Fast gait speed and self-perceived balance as valid predictors and discriminators of independent community walking at 6 months post-stroke – a preliminary study. (January 2015)

• Record Type: Journal Article
• Authors: Rosa, Marlene Cristina; Marques, Alda; Demain, Sara; Metcalf, Cheryl D.
• Is Part Of: Disability and rehabilitation. Volume 37:Number 2(2015:Jan.)
• Page Start: 129
• Page End: 134
• Publication Date: 2015-01
• Subjects: People with disabilities -- Periodicals; Rehabilitation -- Periodicals; 617.03
• DOI: 10.3109/09638288.2014.911969
• Languages: English
• ISSNs: 0963-8288

Abstract

<abstract> <title>Abstract</title> <p> <italic>Purpose</italic>: To determine the validity of walking speed, muscle strength, function of the hemiparetic lower limb and self-perceived balance to predict and discriminate independent community walkers (ICW) within the first 6 months post-stroke. <italic>Methods</italic>: Inpatients with a first ischemic stroke (<3 months), able to walk, were evaluated (<italic>T</italic><sub>0</sub>) and re-evaluated after 6 months post-stroke (<italic>T</italic><sub>1</sub>). Comfortable, fast speed and the difference between fast and comfortable speed, muscle strength of knee flexors and extensors, sensory-motor function of the hemiparetic lower limb and self-perceived balance were assessed at <italic>T</italic><sub>0</sub> and <italic>T</italic><sub>1</sub>. At <italic>T</italic><sub>1</sub>, a self-reported question was used to discriminate ICW versus Dependent Community Walkers (DCW). ROC curve analysis was used to determine valid predictive (<italic>T</italic><sub>0</sub>) and discriminative (<italic>T</italic><sub>1</sub>) cut-offs of ICW. <italic>Results</italic>: Only 25.7% of the 35 participants were ICW at <italic>T</italic><sub>1</sub>. Valid predictive cut-offs at <italic>T</italic><sub>0</sub> were found for fast speed (≥0.42 m/s) and Falls Efficacy Scale (<57). Valid discriminators were found at T1 for fast speed (>0.84 m/s) and FES (<18.50). <italic>Conclusion</italic>: Fast speed and self-perceived balance appear to be important characteristics of ICW at 6 months and may be useful early predictors of the potential for patients to achieve this. Further research is needed to ensure the precision of these functional cut-offs.<list list-type="bullet"><title>Implications for Rehabilitation</title><list-item><p>Prognostic information is important for people with stroke and health services. The ability to walk faster than 0.42 m/s and a fear of falling on the Falls Efficacy Scale of less than 57 in the first 3 months after stroke predict who will be an independent community walker at 6 months.</p></list-item><list-item><p>At 6 months after stroke, people who cannot walk faster than 0.84 m/s or who have a have Falls Efficacy Scale score <18.5 are unlikely to be walking independently in the community.</p></list-item><list-item><p>Rehabilitation to promote independent walking should focus on walking speed, balance re-education and strategies to reduce fear of falling.</p></list-item></list></p> </abstract>