To What Extent is Walking Ability Associated with Participation in People after Stroke?

Ilona J.M De Rooij,Marissa M.R Riemens,Michiel Punt,Jan-Willem G Meijer,Johanna M.A Visser-Meily,Ingrid G.L Van De Port

doi:10.1016/j.jstrokecerebrovasdis.2021.106081

Abstract

ObjectivesThis study aims to 1) identify the relation between walking ability and participation after stroke and 2) explore whether change in walking ability is associated with change in participation over time in community living-people after stroke. Materials and MethodsFifty-two people after stroke were assessed at baseline and after a 6-week gait training intervention. People were included between two weeks and six months after stroke. The Utrecht Scale for Evaluation of Rehabilitation-Participation was used to measure participation. Assessment of walking ability included the six-minute walking test for walking endurance, Timed-up & Go test for functional mobility, Mini Balance Evaluation Systems Test for dynamic balance, and total duration of walking activity per day to measure walking activity. ResultsAt baseline, six-minute walking test, Timed-up & Go test, and Mini Balance Evaluation Systems Test were univariately associated with participation (P < 0.001). Backward multiple regression analysis showed that the Mini Balance Evaluation Systems Test independently explained 55.7% of the variance in participation at baseline. Over time, only change in the six-minute walking test was positively associated with change in participation (R2 = 0.087, P = 0.040). ConclusionsCross-sectional associations showed that walking ability, and especially dynamic balance, contributes to participation after stroke. Dynamic balance, as underlying variable for walking, was an important independently related factor to participation after stroke which needs attention during rehabilitation. Longitudinally, improvement in walking endurance was significantly associated with improvement in participation, which indicates the relevance of training walking endurance to improve participation after stroke.

Highlights

Worldwide, nearly 14 million people suffer from a stroke each year.[1]
Univariate analyses revealed that walking endurance, functional mobility, and dynamic balance were significantly related to participation
Greater walking endurance, better dynamic balance and functional mobility were univariately associated with a higher level of participation

Summary

Introduction

Nearly 14 million people suffer from a stroke each year.[1]. As a result, people after stroke cope with a wide range of impairments affecting motor, sensory, and cognitive function.[2,3]Due to these impairments on function level, people after stroke are often restricted in their ability to participate optimally in the community.[4,5,6,7] In the International Classification of Functioning, Disability and Health (ICF), participation is defined as “the person’s involvement in a life situation”.8 Previous studies have shown that many community-living people after stroke experience restrictions in participation, even on the long term after stroke.[912]. Nearly 14 million people suffer from a stroke each year.[1] As a result, people after stroke cope with a wide range of impairments affecting motor, sensory, and cognitive function.[2,3]. Due to these impairments on function level, people after stroke are often restricted in their ability to participate optimally in the community.[4,5,6,7] In the International Classification of Functioning, Disability and Health (ICF), participation is defined as “the person’s involvement in a life situation”.8. Better understanding of factors that influence the improvement in participation can help to further direct the content of stroke rehabilitation

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Conclusion