOF
R.P.W. Kenny et al. Gait & Posture xxx (xxxx) xxx-xxx
I>DC 6K6>A67A: I=GDJ<= I=:H: G:8:EIDGH 86C :FJ6I: ID EDDG:G EDHIJG6A
E:G;DGB6C8: 9JG>C< FJ>:I HI6C9>C< 45 ':8=6C>86AAN HI>BJA6I>C< I=:
EA6CI6G H@>C K>6 6EEA>86I>DC D; 6 RM:9 E>C B6IG>M ID E6GI>8>E6CIH’
;DG:;::I =6H 7::C H=DLC ID >BEGDK: EDHIJG6A HL6N B:6HJG:H 45 .=>H
>CI:GK:CI>DC =DL:K:G L6H DCAN 6EEA>:9 ID 6 HB6AA G:<>DC D; I=: HDA:H
D; I=: ;::I N JI>A>H>C< 6 I:MIJG: I=6I 8DK:GH I=: :CI>G:IN D; I=: EA6C
I6G HJG;68: D; I=: ;::I BDG: B:8=6CDG:8:EIDGH 8DJA9 7: 68I>K6I:9 6C9
I=:G:;DG: EGDK>9: <G:6I:G HI>BJA6I>DC .D I=>H :C9 H>B>A6G 7:C:RIH DC
HI6I>8 76A6C8: =6K: 7::C D7H:GK:9 L=:C >CIGD9J8>C< I:MIJG: ID I=: :C
I>G: HDA:H D; I=: ;::I >C =:6AI=N NDJC< 6C9 DA9:G E6GI>8>E6CIH 4–5
EEA>86I>DC D; HJ8= I:MIJG: =6H 7::C 688DBEA>H=:9 K>6 :>I=:G 6 I:MIJG:9
HJG;68: 4–5 DG I:MIJG:9 >CHDA:H 4–5 1=:C G:;:GG>C< ID
:68= I:MIJG: BD96A>IN >C9>K>9J6AAN L: L>AA JH: I=>H I:GB>CDAD<N 1=:C
9>H8JHH>C< I:MIJG: 6H 6 8DAA:8I>K: >I L>AA 7: I:GB:9 ‘I:MIJG:9 B6I:G>6A’
.:MIJG:9 B6I:G>6A =6H I=: EDI:CI>6A D; 7:8DB>C< 6 G:A6I>K:AN >C:ME:C
H>K: 6C9 K>67A: L6N D; >BEGDK>C< EDHIJG6A 8DCIGDA :HE:8>6AAN I=GDJ<=
I=: I:MIJG:9 >CHDA:H B:9>JB L=>8= 86C 7: LDGC L>I=>C I=: H=D:H 6C9
I=:G:;DG: =6K: <G:6I:G 6EEA>86I>DC >C :K:GN96N A>;:
'DHI HIJ9>:H DC I=: :;;:8IH D; I:MIJG:9 B6I:G>6AH >CKDAK: 6 8GDHHDK:G
9:H><C L>I= G:A6I>K:AN HB6AA H6BEA: H>O:H ':I66C6ANH:H 86C 7: JH:;JA
ID FJ6CI>;N I=: :;;:8IH D; 6C >CI:GK:CI>DC L>I= <G:6I:G EG:8>H>DC ;GDB
6 EDDA:9 :HI>B6I:  HI6C96G9>H:9 B:6C 9>;;:G:C8: -' >H D;I:C G:
EDGI:9 .=: -' >H 6C :;;:8I H>O: L=>8= 8DBE6G:H I=: 6K:G6<: E:G
;DGB6C8:H D; ILD <GDJEH DG ILD 8DC9>I>DCH DC 6 EG:9:I:GB>C:9 DJI
8DB: 45 #C I=: 8JGG:CI 86H: I=>H LDJA9 7: I:MIJG:9 K:GHJH 8DCIGDA
.=: 9>;;:G:C8: >C B:6CH >H 86A8JA6I:9 6C9 :MEG:HH:9 6H 6 ;G68I>DC D; I=:
HI6C96G9 9:K>6I>DC -D 6C -' D;  >C9>86I:H I=6I I=:G: >H 6 B:6C 9>;
;:G:C8: :FJ>K6A:CI ID DC: HI6C96G9 9:K>6I>DC .=:H: :;;:8I H>O:H 8DGG:
HEDC9 ID I=: HIG:C<I= D; I=: >CI:GK:CI>DC L>I= HJ<<:HI:9 K6AJ:H 7::C
IG>K>6A  HB6AA  BD9:G6I:  6C9 A6G<:  45 
EG>DG B:I66C6ANH>H 6HH:HH>C< BJAI>EA: HJ7EDEJA6I>DCH H=DL:9 I=6I JE
G><=I 76A6C8: L6H G:9J8:9 9JG>C< I:MIJG: :MEDHJG: -'  45
.=>H 8=6C<: >C I=: -' G:EG:H:CIH 6 HB6AA >BEGDK:B:CI >C 76A6C8:
DJI8DB:H CDI=:G B:I66C6ANH>H 6HH:HH:9 I:MIJG:9 6C9 HI>BJA6I>C< >C
HDA:H >C I=DH: L>I= :>I=:G BJAI>EA: H8A:GDH>H DG *6G@>CHDC’H 9>H:6H: 8DC
8AJ9>C< 6 A68@ D; :;;:8I DC )* 9>HEA68:B:CI -'  6C9 )* K:
AD8>IN -'  45 .=:G: >H =DL:K:G 6 A68@ D; G:8:CI HIJ9>:H
L>I=>C I=>H 6C6ANH>H L>I= DCAN ILD D; I=: >C8AJ9:9 HIJ9>:H 45
B::I>C< I=: 8G>I:G>6 ;DG JEG><=I 76A6C8: 99>I>DC6AAN 7DI= EG:K>DJH
B:I66C6ANH:H 9D CDI G:EDGI L=:I=:G I=:N B:G<:9 BJAI>EA: I:MIJG: 8DC
9>I>DCH ID 8DBE6G: 6<6>CHI 6 H>C<JA6G 76H:A>C: HJ<<:HI>C< :K>9:C8: D;
9DJ7A: 8DJCI>C< 45  ;JGI=:G 8DC8:GC D; DC: D; I=:H: HIJ9>:H 45 >H
I=: A68@ D; G:EDGI>C< IDL6G9H I=: >BEJI6I>DC D; 6 E6>G:9 8DGG:A6I>DC 8D
:;R8>:CI ;DG 8GDHHDK:G HIJ9>:H .=>H 86HIH >HHJ:H G:<6G9>C< =DL I=:N 6G
G>K:9 6I I=: G:EDGI:9 HI6C96G9 :GGDGH 6C9 8DCR9:C8: >CI:GK6AH 6H I=:N
9D CDI G:S:8I I=: 8GDHHDK:G C6IJG: D; I=: L>I=>CHJ7?:8I 9:H><CH 45
.=: 8JGG:CI G:K>:L L>AA 699G:HH I=>H >HHJ: K>6 >C8AJH>DC D; 6 8DGG:A6I>DC
8D:;R8>:CI JGI=:GBDG: CD G:K>:L =6H 8A6G>R:9 I=: :;;:8IH D; I:MIJG: DC
JEG><=I 76A6C8: HDA:AN >C =:6AI=N NDJC<:G 6C9 DA9:G 69JAIH N FJ6CI>;N
>C< I=: :;;:8IH D; I:MIJG:9 B6I:G>6AH DC 76A6C8: >C =:6AI=N E6GI>8>E6CIH
L: 86C 6HH:HH I=: >BB:9>6I: 696EI>K: G:HEDCH:H D; I=: (- L=:C >I >H
;G:: D; >BE6>GB:CI -J8= HIJ9>:H 86C >C;DGB 6EEA>:9 LDG@ 6II:BEI>C< ID
7DI= JC9:GHI6C9 6C9 >BEGDK: 76A6C8: >C =:6AI=N EDEJA6I>DCH DG :M6B
EA: >C ;JC8I>DC6A BDK:B:CIH 6C9 >C HEDGI>C< E:G;DGB6C8: =6G68I:G>H
>C< I=: :;;:8I D; I:MIJG:9 B6I:G>6AH >C I=>H L6N EGDK>9:H 6 8A:6G 7:C8=
B6G@ 6<6>CHI L=>8= 8DBE6G>HDCH 86C 7: B69: ID DI=:G EDEJA6I>DCH L=D
EG:H:CI L>I= 6 =><=:G G>H@ D; ;6AA>C< 'DG:DK:G I=>H 6EEGD68= L>AA :MI:C9
I=: :M>HI>C< @CDLA:9<: 76H: DC I:MIJG:9 B6I:G>6A 6H 6 EDI:CI>6AAN 8=:6E
6C9 K>67A: L6N D; >BEGDK>C< 76A6C8: 1: I=:G:;DG: 6>B:9 ID HNCI=:H>H:
I=: :K>9:C8: ;GDB EG:K>DJH HIJ9>:H >CK:HI><6I>C< I=: :;;:8I D; I:MIJG: DC
HI6I>8 EDHIJGD<G6E=N >C =:6AI=N NDJC< 6C9 DA9:G E6GI>8>E6CIH
2. Review method
2.1. Search strategy
1: H:6G8=:9 '&#( #("& ' 6C9 -*),.>H8JH 96I6
76H:H JI>A>H>C< I=: *G:;:GG:9 ,:EDGI>C< #I:BH ;DG -NHI:B6I>8 ,:K>:LH
6C9 ':I6C6ANH>H *,#-' H:: ><  6EEGD68= 45 .=: H:6G8=:H
>C8AJ9:9 9:I6>A:9 I:GBH G:A6I>C< ID I=: JH: D; ;DDI DGI=DI>8H I:MIJG:9
>CHDA:HHJG;68:H HI6I>8 76A6C8: 8DCIGDA 6C9 H:CHDG>BDIDG ;::9768@ 6AA
Fig. 1. ADL 8=6GI D; HIJ9N H:A:8I>DC


UNCORRECTED PROOF
R.P.W. Kenny et al. Gait & Posture xxx (xxxx) xxx-xxx
H:6G8= I:GBH L>I= DDA:6C DE:G6IDGH 86C 7: H::C >C .67A:  -:6G8=:H
L:G: 8DC9J8I:9 ;GDB >C8:EI>DC I=GDJ<= :7GJ6GN 
2.2. Inclusion criteria
DG >C8AJH>DC :68= HIJ9N C::9:9 ID B::I I=: ;DAADL>C< 8G>I:G>6 6H
H:HH:9 I:MIJG:9 >CHDA:H DG HJG;68:H 9JG>C< 96I6 8DAA:8I>DC I=: I:MIJG:
BJHI =6K: 8DCI68I:9 I=: L=DA: EA6CI6G HJG;68: D; I=: ;DDI 6C9 6 8DC
IGDA 8DC9>I>DC L6H EG:H:CI :< CD I:MIJG: *6GI>8>E6CIH L:G: :>I=:G
Table 1
.:GB>CDAD<N JH:9 ;DG HNHI:B6I>8 H:6G8= D; 96I676H:H
-:6G8= +J:GN ,:HJAIH
 ":6AI=N),NDJC<),DA9:G),:A9:GAN(#CHDA:),
>CHDA:H),HJG;68:),HJG;68:H),I:MIJG:9>CHDA:),
I:MIJG:9>CHDA:H),I:MIJG:9HJG;68:),I:MIJG:9HJG;68:H),
DGI=DH>H),DGI=DI>8H),DGI=DH:H),>CH:GIH),H=D:>CH:GIH
(6A6C8:),HI6I>876A6C8:),EDHIJG:),EDHIJG6A
8DCIGDA),EDHIJG6AHI:69>C:HH),EDHIJG6AHI67>A>IN),FJ>:I
HI6C9>C<),BDIDG8DCIGDA),H:CHDG>BDIDG),
HDB6IDH:CHDGN),B:8=6CDG:8:EIDG),B:8=6CDG:8:EIDGH
),;::9768@),;::9768@),H:CHDGNG:L:><=I>C<),
EGDEG>D8:EI>DC),EGDEG>D8:EI>K:

 6A6C8:),HI6I>876A6C8:),EDHIJG:),EDHIJG6A8DCIGDA),
EDHIJG6AHI:69>C:HH),EDHIJG6AHI67>A>IN),FJ>:IHI6C9>C<
),BDIDG8DCIGDA),H:CHDG>BDIDG),HDB6IDH:CHDGN),
B:8=6CDG:8:EIDG),B:8=6CDG:8:EIDGH),;::9768@),
H:CHDGNG:L:><=I>C<),EGDEG>D8:EI>DC),EGDEG>D8:EI>K:


 *GDEG>D8:EI>K: 
 *GDEG>D8:EI>DC 
 -:CHDGNG:L:><=I>C< 
 ::9768@ 

 ':8=6CDG:8:EIDGH 
 ':8=6CDG:8:EIDG 
 -DB6IDH:CHDGN 
 -:CHDG>BDIDG 
 'DIDG8DCIGDA 
 +J>:IHI6C9>C< 
 *DHIJG6AHI67>A>IN 
 *DHIJG6AHI:69>C:HH 
 *DHIJG6A8DCIGDA 
 *DHIJG: 

 -I6I>876A6C8: 
 6A6C8: 

 #CHDA:),>CHDA:H),HJG;68:),HJG;68:H),I:MIJG:9>CHDA:
),I:MIJG:9>CHDA:H),I:MIJG:9HJG;68:),I:MIJG:9HJG;68:H
),DGI=DH>H),DGI=DI>8H),DGI=DH:H),>CH:GIH),H=D:
>CH:GIH


 -=D:>CH:GIH 
 #CH:GIH 
 )GI=DH:H 
 )GI=DI>8H 
 )GI=DH>H 
 .:MIJG:9HJG;68:H 
 .:MIJG:9HJG;68: 
 .:MIJG:9>CHDA:H 
 .:MIJG:9>CHDA: 
 -JG;68:H 

 -JG;68: 

 #CHDA:H 
 #CHDA: 
 ":6AI=N),NDJC<),DA9:G),:A9:GAN 

 A9:GAN 

 )A9:G 

 3DJC< 

 ":6AI=N 
=:6AI=N NDJC<  N:6GH DA9 DG DA9:G 69JAIH ≥ N:6GH DA9 6C9 96I6
L6H 8DAA:8I:9 K>6 EDHIJGD<G6E=N )* 9JG>C< HI6I>8 76A6C8:
2.3. Exclusion criteria
-IJ9>:H L:G: :M8AJ9:9 >; I=: HJG;68:>CHDA: EGDK>9:9 K>7G6IDGN DG
B:8=6C>86A HI>BJA6I>DC 6HH:HH:9 CDCI:MIJG:9 B6I:G>6AH 9>9 CDI 8DC
I68I I=: L=DA: EA6CI6G HJG;68: D; I=: ;::I DG I=: I:MIJG:9 B6I:G>6A DCAN
8DCI68I:9 DC: ;DDI *6GI>8>E6CIH L>I= E6I=DAD<>:H DG DA9:G 69JAIH L>I= 6
=>HIDGN D; ;6AAH L:G: CDI 8DCH>9:G:9 -IJ9>:H I=6I 6HH:HH:9 <6>I L:G: CDI
>C8AJ9:9 >C6AAN B6CJH8G>EIH BJHI =6K: 7::C 6K6>A67A: >C C<A>H=
2.4. Study selection
.LD B:B7:GH D; I=: G:H:6G8= I:6B ,*1% 6C9 ( >C9:E:C9:CIAN
H:A:8I:9 I=: HIJ9>:H ;DG >C8AJH>DC >C I=: HNHI:B6I>8 G:K>:L *DI:CI>6A
HIJ9>:H L:G: >9:CI>R:9 7N :M6B>C>C< I=: I>IA:H 6C9 67HIG68IH ;JAA 8DE>:H
D; I=: I:MI L:G: D7I6>C:9 >; I=:N B:I I=: >C>I>6A 8G>I:G>6 D; :K6AJ6I>C<
I:MIJG: 9JG>C< FJ>:I HI6C9>C< ); I=:  ;JAA I:MIH :M6B>C:9  L:G: >C
8AJ9:9 L>I=>C I=>H G:K>:L )C: HIJ9N L6H :M8AJ9:9 ;GDB I=: B:I66C6AN
H>H 45 9J: ID I=:>G HI6I>HI>86A G:EDGI>C< B:I=D9H .=>H B:6CI I:C HIJ9
>:H L:G: >C8AJ9:9 >C I=: RC6A B:I66C6ANH>H
2.5. Data synthesis
#C8AJ9:9 HIJ9>:H L:G: 6HH:HH:9 ;DG FJ6A>IN >C9:E:C9:CIAN 7N ILD
6JI=DGH ,*1% 6C9 ( JH>C< :HI67A>H=:9 8G>I:G>6 *=NH>DI=:G6EN K
>9:C8: 6I676H: 4*GD5 =IIELLLE:9GDDG<6J:C<A>H=9DLC
AD69HE:9GDH86A: )C: 6JI=DG ,*1% :MIG68I:9 96I6 DC I=: HIJ9N
B:I=D9H H6BEA: H>O: E6GI>8>E6CIH 8=6G68I:G>HI>8H 8:CIG: D; EG:HHJG:
9>HEA68:B:CI BB 6C9 K:AD8>IN BBH B:6CH 6C9 HI6C96G9 9:K>6
I>DCH - .=:H: K6G>67A:H L:G: 8G:6I:9 7N EDDA>C< )* B:6HJG:B:CIH
B:6C>C< 6 9:8G:6H: >C DK:G6AA )* 9>HEA68:B:CI DG K:AD8>IN :FJ6AA:9
6C >BEGDK:B:CI >C EDHIJG6A HL6N 45 .D 688DBEA>H= I=>H L=:C HIJ9
>:H G:EDGI:9 H:E6G6I: ;DG8: EA6I;DGB DJI8DB:H :< 6CI:G>DGEDHI:G>DG
G6C<: 6CI:G>DGEDHI:G>DG K:AD8>IN 6C9 HD DC I=: 6K:G6<:H I=6I L:G:
EG:H:CI:9 >C BB 9>HEA68:B:CI DG BBH K:AD8>IN L:G: EDDA:9 ID 8G:
6I: 6 H>C<JA6G B:6C ;DG 6 <>K:C HIJ9N ;DG :>I=:G )* 9>HEA68:B:CI DG
)* K:AD8>IN AA K6AJ:H 6II6>C:9 L:G: 9:G>K:9 ;GDB B:6CH 6C9 HI6C
96G9 9:K>6I>DCH EG:H:CI:9 >C I=: >C9>K>9J6A HIJ9>:H L=>8= L:G: 6K:G
6<:9 DK:G BJAI>EA: IG>6AH  DG  8DAA:8I:9 DK:G 6 G6C<: D; 96I6 86EIJG:
E:G>D9H – H E:G 8DC9>I>DC )C: HIJ9N 6II6>C:9 I=:>G K6AJ:H ;GDB
6 H>C<A: IG>6A E:G 8DC9>I>DC 45 ->C8: >I >H 8DBBDC ID 6HH:HH I:MIJG:9
B6I:G>6AH JC9:G :N:H DE:C 6C9 :N:H 8ADH:9 8DC9>I>DCH L: B:I66C6ANH:9
I=: 6II6>C:9 96I6 L>I= 8DCH>9:G6I>DC ;DG I=>H ;68IDG 1=:G: I=: 96I6 L6H
CDI G:EDGI:9 >C I:MI DG I67A:H I=: 96I6 L6H 9><>I>H:9 K>6 I=: ‘<G67>I’IDDA
7DM =IIEHJ@B6I=LDG@H8DBB6IA678:CIG6ARA::M8=6C<:<G6
7>I >C '.A67 '.& 6 .=: '6I=1DG@H #C8 (6I>8@ '
2.6. Meta-analysis procedure
':I6HH:CI>6AH HD;IL6G: 45L6H JH:9 ID 8DC9J8I 6 G6C9DB:;;:8IH
L:><=I:9 K6G>6C8: B:I=D9 %C6EE"6GIJC< 69?JHIB:CI L>I= -IJ9:CI’H
t-9>HIG>7JI>DC B:I66C6ANH>H D; I=: B:6C 9>;;:G:C8: >C I:MIJG: 6C9 8DC
IGDA 8DC9>I>DCH ;DG )* 9>HEA68:B:CI 6C9 K:AD8>IN ;DG :N:H DE:C 6C9
8ADH:9 8DC9>I>DCH -I6C96G9>H:9 B:6C 9>;;:G:C8:H :;;:8I H>O:H L:G: 86A
8JA6I:9 JH>C< I=: ":9<:’Hg6H >I 688DJCIH ;DG HB6AA HIJ9N 7>6H L=>8= D
=:C’Hd9D:H CDI 45 .=: >CEJII:9 96I6 >C8AJ9:9 H6BEA: H>O:H B:6CH
6C9 - ;DG I:MIJG:9 6C9 8DCIGDA 8DC9>I>DCH 6C9 6C >BEJI:9 8DGG:A6
I>DC 8D:;R8>:CI ID 8DCH>9:G I=: ;68I I=6I 6AA B:I66C6ANH:9 HIJ9>:H >C
KDAK:9 6 L>I=>CHJ7?:8IH 9:H><C 45 6H L:AA 6H I=: ;68I I=6I B6CN
6JI=DGH 9>9 CDI 9>G:8IAN G:EDGI HI6C96G9 9:K>6I>DCH D; 8=6C<: :M68I
*K6AJ:H 6C9DG I K6AJ:H .=:H: 8DGG:A6I>DC 8D:;R8>:CIH L:G: :HI>


UNCORRECTED PROOF
R.P.W. Kenny et al. Gait & Posture xxx (xxxx) xxx-xxx
B6I:9 ;GDB EG>DG 96I6 8DAA:8I:9 >C DJG A67DG6IDGN L>I= 6 8DCH:GK6I>K:
r  6EEA>:9 ID :68= 6C6ANH>H .=: HD;IL6G: 86A8JA6I:9 I=: EDDA:9
HI6C96G9>H:9 9>;;:G:C8: >C B:6CH ID 9:I:GB>C: I=: :;;:8I H>O: 45 .=:
HI6C96G9>H:9 B:6C 9>;;:G:C8:H 6C9  8DCR9:C8: >CI:GK6AH #H L:G:
86A8JA6I:9 6H HJBB6GN HI6I>HI>8H .=:  #H ;DG :68= HIJ9N L:G: 86A8J
A6I:9 JH>C< I=: IHI6I>HI>8 G6I=:G I=6C I=: OHI6I>HI>8 6H 8DK:G6<: >H BDG:
688JG6I: JH>C< I=: IHI6I>HI>8 76H:9 6EEGD68= 45
-I6C96G9>H:9 B:6C 9>;;:G:C8: -' K6AJ:H L:G: >CI:GEG:I:9 6H ;DA
ADLH IG>K>6A  HB6AA  BD9:G6I:  6C9 A6G<: 
45  EDH>I>K: :;;:8I H>O: >C9>86I:H 6 G:9J8I>DC >C I=: G:EDGI:9 B:6HJG:
)* 9>HEA68:B:CI DG K:AD8>IN L=:C HI6C9>C< DC I:MIJG: 6C9 I=:G:
;DG: 6C >BEGDK:B:CI >C 76A6C8: ":I:GD<:C:>IN 6BDC<HI I=: HIJ9>:H L6H
FJ6CI>R:9 L>I= I=: I6J HI6I>HI>8 τ L=>8= >H 6 HI6C96G9 9:K>6I>DC :M
EG:HH>C< I=: INE>86A K6G>67>A>IN D; I=: B:6C 7:IL::C HIJ9>:H 45 #C 69
9>I>DC I=: B:I6:HH:CI>6AH HD;IL6G: 6JIDB6I>86AAN 86A8JA6I:H  EG:
9>8I>DC >CI:GK6AH *# ;DG FJ6CI>R86I>DC D; I=: :ME:8I:9 G6C<: D; IGJ: K6A
J:H ;DG  D; H>B>A6G ;JIJG: HIJ9>:H L=>8= >H G:8DBB:C9:9 ID 7: G:
EDGI:9 45
3. Results
3.1. Overview
A:K:C HIJ9>:H B:I I=: >C8AJH>DC 8G>I:G>6 ;DG I=>H HNHI:B6I>8 G:K>:L
=DL:K:G DC: HIJ9N 45 L6H CDI >C8AJ9:9 >C I=: B:I66C6ANH>H 9J: ID
I=:>G G:EDGI:9 HI6I>HI>8H L=>8= EGDK>9:9 >CHJ;R8>:CI 96I6 ;DG 6C6ANH>H
.=: I:C HIJ9>:H >C8AJ9:9 >C I=: B:I66C6ANH>H >CKDAK:9 6 IDI6A D; 
E6GI>8>E6CIH AA HIJ9>:H =6K: 7::C EJ7A>H=:9 >C E::GG:K>:L:9 H8>:C
I>R8 ?DJGC6AH .=: :ME:G>B:CI6A IG>6AH >C I=: I:C HIJ9>:H 6HH:HH:9 I=: >C>
I>6A :;;:8IH D; I:MIJG:9 B6I:G>6AH JC9:G ;DDI 99>I>DC6AAN 6AA HIJ9>:H >C
8AJ9:9 L>I=>C I=: B:I66C6ANH>H L:G: 8DBEA:I:9 JH>C< 6 L>I=>CHJ7?:8IH
G:H:6G8= 9:H><C 1>AHDC 6C9 8DAA:6<J:H 45 L:G: I=: DCAN HIJ9N I=6I
G6C 6 E6G6AA:A ADC<>IJ9>C6A HIJ9N JGI=:GBDG: 6AA B:I66C6ANH:9 HIJ9
>:H 6HH:HH:9 E6GI>8>E6CIH >C 6 H>C<A: H:HH>DC >C6AAN 6AA HIJ9>:H 8DAA:8I:9
)* 96I6 9JG>C< :MEDHJG: ID 6 CDCI:MIJG:9 8DC9>I>DC 6C9 I:MIJG:9 B6
I:G>6AH
.=: >C8AJ9:9 HIJ9>:H 6G: HJBB6G>H:9 >C .67A:  .=: B6?DG>IN D;
HIJ9>:H G:8GJ>I:9 E:DEA: D; 7DI= B6A: 6C9 ;:B6A: H:M .=: DCAN :M8:E
I>DC L6H 1>AHDC 6C9 8DAA:6<J:H 45 L=D JI>A>H:9 DCAN ;:B6A:H "6I
IDC 6C9 8DAA:6<J:H 45 L:G: I=: HDA>I6GN G:H:6G8=:GH ID 6HH:HH BDG:
I=6C DC: I:MIJG: INE: 6HH:HH>C< ENG6B>96A 6C9 8DC86K: 8>G8JA6G E6I
I:GCH >C8AJ9:9 L>I=>C I=: B:I66C6ANH:H .=: HIJ9N D; +>J :I 6A 45
6HH:HH:9 I=: H6B: I:MIJG: INE: 7JI 6I K6GN>C< 9:<G::H D; 9:CH>IN =6G9
>CHDA:  9:CH>IN HD;I >CHDA:  9:CH>IN >C6AAN +J 45 6AHD B:6
HJG:9 )* 8=6C<:H 9JG>C< ;DJG >CHDA: INE:H 7JI DCAN DC: EGDK>9:9 I:M
IJG:9 HI>BJA6I>DC ID I=: HDA: D; I=: ;DDI 8DCK:M 8>G8JA6G E6II:GC H
L: L:G: 8DC8:GC:9 L>I= I=: I:MIJG: :;;:8I DK:G6AA 6C9 ID 6KD>9 9DJ7A:
8DJCI>C< I=: I:MIJG:H L:G: <GDJE:9 ID<:I=:G 6H 6 H>C<A: >CI:GK:CI>DC
)* 8=6C<:H L:G: 6HH:HH:9 9JG>C< I:MIJG:9 >CHDA: :MEDHJG: >C RK: HIJ9
>:H L=>AHI I=: G:B6>C>C< RK: HIJ9>:H JI>A>H:9 6 I:MIJG:9 HJG;68: L>I=DJI
H=D:H ); I=: I:C B:I66C6ANH:9 HIJ9>:H C>C: B:6HJG:9 EDHIJG6A HL6N
9JG>C< 7>E:96A HI6C9>C< DCAN L=>AHI DG7>C :I 6A 45 6HH:HH:9 7DI=
7>E:96A 6C9 JC>E:96A HI6C9>C< .=: B:6C *GD H8DG: ;DG I=: I:C HIJ9>:H
L6H  G6I>C< 6AA HIJ9>:H ID =6K: 6 “<DD9”B:I=D9DAD<>86A FJ6A>IN
3.2. Participant demographics and insole characteristics
); I=:  B:I66C6ANH:9 E6GI>8>E6CIH   L:G: ;:B6A: 6C9
  L:G: B6A: -:K:C D; I=: HIJ9>:H 6HH:HH:9   ;:B6A:
NDJC< E6GI>8>E6CIH M6<:  N:6GH 6C9 H>M HIJ9>:H 6HH:HH:9 
 ;:B6A: DA9:G E6GI>8>E6CIH M6<:  N:6GH '6CN 9>;;:G:CI
I:MIJG:H L:G: JH:9 >C I=: A>I:G6IJG: 6 HJBB6GN D; L=>8= 86C 7: ;DJC9
>C .67A: 
3.3. Meta-analysis
3.3.1. Centre of pressure (COP) displacement
><  H=DLH I=: >BB:9>6I: :;;:8I D; I:MIJG:9 B6I:G>6A 9JG>C< :N:H
DE:C ) 6C9 ><  ;DG :N:H 8ADH:9  G:<6G9>C< I=: )* 9>HEA68:
B:CI BB DJI8DB: .=:G: L6H :K>9:C8: D; 6C :;;:8I ;DG I:MIJG:9 B6I:
G>6AH 8DBE6G:9 L>I= I=:>G 8DGG:HEDC9>C< 8DCIGDAH EGDK>9>C< 6 G:9J8I>DC
>C )* 9>HEA68:B:CI 9JG>C<  HJ7IDI6A -'   # –
.=>H :;;:8I L6H HB6AA:G >C I=: ) 8DC9>I>DC HJ7IDI6A -'  
#  ID  #C 7DI= >CHI6C8:H’=:I:GD<:C:>IN L6H EG:H:CI L>I= τ
7:>C<  6C9  G:HE:8I>K:AN .=:  *# ;DG I:MIJG: :;;:8I >C I=:
 8DC9>I>DC L6H :HI>B6I:9 ID 7:  ID  L=>AHI I=: ) 8DC9>I>DC
L6H :HI>B6I:9 6I  ID 
3.3.2. Centre of pressure (COP) velocity
><  >AAJHIG6I:H I=: >BB:9>6I: :;;:8I D; I:MIJG:9 B6I:G>6A 9JG>C<
:N:H DE:C 6C9 ><  ;DG :N:H 8ADH:9 G:<6G9>C< I=: )* K:AD8>IN BBH
DJI8DB: .:MIJG:9 B6I:G>6AH G:9J8:9 )* K:AD8>IN 8DBE6G:9 ID I=:>G
G:HE:8I>K: 8DCIGDAH ;DG I=:  8DC9>I>DC HJ7IDI6A -'   #
 ID  1=:G:6H I=:G: 6EE:6G:9 ID 7: 6 IG>K>6A :;;:8I 9JG>C< )
8DC9>I>DCH HJ7IDI6A -'   #  ID  .=: D7H:GK:9
=:I:GD<:C:>IN L6H ADL:G >C I=: K:AD8>IN B:6HJG: I=6C I=: )* 9>HEA68:
B:CI B:6HJG: τ7:>C<  ;DG 7DI= K>HJ6A 8DC9>I>DCH .=:  *# ;DG
I:MIJG: :;;:8I >C I=:  8DC9>I>DC L6H :HI>B6I:9 ID 7:  ID 
L=>AHI I=: ) 8DC9>I>DC L6H :HI>B6I:9 6I  ID 
4. Discussion
.=: >BEGDK:B:CI D; 76A6C8: per se :K:C >C =:6AI=N >C9>K>9J6AH >H
>BEDGI6CI 7:86JH: I=>H 86C IG6CHA6I: >CID G:9J8:9 G>H@ D; ;6AA>C< DG >C
8G:6H:9 HEDGIH E:G;DGB6C8: ":6AI=N EDEJA6I>DCH 86C 6AHD 68I 6H 6 ED
I:CI>6A 76H:A>C: ;DG 8DBE6G>HDC ID EDEJA6I>DCH L=D 6G: BDG: A>@:AN ID
;6AA :< CDGB6I>K: K6AJ:H .D I=>H :C9 I=: EJGEDH: D; I=: EG:H:CI G:
K>:L 6C9 B:I66C6ANH>H L6H ID :M6B>C: I=: :;;:8I D; I:MIJG:9 B6I:G>6AH
DC )* B:6HJG:H >C =:6AI=N NDJC< 6C9 DA9:G 69JAIH 9JG>C< HI6I>8 76A
6C8:
)K:G6AA L: D7H:GK:9 6 H><C>;>86CI G:9J8I>DC >C )* 76H:9 B:6HJG:H
7DI= ;DG 9>HEA68:B:CI 6C9 K:AD8>IN )* 9>HEA68:B:CI L6H G:9J8:9 >C
7DI= K>HJ6A 8DC9>I>DCH –6AI=DJ<= I=: :;;:8I L6H 6BEA>R:9 9JG>C< 
8DBE6G:9 ID ) -'  KH  G:HE:8I>K:AN .=: H6B: IG:C9 L6H
D7H:GK:9 >C I=: K:AD8>IN K6G>67A: L>I= 6 HA><=IAN <G:6I:G :;;:8I 9JG>C<
 8DBE6G:9 ID ) -'  KH  G:HE:8I>K:AN 1=:C :M6B>C>C<
I=: *#H L: 86C H:: I=6I I=: :;;:8I D; I:MIJG:9 B6I:G>6AH 9D:H CDI G:B6>C
EDH>I>K: I=: IGJ: :;;:8I 9D:H CDI 8GDHH O:GD ;DG 6CN D; I=: )* K6G>
67A:H 6AI=DJ<= )* 9>HEA68:B:CI 9JG>C< 7DI= K>HJ6A 8DC9>I>DCH D;;:G 6
EDHH>7A: A6G<: :;;:8I H>O: >C ;6KDJG D; I:MIJG:9 B6I:G>6AH  *#  
 ID  )   ID  .=: )* K:AD8>IN K6G>67A: 6EE:6G ID
7: A:HH :;;:8I:9  *#   ID  )  ID  .=>H LDJA9
HJ<<:HI I=6I >C  D; H>B>A6G HIJ9>:H L: 8DJA9 :ME:8I ID RC9 6 8=6C<:
>C )* 9>HEA68:B:CI L>I=>C I=>H G6C<: D; B6<C>IJ9: 45 .=: -'H
6C9  #H HJ<<:HI I=6I 76A6C8: 86C 7: >BEGDK:9 >C =:6AI=N NDJC< 6C9
DA9:G 69JAIH 7N HI6C9>C< DC I:MIJG:9 B6I:G>6AH #; L: =DL:K:G 8DCH>9:G
I=: =><= =:I:GD<:C:>IN 6C9  *#H >I >H :K>9:CI I=:H: EDH>I>K: G:HJAIH
L:G: CDI J7>FJ>IDJH 88DG9>C<AN 6 BDG: CJ6C8:9 6EEGD68= B6N 7: ID
G:8DBB:C9 JH>C< I:MIJG:9 B6I:G>6AH >C =:6AI=N 69JAIH 6C9 EDI:CI>6AAN
>C EDEJA6I>DCH 6I <G:6I:G G>H@ D; ;6AAH ;DG I=: EJGEDH: D; I6G<:I>C< HE:
8>R8 8DBEDC:CIH D; 76A6C8: L=:G: I:MIJG:9 B6I:G>6AH B6N EGDK: ID 7:
6C >C:ME:CH>K: >CI:GK:CI>DC JGI=:G LDG@ >H I=:G:;DG: C:8:HH6GN ID ;JAAN
FJ6CI>;N I=: >C>I>6A :;;:8IH D; I:MIJG:9 B6I:G>6AH DC HI6I>8 76A6C8:
.=: <G:6I:G :;;:8I D; I:MIJG: L=:C K>H>DC >H D88AJ9:9 8DJA9 7: :M
EA6>C:9 7N I=: ;68I I=6I K>H>DC >H 6 B6?DG 8DCIG>7JIDG ID <:C:G6I>C< 6C
>CI:GC6A BD9:A D; I=: 7D9N >C HE68: 45 1=:C K>H>DC >H D88AJ9:9 EDH


UNCORRECTED PROOF
R.P.W. Kenny et al. Gait & Posture xxx (xxxx) xxx-xxx
Table 2
:H8G>EI>DC D; :68= HIJ9>:H EDEJA6I>DC 6C9 I:MIJG: INE: JI>A>H:9
JI=DGH
96I:
-IJ9>:9
EDEJA6I>DC
 :B6A:B:6C
6<: -IJ9NB:I=D9 .:MIJG:9B6I:G>6A #C9:CI6I>DCH DCIGDA8DC9>I>DC
CC>CD:I
6A

=:6AI=N
NDJC<69JAIH
NGH
1>I=>CHJ7?:8IH
G6C9DB>H:9DG9:G
>GBI:MIJG:99>H8 -:B>8>G8JA6GH=DIE:AA:IH BB=><=9>6B:I:GD;
 BB8:CIG:ID8:CIG:9>HI6C8:D; BB
DG8:EA6I;DGBCDI:MIJG:9
9>H8
DG7>C:I
6A

=:6AI=N
NDJC<69JAIH
NGH
1>I=>CHJ7?:8IH
8DJCI:G76A6C8:9DG9:G
*A6HI>8SDDGB6II>C<
8JI>CID>CHDA:H
-B6AAGDJC9:9EA6HI>8CD9JA:H BB=><= )LC6I=A:I>8H=D:HCD
>CHDA:H
"6IIDC:I
6A

=:6AI=N
NDJC<69JAIH
NGH
1>I=>CHJ7?:8IH
G6C9DB>H:9DG9:G
.:MIJG:K6A>I:
ENG6B>9H=DG:K6AJ:

.:MIJG:
CDG6P&JB6HD;IB>C>
CDCHA>EH=DG:K6AJ:

.:MIJG:-B6AAENG6B>96AE:6@H BB=><=8:CIG:ID
8:CIG:9>HI6C8:D; BB.DI6AI=>8@C:HH BB
.:MIJG:8DCK:M8>G8JA6GE6II:GC BB=><=9>6B:I:G
D; BB8:CIG:ID8:CIG:9>HI6C8:D; BB.DI6A
I=>8@C:HHD; BB
-BDDI=HJG;68:':9>JB
9:CH>IN0 BB
I=>8@C:HHH=DG:K6AJ:
"6IIDC:I
6A

=:6AI=N
DA9:G69JAIH
NGH
1>I=>CHJ7?:8IH
G6C9DB>H:9DG9:G
.:MIJG:K6A>I:
ENG6B>9H=DG:K6AJ:

.:MIJG:
CDG6P&JB6HD;IB>C>
CDCHA>EH=DG:K6AJ:

.:MIJG:-B6AAENG6B>96AE:6@H BB=><=8:CIG:ID
8:CIG:9>HI6C8:D; BB.DI6AI=>8@C:HH BB
.:MIJG:8DCK:M8>G8JA6GE6II:GC BB=><=9>6B:I:G
D; BB8:CIG:ID8:CIG:9>HI6C8:D; BB.DI6A
I=>8@C:HHD; BB
-BDDI=HJG;68:':9>JB
9:CH>IN0 BB
I=>8@C:HHH=DG:K6AJ:
*6A6OOD:I
6A

=:6AI=N
DA9:G69JAIH
NGH
1>I=>CHJ7?:8IH
G6C9DB>H:9DG9:G
>GBI:MIJG:99>H8 -:B>8>G8JA6GH=DIE:AA:IH BB=><=9>6B:I:GD;
 BB8:CIG:ID8:CIG:9>HI6C8:D; BB
DG8:EA6I;DGBCDI:MIJG:9
9>H8
*6AAJ:A:I
6A

=:6AI=N
NDJC<69JAIH
NGH
=:6AI=N
DA9:G69JAIH
NGH
1>I=>CHJ7?:8IH
8DJCI:G76A6C8:9DG9:G
-:B>G><>9*0 -E>@:H BB=><=9>6B:I:GD; BBHE>@:HE:G8BU
><<:GHE>@:HJC9:GB:9>6A6G8= BB=><=9>6B:I:G
D; BBHE>@:HE:G8BU
-BDDI=>CHDA:H BB
I=>8@C:HH
*6AAJ:A:I
6A

=:6AI=N
NDJC<69JAIH
NGH
=:6AI=N
DA9:G69JAIH
NGH
1>I=>CHJ7?:8IH
8DJCI:G76A6C8:9DG9:G
-:B>G><>9*0 -E>@:H BB=><=9>6B:I:GD; BBHE>@:HE:G8BU
><<:GHE>@:HJC9:GB:9>6A6G8= BB=><=9>6B:I:G
D; BBHE>@:HE:G8BU
-BDDI=>CHDA:H BB
I=>8@C:HH
*G:HOC:G
DB?6C
:I6A

=:6AI=N
NDJC<69JAIH
NGH
1>I=>CHJ7?:8IHCD
G6C9DB>H6I>DCDG
8DJCI:G76A6C8>C<
G:EDGI:9
.=>C:A6HI>8A6N:GD;
GJ77:G
-E>@:H BB=><=9>6B:I:GD; BBHE>@:HE:G8BU DG8:EA6I;DGBCDI:MIJG:9
A6N:G
+>J:I6A

=:6AI=N
NDJC<69JAIH
NGH
=:6AI=NDA9:G
69JAIH
NGH
1>I=>CHJ7?:8IH
G6C9DB>H:9DG9:G
*DAN:HI:G6C90 DCK:M8>G8JA6GE6II:GC>C<8:CIG:ID8:CIG:9>HI6C8:D;
 BB
DG8:EA6I;DGB76G:;DDI
+J =:6AI=N
DA9:G69JAIH
NGH
1>I=>CHJ7?:8IH
G6C9DB>H:9DG9:G
"6G9I:MIJG:
:I=NA:C:K>CNA
68:I6I:9:CH>IN
-D;II:MIJG::I=NA:C:
K>CNA68:I6I:
9:CH>IN
DI==69<G6CJA6I>DCH BB=><=9>6B:I:GD; BB
K:CAN9>HIG>7JI:968GDHHI=:HJG;68:.DI6AI=>8@C:HHD;
 BB
-BDDI=>CHDA:H
1>AHDC:I
6A

=:6AI=N
B>99A:6<:9
;:B6A:H
NGH
->C<A:7A>C9G6C9DB>H:9
8A>C>86AIG>6ADK:G;DJG
L::@H
.:MIJG:K6A>I:
ENG6B>9H=DG:K6AJ:

.:MIJG:
CDG6P&JB6HD;IB>C>
CDCHA>EH=DG:K6AJ:

.:MIJG:-B6AAENG6B>96AE:6@H BB=><=8:CIG:ID
8:CIG:9>HI6C8:D; BB.DI6AI=>8@C:HH BB
.:MIJG:8DCK:M8>G8JA6GE6II:GC BB=><=9>6B:I:G
D; BB8:CIG:ID8:CIG:9>HI6C8:D; BB.DI6A
I=>8@C:HHD; BB
-I6C96G9"DII:G>CHDA:H
H=DG:K6AJ:
IJG6A HL6N >C8G:6H:H H><C>;>86CIAN 8DBE6G:9 L>I= ) 45 .:MIJG:9 B6
I:G>6AH B6N I=:G:;DG: =6K: <G:6I:G :;;:8I 9JG>C<  L=:C I=:G: >H BDG:
GDDB ;DG >BEGDK:B:CI >: G:9J8I>DC D; EDHIJG6A HL6N  ;JGI=:G EDH
H>7>A>IN >H I=6I I=: <G:6I:G :;;:8I D; I:MIJG: 9JG>C< :N:H 8ADH:9 G:A6
I>K: ID L=:C :N:H 6G: DE:C B6N 7: 6IIG>7JI:9 ID H:CHDGN G:L:><=I
>C< .=>H >H 6 E=:CDB:CDC L=:G:7N I=: G:A6I>K: 8DCIG>7JI>DC D; :68=
H:CHDGN HNHI:B 8=6C<:H 9:E:C9>C< DC :CK>GDCB:CI6A 8DCHIG6>CIH 45
-J8= G:L:><=I>C< LDJA9 6AADL I=: >CI:GC6A BD9:A ID B6>CI6>C <G:6I:G
688JG68N L=:C K>HJ6A ;::9768@ >H CDI 6K6>A67A: )C: 8DC8AJH>DC I=6I
8DJA9 7: 9G6LC ;GDB I=>H RC9>C< >H I=6I I:MIJG:9 B6I:G>6AH B6N 7: BDHI
69K6CI6<:DJH ;DG I=DH: L>I= K>HJ6A >BE6>GB:CIH
.=: D7H:GK:9 :;;:8I >C =:6AI=N >C9>K>9J6AH ;DG I:MIJG:9 B6I:G>6AH DC
)* 9>HEA68:B:CI 9>HEA6N:9 6 HB6AA ID BD9:G6I: >BEGDK:B:CI >C 76A
6C8: 1>I= G:<6G9H ID I=: )* K:AD8>IN DJI8DB: I=:G: L6H 6 IG>K>6A >B
EGDK:B:CI >C 76A6C8: #I >H I=DJ<=I I=6I 6C >C8G:6H: >C )* B:6HJG:H
G:A6I:H ID 6C >C8G:6H:9 ;6AA G>H@ 9J: ID HADL:G G:68I>K: G:HEDCH:H 6C9
G:9J8:9 8DCIGDA D; I=: 9>G:8I>DC D; 7D9N BDK:B:CI 45 .=>H 6C6ANH>H
=><=A><=IH I=: EDI:CI>6A ;DG I:MIJG:9 B6I:G>6AH ID G:9J8: EDHIJG6A HL6N
6C9 I=:G:;DG: >BEGDK: 76A6C8: 1=>A: I=:H: RC9>C<H B><=I :MI:C9 ID


UNCORRECTED PROOF
R.P.W. Kenny et al. Gait & Posture xxx (xxxx) xxx-xxx
Fig. 2. DG:HI EADI D; :;;:8I H>O:H HI6C96G9>H:9 B:6C 9>;;:G:C8:H L>I=  8DCR9:C8: A>B>IH 6C9 B:I66C6ANH>H L:><=I>C<H ;DG HIJ9>:H :K6AJ6I>C< I=: :;;:8IH D; I:MIJG:9 B6I:G>6AH DC )*
9>HEA68:B:CI 9JG>C< :N:H DE:C 8DC9>I>DCH .=: EDDA:9 :;;:8I H>O: >H <>K:C >C I=: RC6A GDL D; I=: ;DG:HI EADI .=: <G::C A>C: G:EG:H:CIH I=: L>9I= D; I=:  EG:9>8I>DC >CI:GK6A ;DG I=:
EDDA:9 :;;:8I H>O:  ID   DG >CI:GEG:I6I>DC D; I=: G:;:G:C8:H ID 8DADJG >C I=>H R<JG: A:<:C9 I=: G:69:G >H G:;:GG:9 ID I=: L:7 K:GH>DC D; I=>H 6GI>8A:
Fig. 3. DG:HI EADI D; :;;:8I H>O:H HI6C96G9>H:9 B:6C 9>;;:G:C8:H L>I=  8DCR9:C8: A>B>IH 6C9 B:I66C6ANH>H L:><=I>C<H ;DG HIJ9>:H :K6AJ6I>C< I=: :;;:8IH D; I:MIJG:9 B6I:G>6AH DC )*
9>HEA68:B:CI 9JG>C< :N:H 8ADH:9 8DC9>I>DCH .=: EDDA:9 :;;:8I H>O: >H <>K:C >C I=: RC6A GDL D; I=: ;DG:HI EADI .=: <G::C A>C: G:EG:H:CIH I=: L>9I= D; I=:  EG:9>8I>DC >CI:GK6A ;DG I=:
EDDA:9 :;;:8I H>O:  ID   DG >CI:GEG:I6I>DC D; I=: G:;:G:C8:H ID 8DADJG >C I=>H R<JG: A:<:C9 I=: G:69:G >H G:;:GG:9 ID I=: L:7 K:GH>DC D; I=>H 6GI>8A:
Fig. 4. DG:HI EADI D; :;;:8I H>O:H HI6C96G9>H:9 B:6C 9>;;:G:C8:H L>I=  8DCR9:C8: A>B>IH 6C9 B:I66C6ANH>H L:><=I>C<H ;DG HIJ9>:H :K6AJ6I>C< I=: :;;:8IH D; I:MIJG:9 B6I:G>6AH DC )*
K:AD8>IN 9JG>C< :N:H DE:C 8DC9>I>DCH .=: EDDA:9 :;;:8I H>O: >H <>K:C >C I=: RC6A GDL D; I=: ;DG:HI EADI .=: <G::C A>C: G:EG:H:CIH I=: L>9I= D; I=:  EG:9>8I>DC >CI:GK6A ;DG I=: EDDA:9
:;;:8I H>O:  ID   DG >CI:GEG:I6I>DC D; I=: G:;:G:C8:H ID 8DADJG >C I=>H R<JG: A:<:C9 I=: G:69:G >H G:;:GG:9 ID I=: L:7 K:GH>DC D; I=>H 6GI>8A:
Fig. 5. DG:HI EADI D; :;;:8I H>O:H HI6C96G9>H:9 B:6C 9>;;:G:C8:H L>I=  8DCR9:C8: A>B>IH 6C9 B:I66C6ANH>H L:><=I>C<H ;DG HIJ9>:H :K6AJ6I>C< I=: :;;:8IH D; I:MIJG:9 B6I:G>6AH DC )*
K:AD8>IN 9JG>C< :N:H 8ADH:9 8DC9>I>DCH .=: EDDA:9 :;;:8I H>O: >H <>K:C >C I=: RC6A GDL D; I=: ;DG:HI EADI .=: <G::C A>C: G:EG:H:CIH I=: L>9I= D; I=:  EG:9>8I>DC >CI:GK6A ;DG I=: EDDA:9
:;;:8I H>O:  ID   DG >CI:GEG:I6I>DC D; I=: G:;:G:C8:H ID 8DADJG >C I=>H R<JG: A:<:C9 I=: G:69:G >H G:;:GG:9 ID I=: L:7 K:GH>DC D; I=>H 6GI>8A:


UNCORRECTED PROOF
R.P.W. Kenny et al. Gait & Posture xxx (xxxx) xxx-xxx
DI=:G EDEJA6I>DCH ;JGI=:G LDG@ >H C::9:9 ID 6H8:GI6>C I=: :;;:8IH D;
I=: BDG: :8DAD<>86A K6A>9 I:MIJG:9 >CHDA:H >C 9>;;:G:CI <GDJEH .=>H >H
B69: 6EE6G:CI 7N I=: A68@ D; 6K6>A67A: HIJ9>:H >C E:DEA: L>I= BJAI>EA:
H8A:GDH>H 6C9 *6G@>CHDC’H 9>H:6H: L=>8= L:G: 6C6ANH:9 7N 6 EG:K>DJH
B:I66C6ANH>H RC9>C< CD :;;:8I D; I:MIJG: 45 .=:>G G:K>:L 8DBEGD
B>H:9 D; H>M HIJ9>:H D; L=>8= DCAN ILD HIJ9>:H 45 6HH:HH:9 I:MIJG:9
B6I:G>6AH :;;:8IH DC FJ>:I HI6C9>C< DJI8DB:H )K:G6AA  E6GI>8>E6CIH
L:G: >C8AJ9:9 >C I=: A;JI= G:K>:L :FJ6I>C< ID 6EEGDM>B6I:AN 6 FJ6GI:G
A:HH E:DEA: I=6C >C I=: 8JGG:CI G:K>:L .=: ILD HIJ9>:H L=>8= 9>9 6HH:HH
I:MIJG: H>B>A6G ID I=6I G:EDGI:9 =:G: DCAN 6HH:HH:9 6 HB6AA CJB7:G D;
E6GI>8>E6CIH n  I=JH H=DL>C< I=: C::9 ;DG ;JGI=:G HIJ9N >C I=:H:
HJ7EDEJA6I>DCH ID >CK:HI><6I: I:MIJG: :;;:8IH
.D 6HH:HH )* BDK:B:CIH >I >H 8DBBDC EG68I>8: ID ‘7G:6@9DLC’
I=: DK:G6AA )* >CID BJAI>EA: DJI8DB:H HJ8= 6H 6CI:G>DGEDHI:G>DG 6C9
B:9>6AA6I:G6A G6C<: HI6C96G9 9:K>6I>DC K:AD8>IN 6C9 DK:G6AA HL6N E6I=
6G: HDB: 8DBBDCAN G:EDGI:9 DJI8DB:H !>K:C I=: B>M D; G:EDGI:9 DJI
8DB: K6G>67A:H 68GDHH EG:K>DJH HIJ9>:H L: 69DEI:9 I=: DK:G6AA ‘)*
9>HEA68:B:CI’6C9 ‘)* K:AD8>IN’6H DJI8DB:H 6H 6C >C9>K>9J6A 6C6AN
H>H ;DG :68= B:6HJG: LDJA9 CDI 7: EDHH>7A: 9J: ID 9>;;:G:C8:H >C I=:
HIJ9>:H 8=DH:C K6G>67A:H 1>I=>C I=: :M>HI>C< A>I:G6IJG: >I >H CDI JC8DB
BDC ID RC9 6 H><C>;>86CI 6AI:G6I>DC ID 76A6C8: >C DCAN DC: DJI8DB:
DG :M6BEA: "6IIDC 6C9 8DAA:6<J:H 45 G:EDGI:9 I=6I DCAN I=: B:
9>6AA6I:G6A HI6C96G9 9:K>6I>DC 6C9 G6C<: 9JG>C< :N: 8ADHJG: L:G: H><
C>;>86CIAN G:9J8:9 >C 6 =:6AI=N DA9:G EDEJA6I>DC 1=>AHI I=>H >H 6C >B
EDGI6CI RC9>C< <>K:C I=: G:A6I>DCH=>E 7:IL::C >C8G:6H:9 B:9>6AA6I:G6A
HL6N 6C9 >C8G:6H:9 ;6AA G>H@ 45 DJG B:I66C6ANH>H ;JGI=:GH I=:H: RC9
>C<H 7N EGDK>9>C< :K>9:C8: I=6I DK:G6AA )* 9>HEA68:B:CI B6N 7: G:
9J8:9 >C =:6AI=N 69JAIH G:<6G9A:HH D; I=: K>H>DC 8DC9>I>DC !>K:C I=:
=:6AI=N 69JAI H6BEA:H >C8AJ9:9 >C I=>H G:K>:L I=>H >BEGDK:B:CI B6N
IG6CHA6I: >CID G:9J8I>DCH >C >C?JGN G>H@ 9JG>C< HEDGI DG 68I 6H 6 EG:K:CI>K:
;DG ;6AAH <6>C I=>H LDJA9 6EE:6G 6 ;GJ>I;JA 6K:CJ: ;DG ;JIJG: G:H:6G8=
AA B:I66C6ANH:9 HIJ9>:H 6HH:HH:9 I=: H=DGI I:GB >C>I>6A :;;:8IH D;
I:MIJG:9 B6I:G>6AH DC 76A6C8: DJI8DB:H .=: DCAN HIJ9N ID :M6B>C: I:M
IJG:9 >CHDA:H ADC<>IJ9>C6AAN L6H I=6I D; 1>AHDC 6C9 8DAA:6<J:H 45
L=>8= ;DJC9 CD :;;:8I D; I:MIJG: DC 6CN DJI8DB: K6G>67A: >C B>99A:
6<:9 LDB:C 6I 76H:A>C: 6C9 6;I:G L::@H D; L:6G 1=>AHI L: H=DL =:G:
I=:G: >H 6C >C>I>6A 696EI6I>DC ID 76A6C8: >C =:6AI=N 69JAIH ;JGI=:G G:
H:6G8= >H CDL 86AA:9 ;DG ID 8DCRGB I=: C6IJG: D; I=: ADC<>IJ9>C6A :;;:8IH
D; I:MIJG:9 >CHDA:H -J8= G:H:6G8= L>AA 6AADL FJ6CI>R86I>DC D; 6CN EDHH>
7A: =67>IJ6I>DC E=6H: I=6I B6N D88JG
C >BEDGI6CI 8DCH>9:G6I>DC D; I=: 8JGG:CI B:I66C6ANH>H >H I=6I L:
DCAN JI>A>H:9 I:C HIJ9>:H L>I= 6 B>C>BJB D; RK: HIJ9>:H >C 6 H>C<A:
6C6ANH>H )* K:AD8>IN ) .=>H >H 6 EDI:CI>6A A>B>I6I>DC 6H B:I66C6AN
H:H 6G: CDI >BBJC: ID HI6I>HI>86A EDL:G >HHJ:H 6C9 7N EDDA>C< 96I6 ;GDB
6 HB6AA 6BDJCI D; HIJ9>:H 86C HI>AA >C8JG G:A6I>K:AN ADL HI6I>HI>86A 688J
G68N L>9: 8DCR9:C8: >CI:GK6A ;DG EDDA:9 :;;:8I 45 JGI=:G LDG@ >H
I=:G:;DG: C::9:9 ID 8A6G>;N >; I:MIJG:9 >CHDA:H 6G: 6 I=:DG:I>86AAN 8=:6E
6C9 K>67A: B:I=D9 D; 6II6>C>C< I=:H: 9:H>G:9 :;;:8IH
4.1. Conclusion
.:MIJG:9 B6I:G>6AH 86C >BEGDK: FJ>:I HI6C9>C< 76A6C8: >C =:6AI=N
NDJC< 6C9 DA9:G 69JAIH L=>8= B6N :FJ6I: ID >BEGDK:9 HEDGIH E:G;DG
B6C8: 6C9 G:9J8:9 G>H@ D; ;6AAH .=: -' 6C9  # HJ<<:HI I=6I
)* 9>HEA68:B:CI 86C 7: G:9J8:9 JH>C< I:MIJG:9 B6I:G>6AH >C =:6AI=N
NDJC< 6C9 DA9:G 69JAIH G:<6G9A:HH D; L=:I=:G K>H>DC >H 6K6>A67A: JG
I=:GBDG: )* K:AD8>IN B:6HJG:H 6EE:6G A:HH 6;;:8I:9 7N I:MIJG:9 B6
I:G>6AH L>I= I=: :;;:8I DCAN 7:>C< H><C>;>86CI >C I=:  8DC9>I>DCH -'
6C9  # .=:  *# G:HJAIH =DL:K:G HJ<<:HI I=6I I:MIJG:9 B6
I:G>6AH B6N CDI 6AL6NH EGDK>9: 8DCH>HI:CIAN 7:C:R8>6A :;;:8IH >C 6CN
)* DJI8DB: )K:G6AA I=: G:HJAIH 6G: >C ;6KDJG D; <6>C>C< BD9:HI 7:C
:R8>6A >BEGDK:B:CIH >C 76A6C8: ;GDB HI6C9>C< DC I:MIJG:9 B6I:G>6AH
>C =:6AI=N EDEJA6I>DCH 7JI ;JGI=:G LDG@ >H C::9:9 -E:8>;>86AAN ;JIJG:
HIJ9>:H H=DJA9 ADD@ ID 6H8:GI6>C I=: ADC<>IJ9>C6A :;;:8IH D; I:MIJG:9 >C
HDA:H >C =:6AI=N 69JAI EDEJA6I>DCH 6C9 >C DI=:G HJ7EDEJA6I>DCH HJ8=
6H I=DH: L>I= K>HJ6A >BE6>GB:CI DG C:JGD9:<:C:G6I>K: 9>H:6H:H .=>H >H
7:86JH: >I >H CDI N:I 8A:6G =DL I=: HE:8>R8 69K6CI6<:H D;;:G:9 7N I:M
IJG:9 >CHDA:H 86C >BEGDK: 76A6C8: >C EDEJA6I>DCH L>I= 9>;;:G:CI 76A6C8:
>BE6>GB:CIH
Con"icts of interest
.=: 6JI=DGH =6K: CD 8DCS>8I>C< >CI:G:HIH
Funding
.=>H G:H:6G8= G:8:>K:9 CD HE:8>R8 <G6CI ;GDB 6CN ;JC9>C< 6<:C8N >C
I=: EJ7A>8 8DBB:G8>6A DG CDCEGDRI H:8IDGH
References
45  1>CI:G "JB6C 76A6C8: 6C9 EDHIJG: 8DCIGDA 9JG>C< HI6C9>C< 6C9 L6A@>C<
!6>I *DHIJG:   –
45 , -6BJ:A $ -DADBDC  'D=6C  8G>I>86A G:K>:L DC I=: CDGB6A EDHIJG6A 8DC
IGDA *DI $   –
45 - !DAG>O $$ ":7:GI % DG:B6C   16A@:G .=: G:A>67>A>IN D; 6 EDGI67A: 8A>C>
86A ;DG8: EA6I: JH:9 ;DG I=: 6HH:HHB:CI D; HI6I>8 EDHIJG6A 8DCIGDA G:E:6I:9 B:6HJG:H
G:A>67>A>IN HIJ9N =G>DEG '6C .=:G  
45 ,$ *:I:G@6 -:CHDG>BDIDG >CI:<G6I>DC >C =JB6C EDHIJG6A 8DCIGDA $ (:JGDE=NH>DA
  –
45 ' '6C8>C>  "DG6@ .=: G:A:K6C8: D; 8A>C>86A 76A6C8: 6HH:HHB:CI IDDAH ID 9>;
;:G:CI>6I: 76A6C8: 9:R8>IH JG $ *=NH ,:=67>A ':9   –
45 %* %DG9>C< ' 1DAE:GI 6N:H>6C 9:8>H>DC I=:DGN >C H:CHDG>BDIDG 8DCIGDA
.G:C9H D<C -8>   –
45  %6KDJCDJ9>6H , ,DAA $* ,DAA DDI HDA: 6C9 6C@A: BJH8A: >CEJIH 8DCIG>7JI:
?D>CIAN ID =JB6C :G:8I EDHIJG: G:<JA6I>DC $ *=NH>DA   –
45 , ,DAA  %6KDJCDJ9>6H $* ,DAA JI6C:DJH 6;;:G:CIH ;GDB =JB6C EA6CI6G HDA:
8DCIG>7JI: ID 7D9N EDHIJG: 6L6G:C:HH (:JGDG:EDGI   –
45 *' %:CC:9N $. #C<A>H >HIG>7JI>DC 6C9 7:=6K>DJG D; <A67GDJH 8JI6C:DJH G:8:E
IDGH >C I=: =JB6C ;DDI HDA: $ *=NH>DA   –
45 *  ':N:G &# )99HHDC $ : &J86 .=: GDA: D; EA6CI6G 8JI6C:DJH H:CH6I>DC >C
JCE:GIJG7:9 HI6C8: ME G6>C ,:H   –
45  '6JG:G . ':G<C:G  DA=6  "A6K68@6 "JB6C 76A6C8: 8DCIGDA 9JG>C< 8JI6
C:DJH HI>BJA6I>DC D; I=: EA6CI6G HDA:H (:JGDH8> &:II   –
45 ' DG7>C $' "6GI , *6AB>:G>-B>I=  #C<:GHDAA $ ":GI:A .=: :;;:8I D;
I:MIJG:9 >CHDA:H DC EDHIJG6A 8DCIGDA >C 9DJ7A: 6C9 H>C<A: A>B7 HI6C8: $ -EDGI ,:
=67   –
45 & "6IIDC $ >MDC % ,DB:  '6GI>C -I6C9>C< DC I:MIJG:9 HJG;68:H :T:8IH DC
HI6C9>C< 76A6C8: >C =:6AI=N DA9:G 69JAIH <: <:>C<   –
45  +>J '" DA: %1 6K>9H ' ":CC>< * ->A7JGC " (:IH8=:G :I 6A C
=6C8:9 HDB6IDH:CHDGN >C;DGB6I>DC 9:8G:6H:H EDHIJG6A HL6N >C DA9:G E:DEA: !6>I
*DHIJG:   –
45 & "6IIDC $ >MDC  '6GI>C % ,DB: .=: :;;:8I D; I:MIJG:9 HJG;68:H DC EDH
IJG6A HI67>A>IN 6C9 ADL:G A>B7 BJH8A: 68I>K>IN $ A:8IGDBND<G %>C:H>DA  
–
45  *G:HOC:GDB?6C  (6<N  -O>K:G  :=:G%>HH ! "DGK6I= $ %G6C>8O
1=:C 9D:H B:8=6C>86A EA6CI6G HI>BJA6I>DC EGDBDI: H:CHDGN G:L:><=>C< HI6C9>C<
DC 6 RGB DG 8DBEA>6CI HJG;68: JG $ EEA *=NH>DA   –
45 ! CC>CD  *6A6OOD * &:7DC:  6GDCI> ' &DB76G9D :I 6A .=: :;R868N D;
EA6CI6G H>BJA6I>DC DC =JB6C 76A6C8: 8DCIGDA -DB6IDH:CH 'DI ,:H  
–
45  *6A6OOD  6GDCI> * &:7DC:  *GD>:II> ' *6CO6G>CD ! CC>CD ;;:8IH D;
HI>BJA6I>C< HJG;68: 9JG>C< HI6I>8 JEG><=I EDHIJG: >C I=: :A9:GAN -DB6IDH:CH 'DI
,:H   –
45 *6AAJ:A 0 (DJ<>:G # )A>K>:G D HE>@: >CHDA:H :C=6C8: EDHIJG6A HI67>A>IN 6C9 EA6C
I6GHJG;68: 8JI6C:DJH H:CH>I>K>IN >C I=: :A9:GAN <:   –
45  *6AAJ:A # )A>K>:G 0 (DJ<>:G .=: A6HI>C< :;;:8IH D; HE>@: >CHDA:H DC EDHIJG6A
8DCIGDA >C I=: :A9:GAN :=6K (:JGDH8>   –
45 '& 1>AHDC % ,DB:  "D9<HDC * 6AA ;;:8I D; I:MIJG:9 ;DDI DGI=DI>8H DC HI6
I>8 6C9 9NC6B>8 EDHIJG6A HI67>A>IN >C B>99A:6<:9 ;:B6A:H !6>I *DHIJG:  
–
45 2 +J #BE68IH D; 9>;;:G:CI INE:H D; >CHDA:H DC EDHIJG6A HI67>A>IN >C DA9:G 69JAIH
EEA G<DC   –
45 & D=C $ :8@:G "DL B:I66C6ANH>H >C8G:6H:H HI6I>HI>86A EDL:G *HN8=DA
':I=D9H  –
45 1! "DE@>CH -1 '6GH=6AA ' 6II:G=6B $ "6C>C *GD<G:HH>K: HI6I>HI>8H ;DG
HIJ9>:H >C HEDGIH B:9>8>C: 6C9 :M:G8>H: H8>:C8: ':9 -8> -EDGIH M:G8  
–
45  )GI= % 6K>9H $ 1=:6I & -:>;:GI $ &>J@@DC:C . $66@@DA6 :I 6A .=: GDA:
D; I:MIJG:9 B6I:G>6A >C HJEEDGI>C< E:G8:EIJ6ABDIDG ;JC8I>DCH *&D- )C:  
=IIEH9D>DG<?DJGC6AEDC:
45 ' A;JI= .:MIJG:9 6C9 HI>BJA6I>C< >CHDA:H ;DG 76A6C8: 6C9 <6>I >BE6>GB:CIH >C
E6I>:CIH L>I= BJAI>EA: H8A:GDH>H 6C9 *6G@>CHDC’H 9>H:6H: 6 HNHI:B6I>8 G:K>:L 6C9
B:I66C6ANH>H !6>I *DHIJG:   –


UNCORRECTED PROOF
R.P.W. Kenny et al. Gait & Posture xxx (xxxx) xxx-xxx
45 $ >MDC & "6IIDC $ ,D7>CHDC " !6B:H7N#N6N>  "D9<HDC % ,DB: :I 6A
;;:8I D; I:MIJG:9 >CHDA:H DC 76A6C8: 6C9 <6>I >C E:DEA: L>I= BJAI>EA: H8A:GDH>H 6C
:MEADG6IDGN IG>6A *=NH>DI=:G6EN   –
45  %6AGDC  *6H>IH:AH@N ' !G::C7:G<7G6=B>  8=>GDC D I:MIJG:9 >CHDA:H
6;;:8I EDHIJG6A 8DCIGDA 6C9 HE6I>DI:BEDG6A E6G6B:I:GH D; <6>I 6C9 EA6CI6G H:CH6I>DC
>C E:DEA: L>I= BJAI>EA: H8A:GDH>H *' ,   – '
45 -$ -:CC )K:GHI6I>C< I=: :K>9:C8: –9DJ7A: 8DJCI>C< >C B:I66C6ANH>H 6C9 G:A6I:9
EGD7A:BH ' ':9 ,:H ':I=D9DA   =IIEH9D>DG<

45 ! I@>CHDC $ DJ<A6H $ -I:CH:A .=: B:I66C6ANH>H D; 8GDHHDK:G HIJ9>:H DC
:M:G8>H: 6C9 6EE:I>I:G:A6I:9 =DGBDC:H -EDGIH ':9   =IIEH9D>DG<
H
45  &>7:G6I> ! AIB6C $ .:IOA6T  'JAGDL * !DIOH8=: :I 6A .=: *,#-'
HI6I:B:CI ;DG G:EDGI>C< HNHI:B6I>8 G:K>:LH 6C9 B:I66C6ANH:H D; HIJ9>:H I=6I :K6AJ
6I: =:6AI= 86G: >CI:GK:CI>DCH :MEA6C6I>DC 6C9 :A67DG6I>DC *&D- ':9  
=IIEH9D>DG<?DJGC6AEB:9
45 , -JJGBDC9 " K6C ,=:: . "6@ #CIGD9J8I>DC 8DBE6G>HDC 6C9 K6A>96I>DC D;
':I6HH:CI>6AH 6 ;G:: 6C9 H>BEA: IDDA ;DG B:I66C6ANH>H -D;IL ,:K  
=IIEH9D>DG<?GHB
45 $ :G<JHDC C :;;:8I H>O: EG>B:G 6 <J>9: ;DG 8A>C>8>6CH 6C9 G:H:6G8=:GH *GD;:HH
*HN8=DA ,:H *G68I  
45 $*. "><<>CH $$ ::@H =6EI:G  I=: 8D8=G6C: 8DAA67DG6I>DC >C $*. "><<>CH
$$ ::@H 9H -:A:8I>C< -IJ9>:H 6C9 DAA:8I>C< 6I6 >C D8=G6C: "6C97DD@ ;DG
-NHI:B6I>8 ,:K>:LH D; #CI:GK:CI>DCH 0:GH>DC  
45 % ->9>@ $( $DC@B6C  H>BEA: 8DCR9:C8: >CI:GK6A ;DG B:I66C6ANH>H -I6I ':9
 
45 % ->9>@ $( $DC@B6C )C 8DCHIGJ8I>C< 8DCR9:C8: >CI:GK6AH ;DG 6 HI6C96G9>O:9
B:6C 9>;;:G:C8: >C B:I66C6ANH>H DBBJC -I6I ->BJA DBEJI  
45 $*. "><<>CH DBB:CI6GN =:I:GD<:C:>IN >C B:I66C6ANH>H H=DJA9 7: :ME:8I:9
6C9 6EEGDEG>6I:AN FJ6CI>R:9 #CI $ E>9:B>DA   –
45 $ #CI"DJI $* #D6CC>9>H '' ,DK:GH $$ !D:B6C *A:6 ;DG GDJI>C:AN EG:H:CI
>C< EG:9>8I>DC >CI:GK6AH >C B:I66C6ANH>H '$ )E:C   :
45 & 6N '$ -I:><:G * .=DBEHDC  '6GH9:C ;;:8I D; K>H>DC 6C9 HI6C8:
L>9I= DC =JB6C 7D9N BDI>DC L=:C HI6C9>C< >BEA>86I>DCH ;DG 6;;:G:CI 8DCIGDA D;
A6I:G6A HL6N $ *=NH>DA   –
45 & HHA6C9:G ,$ *:I:G@6 -:CHDGN G:L:><=I>C< 9NC6B>8H >C =JB6C EDHIJG6A 8DC
IGDA $ (:JGDE=NH>DA   –
45 '! .J8@:G $$ %6K6C6<= - 'DGG>HDC ,- 6GG:II 0DAJCI6GN HL6N 6C9 G6E>9
DGI=D<DC6A IG6CH>I>DCH D; KDAJCI6GN HL6N >C NDJC< 69JAIH 6C9 ADL 6C9 =><=
;6AAG>H@ DA9:G 69JAIH A>C >DB:8=  –
45 $ DJ<A6H % :><=IDC $' I@>CHDC 0 -6G>-6GG6; $ -I:CH:A ! I@>CHDC
8JI: :M:G8>H: 6C9 6EE:I>I:G:<JA6I>C< =DGBDC:H >C DK:GL:><=I 6C9 D7:H: >C9>K>9
J6AH 6 B:I66C6ANH>H $ )7:H  =IIEH9D>DG<
