Article
Community ambulation after stroke: how important and obtainable is it and what measures appear predictive?1,

Preliminary results presented at the 3rd World Congress in Neurological Rehabilitation, April 2002, Venice, Italy.
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Abstract

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.

Section snippets

Participants

In this multicenter, observational study, stroke survivors from 3 regional hospitals in New Zealand, which serve a combined population of approximately 800,000 people, were recruited between July 2000 and February 2002. The inclusion criteria were people who presented with a first-ever or recurrent stroke (MONICA definition)14 and who had been ambulant in the community before their stroke. The participants were a convenient sample of people who had been discharged home after inpatient

Sample characteristics

A total of 130 people with stroke participated in the study: 50 subjects from each of 2 centers and 30 subjects from the third center. Based on the findings of a community-based study of stroke in Auckland, New Zealand, this figure is likely to represent about one third of stroke survivors who present with a moderate or severe motor deficit 1 month after stroke and who live at home.19Table 1 describes the characteristics of the total sample and the amount of PT they received after their stroke.

Discussion

This study describes the level of ambulation for a cohort of home-dwelling people with stroke on discharge from PT services. Our findings suggest that although mobility outcomes were good overall, almost one third of the people were still unable to walk unsupervised in their communities. Of those who did achieve independent community ambulation, most were reluctant, or unable, to use public transportation and therefore had to rely on their carers if they were to go outside the home. Although

Conclusions

Despite favorable mobility outcomes having been achieved for this home-dwelling cohort of people with stroke, questions remain as to why such outcomes are not necessarily linked to good levels of community ambulation. It may be that rehabilitation efforts need to be refined to achieve a level of mobility sufficient for these people to be adept community ambulators. Research is required to identify treatment approaches that maximize community ambulation based on the attributes required for the

Acknowledgements

We thank the research assistants who collected data at each of the centers: Jackie Pithie at Princess Margaret Hospital, Leanne Robinson at Waikato Hospital, and Nik Yarrall at Hutt Hospital, and the physical therapists at the 3 centers.

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    Supported by the New Zealand Society of Physiotherapists.

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