Factors related to community ambulation in patients with chronic stroke

Background: The focus of gait rehabilitation for walking in real-life settings should vary according to different aspects of gait performance. Investigation of factors related to impairments specific to community ambulation or activity participation may be helpful in determining and targeting appropriate treatment for gait rehabilitation. Objective: To investigate the relationship between community ambulation and factors determining gait ability. Methods: Forty-six outpatients with a previous stroke participated in a cross-sectional assessment. Community ambulation was assessed using a self-administered questionnaire. Outcome measures included impairments (strength, sensation, muscle tone, and balance) and ambulatory activity limitations (self-paced and maximum 10-m gait speed, 6-minute walking test, and concurrent manual/cognitive dual-task walking speed). Ability to increase speed and the dual-tasks cost were calculated. Multivariate analysis of variance and multiple regression analyses were used to determine differences in walking and identify important factors related to community ambulation. Results: Pearson and Spearman analyses revealed that impairments (balance, r=0.665; muscle strength, r=0.653) and ambulatory activity limitation (gait speed, r=0.684; walking distance, r=0.654; ability to increase speed, r=0.413) were significantly positively correlated with community ambulation level. Balance was an important factor in predicting increasing speed (P<0.001). Muscle strength and tone were positive contributors to gait speed (P=0.001 for both) and distance (P=0.019 and P=0.002, respectively). Cognitive and manual dual tasks showed no significant relationship to other variables. Stepwise multivariate regression analysis showed that important determinants of community ambulation level were strength (P<0.001) and gait endurance (P=0.001). Conclusions: Muscle strength and walking distance are contributing factors in community ambulation for patients with chronic stroke.