Predicting Home and Community Walking Activity Poststroke

Abstract

Background and Purpose-Walking ability poststroke is commonly assessed using gait speed categories developed by Perry et al. The purpose of this study was to reexamine factors that predict home and community ambulators determined from real-world walking activity data using activity monitors. Methods-Secondary analyses of real-world walking activity from 2 stroke trials. Home (100-2499 steps/d), most limited community (2500-4499 steps/d), least limited community (5000-74 999), and full community (≥7500 steps/d) walking categories were developed based on normative data. Independent variables to predict walking categories were comfortable and fast gait speed, 6-minute walk test, Berg Balance Scale, Fugl Meyer, and Stroke Impact Scale. Data were analyzed using multivariate analyses to identify significant variables associated with walking categories, bootstrap method to select the most stable model and receiver-operating characteristic to identify cutoff values. Results-Data from 441 individuals poststroke were analyzed. The 6-minute walk test, Fugl Meyer, and Berg Balance Scale combined were the strongest predictors of home versus community and limited versus unlimited community ambulators. The 6-minute walk test was the strongest individual variable in predicting home versus community (receiver-operating characteristic area under curve=0.82) and limited versus full community ambulators (receiver-operating characteristic area under curve=0.76). A comfortable gait speed of 0.49 m/s discriminated between home and community and a comfortable gait speed of 0.93 m/s discriminated between limited community and full community ambulators. Conclusions-The 6-minute walk test was better able to discriminate among home, limited community, and full community ambulators than comfortable gait speed. Gait speed values commonly used to distinguish between home and community walkers may overestimate walking activity.

Bilateral Transcutaneous Electrical Nerve Stimulation Improves Lower‐Limb Motor Function in Subjects With Chronic Stroke: A Randomized Controlled Trial

“…Their mean age was 62.0 years, and the mean time since the stroke was 5.2 years. Their mean walking speed was 0.77 ms −1 , which indicated limited ambulatory ability46 (Table 1). No significant differences existed between the 2 groups at baseline (Table 1).…”

Retraining Automaticity: Recovering the Procedural Memory of Walking after Stroke

“…However, ultimately walking disability, the actual amount of home and community based walking activity, is likely more important to people with stroke. Although there are many factors that likely influence walking activity post stroke such as gait speed, functional balance, self-efficacy, and motor function; walking endurance as measured by the 6MWT appears to be the strongest predictor [83,84]. This begs the question, "Is it possible that through increased dual task training, and subsequent "forced" creation of a procedure of walking (motor plan considering the new post-stroke capabilities of the system), that a stroke survivor would have lower gait variability and therefore higher performance throughout the length of this standardized test?…”

Publication language and the estimate of treatment effects of physical therapy on balance and postural control after stroke in meta-analyses of randomised controlled trials

“…After stroke, patients suffer frequently postural and balance disorders [1][2][3][4][5] leading to an increased risk of falls [6] as well as a reduced level of activity and participation [7,8]. Balance disorders have a negative impact on gait abilities [9][10][11][12] and quality of life [13]. Addressing the issue of rehabilitation of stroke patients is therefore relevant.…”