Walking Performance in People with Stroke

Abstract

Abstract Review Background and Purpose: Improving hemiplegic gait has a high priority in stroke rehabilitation. To optimize this rehabilitation it is important to get more insight into the factors that are related to hemiplegic gait and more specific to gait speed. The purpose of this review is to determine the factors which are related to comfortable gait speed in people with stroke. Methods: A computerized search for studies was conducted in CINAHL, Cochrane, EMBASE and PubMed (until November 2008). The inclusion criteria were: (1) subjects with stroke, (2) comfortable or self-selected gait speed as outcome measure, (3) statistical data concerning the relationship between gait speed and other factors (excluding biomechanical factors) and (4) written in English, German or Dutch. Two independent reviewers extracted the data by using a standardized form and determined the methodological quality of the studies. The identified related factors were categorized in the Core Set “Stroke” of the International Classification of Functioning, disability and health (ICF). Results: Twenty-five studies were included; 19 studies had a cross-sectional design and six studies a longitudinal design. A total of 57 factors have been studied having a relation with comfortable gait speed. The most striking factors which were significantly related to comfortable gait speed were strength measures of the paretic leg and the factors categorized in chapter D4 “Mobility”. Conclusions: A large variety of factors are related to comfortable gait speed and many of these factors might be influenced in stroke rehabilitation.

Abstract Research Project Background and Purpose: Many people with stroke suffer from post-stroke fatigue (PSF). PSF is a frequently overlooked sequel and usually receives little attention from healthcare professionals. In addition, PSF has been proven to be a negative factor for functional outcome. The purpose of this study is to investigate the relation between PSF and walking performance and to identify the impact of PSF on walking performance corrected for potential confounding variables. Methods: Eighty stroke survivors were evaluated at the start of an outpatient rehabilitation program in nine rehabilitation centers in The Netherlands. Walking performance was quantified by walking distance (six-minute walk test), gait speed (5-meter walk test) and functional mobility (domain “Mobility” of the Stroke Impact Scale). The relation between PSF, measured by the Fatigue Severity Scale, and the three components of walking performance was studied by calculating correlation coefficients. Multiple regression analyses identified the impact of PSF on walking distance, gait speed and functional mobility corrected for age, gender, time since stroke onset, anxiety, depression, lower limb strength and balance. Results: PSF was not significantly correlated with the three components of walking performance. A multiple linear regression analysis with walking distance and two multiple logistic regression analyses with gait speed and functional mobility showed no significant contribution of PSF in explaining the variance of the three components of walking performance. Conclusion: PSF was not strongly related to walking performance in people with stroke at the start of an outpatient rehabilitation program.