Predictors of gait velocity among community-dwelling stroke survivors

Introduction: Gait velocity is an objective, fundamental indicator of post-stroke walking ability. Most stroke survivors have diminished aerobic endurance or paretic leg strength affecting their walking ability. Other reported underlying factors affecting gait velocity include functional disability, balance, cognitive impairment, or the distance they are required to walk. Objective: To examine the relationship between gait velocity and measures of physical and cognitive functioning in chronic stroke. Methods: Cross-sectional design using baseline data from community-dwelling stroke survivors enrolled in an exercise intervention study. Functional disability (modified Rankin Scale), aerobic endurance (2-min step-test), leg strength (timed 5-chair stand test), balance (single-leg stance) and cognitive impairment (Mini-Mental Status Exam) were assessed. Gait velocity was assessed using a timed 4-m walk test. Multiple linear regression was used to explore potential independent predictors of gait velocity. Results: Subjects had an average gait velocity of 0.75 +/- 0.23 m/s, categorized as limited community walkers. Approximately 37% of the variance in gait velocity, could be explained by the 5 independent variables, functional disability, aerobic endurance, leg strength, balance, and cognitive impairment (R-2 = 0.37, F-5.74 = 8.64, p < 0.01). Aerobic endurance (t(1,74) = 3.41, p < 0.01) and leg strength (t(1,74) = -2.23, p = 0.03) contributed significantly to gait velocity. Conclusion: Diminished aerobic endurance and leg strength are major contributors to slow gait velocity in chronic stroke. Long term rehabilitation efforts are needed to improve gait velocity in chronic stroke, and may need to incorporate multifaceted strategies concurrently, focusing on aerobic endurance and leg strength, to maximize community ambulation and reintegration. (C) 2011 Elsevier B.V. All rights reserved.