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Community ambulation after stroke: how important and obtainable is it and what measures appear predictive?

2004; Elsevier BV; Volume: 85; Issue: 2 Linguagem: Inglês

10.1016/j.apmr.2003.05.002

1532-821X

S. Lord, Kathryn McPherson, Harry McNaughton, Lynn Rochester, Mark Weatherall,

Musculoskeletal pain and rehabilitation

Lord SE, McPherson K, McNaughton HK, Rochester L, Weatherall M. Community ambulation after stroke: how important and obtainable is it and what measures appear predictive? Arch Phys Med Rehabil 2004;85:234–9. Objectives To assess how important community ambulation is to stroke survivors and to assess the relation between the level of community ambulation achieved and other aspects of mobility. Design A multicenter observational survey. Setting Community setting in New Zealand. Participants One hundred fifteen stroke survivors living at home were referred from physical therapy (PT) services at 3 regional hospitals at the time of discharge and were assessed within 1 week after returning home. Another 15 people with stroke who did not require further PT when discharged were assessed within 2 weeks after they returned home to provide insight into community ambulation status for those without mobility impairment, as recognized by health professionals. Interventions Not applicable. Main outcome measures Self-reported levels of community ambulation ascertained by questionnaire, gait velocity (m/min), Functional Ambulation Categories (FAC) score, and Rivermead Mobility Index (RMI) score. Results Mean gait velocity for the participants was 53.9m/min (95% confidence interval [CI], 52.3–61.1); mean treadmill distance was 165.5m (95% CI, 141.6–189.5); median RMI score was 14; and median FAC score was 6. Mobility scores for the 15 people who did not require PT were within the normal range. Based on self-reported levels of ambulation, 19 (14.6%) participants were unable to leave the home unsupervised, 22 (16.9%) were walking as far as the letterbox, 10 (7.6%) were limited to walking within their immediate environment, and 79 (60.7%) could access shopping malls and/or places of interest. Participants with different levels of community ambulation showed a significant difference in gait velocity (P<.001). The ability to “get out and about” in the community was considered to be either essential or very important by 97 subjects (74.6%). Conclusions Community ambulation is a meaningful outcome after stroke. However, despite good mobility outcomes on standardized measures for this cohort of home-dwelling stroke survivors, nearly one third were not getting out unsupervised in the community. Furthermore, gait velocity may be a measure that discriminates between different categories of community ambulation. These findings may have implications for PT practice for people with mobility problems after stroke.