Longitudinal changes in life-space mobility and the factors influencing it among chronic community-dwelling post-stroke patients

Abstract

Purpose To identify longitudinal changes in life-space mobility and the factors influencing it among chronic, stable post-stroke patients. Materials and methods This prospective study included Japanese post-stroke patients who received day-care rehabilitation services and could undergo three life-space mobility assessments (at baseline, 12, and 24 months) for over 2 years, using the Life-Space Assessment (LSA) tool. Physical function, cognitive function, and activities of daily living were assessed by self-selected comfortable gait speed, Mini-Mental State Examination (MMSE), and Functional Independence Measure Motor subscale (FIM motor) scores, respectively, in addition to age, sex, time from onset, stroke type, and comorbidities. A multivariable linear mixed-effects model was used to examine the longitudinal changes in LSA scores and associated factors. Results A total of 89 participants were enrolled. At baseline, the median age was 74 years, 33% were women, and median time from onset was 75 months. The LSA scores significantly declined over the two-year period. In the multivariate linear mixed-effects model adjusted for clinical characteristics, comfortable gait speed and age were significantly associated with changes in the LSA score, independent of FIM motor scores and MMSE scores. Conclusions Life-space mobility may persistently decline, and gait function may be a determinant influencing these changes in community-dwelling chronic post-stroke patients. Implications for Rehabilitation Limited life-space mobility leads to less frequent participation in social activities and an increased risk of adverse health outcomes such as hospitalization. Changes in life-space mobility should be considered in the rehabilitation care plan for chronic post-stroke patients. Life-space mobility may decline persistently in stable post-stroke patients, even if they have periodically received day-care rehabilitation services. Since gait speed is a predominant factor affecting life-space mobility, regular assessment of gait function and appropriate strategies are needed to prevent deterioration of gait speed in chronic post-stroke patients.