Linking gait mechanics with perceived quality of life and participation after stroke.

Abstract

Individuals with hemiparesis following stroke often experience a decline in the paretic limb's anteriorly directed ground reaction force during walking (i.e., limb propulsive force). Gait speed and walking capacity have been independently associated with paretic limb propulsion, quality of life, and participation in people with stroke. However, it is unclear as to the extent that underlying limb mechanics (i.e., propulsion) play in influencing perceptions of quality of life and participation. We therefore sought to determine the role of limb propulsion during gait on the perception of quality of life and participation in people following stroke. This study is a secondary analysis of individuals involved in a gait retraining randomized control trial. Gait speed, walking capacity, limb propulsion, Stroke Impact Scale, and average daily step counts were assessed prior to and following 6 weeks of training. The pre-training data from 40 individuals were analyzed cross-sectionally using Pearson and Spearman correlations, to evaluate the potential relationship between limb propulsion (ratio of paretic limb propulsion to total propulsion) with gait speed, gait capacity, perceived quality of life domains, and average daily step counts. Partial correlations were used to control for gait speed. Thirty-one individuals were assessed longitudinally for the same relationships. We observed a training effect for gait speed, walking capacity, and some quality of life measures. However, after controlling for gait speed, we observed no significant (p≤0.05) correlations in the cross-sectional and longitudinal analyses. After controlling for the influence of gait speed, paretic limb propulsion is not directly related to perceived quality of life or participation. Although limb propulsion may not have a direct effect on participant's perceived quality of life, it appears to be an important factor to enhance gait performance, and therefore may be important to target in rehabilitation, when feasible.