Does Speed-Normalized Double-Support Reflect Gait Stability in Parkinson’s Disease? A Model-Based Analysis

Background: Double-support percentage (DS%) is often interpreted as a proxy for dynamic gait stability, yet its biomechanical meaning is confounded by its strong inverse coupling with walking speed. This distinction is critical in Parkinson’s disease (PD), where bradykinetic gait inherently prolongs DS%. To isolate speed-independent stability demands, we introduced a model-based Stability Reserve Index (SRI), representing the deviation between predicted and observed double support after normalizing for velocity and anthropometrics. Methods: Using an open-access dataset of 63 individuals with PD (ON medication; Hoehn & Yahr 1–3) and 63 matched controls, step-based DS% was modeled using ANCOVA, incorporating centered walking speed, group, their interaction, and covariates. Predicted DS% at the sample’s grand mean speed was subtracted from observed DS% to derive the SRI, indexing whether double support exceeded expectations for a given biomechanical operating point. Results: PD participants walked slower than controls (p < 0.001), but once velocity was accounted for, DS% no longer differed between groups (p = 0.795–0.880), and the DS%–speed coupling remained intact (interaction p = 0.387). Speed-normalized predicted DS% (p = 0.159) and the SRI (p = 0.989) were likewise similar across groups. Within PD, SRI did not correspond to UPDRS-III or Hoehn & Yahr stage (ρ = 0.129–0.223, p > 0.05). Conclusions: These findings indicate that double-support behavior in mild-to-moderate PD is largely velocity-driven rather than reflecting altered dynamic stabilization strategies. While conceptually grounded in stability reserve theory, the SRI showed limited discriminatory value under ON-medication walking, suggesting that more sensitive multidimensional metrics—integrating CoM dynamics, variability, and step-to-step control—may be required to capture early instability in PD.