Mobility beyond the clinic: the effect of environment on gait and its measurement in community-ambulant stroke survivors.
OBJECTIVE
To explore the impact of a complex community environment on gait parameters (speed, step length and cadence) for community-dwelling participants with a previous stroke, and compare outcome measures commonly used in a clinical environment.


METHODS
Repeated measurement of participants in different environments.


METHODS
One clinic and two community environments (suburban street and shopping mall).


METHODS
Thirty community-dwelling stroke participants with chronic stroke who were classified according to gait speed (20-50 m/min on 10-metre timed walk) as marginal community walkers.


METHODS
During a six-minute walk test (6MWT) a step activity monitor (SAM) and odometer were used to calculate gait speed, step length and cadence. The 10-metre timed walk (10MTW) was measured in a clinic environment.


METHODS
A mixed linear model examined differences in gait measurements in the different environments. Bland-Altman analysis illustrated agreement between gait speed measures (6MWT and 10MTW).


RESULTS
A statistically significant, but not a clinically significant difference in gait speed between some environments was found. Gait speed was slowest in the mall and fastest in the street with a difference of only 2.1 m/min between these environments (95% confidence interval (CI) -3.8 to -0.5, P<0.01). Comparison of clinic 10MTW and street 6MWT showed wide limits of agreement (-18.5 to 16.9 m/min) which improved for clinic 6MWT and street 6MWT comparisons (-5.7 to 8.9 m/min).


CONCLUSIONS
Despite residual gait deficit, the gait parameters of these chronic stroke survivors did not deteriorate markedly under challenging conditions. The 6MWT is recommended as a clinical measure for community ambulation.
School of Physiotherapy, Centre for Physiotherapy Research, University of Otago, New Zealand. kim.donovan@otago.ac.nz
Kimberley
K
Donovan
Susan E
SE
Lord
Harry K
HK
McNaughton
Mark
M
Weatherall
D000203:Activities of Daily Living / Q000523:psychology; D000368:Aged; D002908:Chronic Disease; D004777:Environment; D005080:Exercise Test; D005260:Female; D005684:Gait; D020233:Gait Disorders, Neurologic / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D020127:Recovery of Function; D012111:Residence Characteristics; D020521:Stroke / Q000523:psychology; D000071939:Stroke Rehabilitation; D017741:Survivors; D013647:Task Performance and Analysis; D016138:Walking