Responsiveness and predictability of gait speed and other disability measures in acute stroke

doi:10.1053/apmr.2001.24907

Archives of Physical Medicine and Rehabilitation

Volume 82, Issue 9, September 2001, Pages 1204-1212

Presented in part at the American Congress of Rehabilitation Medicine's 74th Annual Meeting, September 12, 1997, Boston, MA.

https://doi.org/10.1053/apmr.2001.24907 Get rights and content

Abstract

Salbach NM, Mayo NE, Higgins J, Ahmed S, Finch LE, Richards CL. Responsiveness and predictability of gait speed and other disability measures in acute stroke. Arch Phys Med Rehabil 2001;82;1204-12. Objectives: To identify the most responsive method of measuring gait speed, to estimate the responsiveness of other outcome measures, and to determine whether gait speed predicts discharge destination in acute stroke. Design: A prospective cohort study. Setting: Five acute-care hospitals. Patients: Fifty subjects with residual gait deficits after a first-time stroke. Interventions: Five- (5mWT) and 10-meter walk tests (10mWT) at comfortable and maximum speeds, with 2 evaluations conducted an average ± standard deviation (SD) of 8 ± 3 and 38 ± 5 days poststroke. Main Outcome Measure: Standardized response mean (SRM = mean change/SD of change) was used to estimate responsiveness for each walk test, the Berg Balance Scale, the Barthel Index, the Stroke Rehabilitation Assessment of Movement (STREAM), and the Timed Up and Go (TUG). Results: The SRMs were 1.22 and 1.00 for the 5mWT, and .92 and .83 for the 10mWT performed at a comfortable and maximum pace, respectively. The SRMs for the Berg Balance Scale, the Barthel Index, the STREAM, and the TUG were 1.04, .99, .89, and .73, respectively. The probability of discharge to a rehabilitation center for persons walking at ≤ 0.3m/s or > 0.6m/s at the first evaluation was .95 and .22, respectively. Conclusions: The 5mWT at a comfortable pace is recommended as the measure of choice for clinicians and researchers who need to detect longitudinal change in walking disability in the first 5 weeks poststroke. © 2001 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Design

In this prospective study, the gait speed of stroke survivors with residual gait deficits was assessed over a 4-week period starting as soon as patients became ambulatory. The first visit was usually attempted within 8 days of stroke. Four conditions were evaluated: the 5-meter walk test (5mWT) and 10-meter walk test (10mWT) with instructions to walk at a comfortable and maximum pace. The order of these 4 conditions was assigned at random. Other measures included the Stroke Rehabilitation

The study sample and eligible nonparticipants

During the 10-month period of recruitment, 357 patients were admitted with a first-time stroke to the 5 acute-care hospitals. Of these, 170 patients met the eligibility criteria, 65 were approached, and 53 consented to participate. Final results were based on data from 50 subjects. Of the 170 patients who met the eligibility criteria, 105 patients were not available to investigators because they either had been discharged home rapidly after a mild stroke or their participation in other studies

Discussion

The 5mWT performed at a comfortable pace was the most responsive method of measuring gait speed over the first 5 weeks after stroke (fig 1). In comparison with other measures of stroke outcome, the 5mWT (comfortable pace) remained the most responsive, followed by the Berg Balance Scale, and the Barthel Index. In addition, this measure of gait speed was predictive of discharge to a rehabilitation center or home.

There are several reasons why the 5mWT at a comfortable pace was most responsive.

Conclusion

The 5mWT performed at a comfortable pace is recommended as the most responsive method of measuring gait speed over the first 5 weeks poststroke. Outcome measures such as the Berg Balance Scale, the Barthel Index, and the STREAM are recommended over gait speed for use in patients who have suffered a severe stroke. The attractiveness of gait speed as a measure of stroke rehabilitation outcome is supported by this study. It is a continuous measure; it has a natural zero and published target gait

Acknowledgements

The authors thank Michael deB. Edwardes for writing the FORTRAN program that generated confidence intervals for the SRM by using a jacknife procedure.

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^☆: Supported by fellowships from the Fonds pour la Formation de Chercheurs et l'Aide à la Recherche, the Fonds de la Recherche en Santé du Québec, and the Physiotherapy Foundation of Canada.

^☆☆: No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

^★: Reprints will not be available. Correspondence to Nancy E. Mayo, PhD, Royal Victoria Hospital, Div of Clinical Epidemiology, 687 Pine Ave W, Ross 4.29, Montreal, Que H3A 1A1, Canada, e-mail: [email protected].

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^♢: a. Micronta LCD quartz stopwatch; InterTAN Canada Ltd, 279 Bayview Dr, Barrie, Ont L4M 4W5 Canada.

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ArticlesResponsiveness and predictability of gait speed and other disability measures in acute stroke☆,☆☆,★,★★,♢

Abstract

Section snippets

Design

The study sample and eligible nonparticipants

Discussion

Conclusion

Acknowledgements

Arch Phys Med Rehabil

J Chronic Dis

J Chronic Dis

J Clin Epidemiol

Lancet

Arch Phys Med Rehabil

Gait Posture

Arch Phys Med Rehabil

Gait velocity as an outcome measure of locomotor recovery after stroke

Walking after stroke. Measurement and recovery over the first 3 months

Scand J Rehabil Med

Strength of lower limb related to gait velocity and cadence in stroke patients

Physiother Can

Correlation of knee extensor muscle torque and spasticity with gait speed in patients with stroke [published erratum appears in Arch Phys Med Rehabil 1990;71:464]

Arch Phys Med Rehabil

Walking after stroke: comfortable versus maximum safe speed

Int J Rehabil Res

Mobility after stroke: reliability of measures of impairment and disability

Int Disabil Stud

The Rivermead Mobility Index: a further development of the Rivermead Motor Assessment

Int Disabil Stud

Gait recovery after hemiplegic stroke

Int Disabil Stud

Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness

Phys Ther

Gait assessment for neurologically impaired patients. Standards for outcome assessment

Phys Ther

Application of computer-assisted gait training (CAGT) program for hemiparetic stroke patients: a preliminary report

Tohoku J Exp Med

Walking cycle after stroke

Tohoku J Exp Med

Computer-assisted gait training (CAGT) of hemiparetic stroke patients: whose recovery is most predictable?

Tohoku J Exp Med

Functional ambulation profile

Phys Ther

Quantitative gait evaluation in the clinic

Phys Ther

Determinants of maximum walking speed in hemiparetic stroke patients

Tohoku J Exp Med

Measurement in neurological rehabilitation

Evaluating measurement responsiveness

J Rheumatol

Monitoring status and evaluating outcomes: an overview of rating scales for use with patients who have sustained a stroke

Top Geriatr Rehabil

Reproducibility and responsiveness of health status measures. Statistics and strategies for evaluation

Control Clin Trials

Articles
Responsiveness and predictability of gait speed and other disability measures in acute stroke☆,☆☆,★,★★,♢