Beyond Physical Capacity: Factors Associated With Real-world Walking Activity After Stroke.
Allison Miller, Ryan T Pohlig, Tamara Wright and 2 others
PMID 33894218WHAT IT FOUND
Stroke survivors with higher walking speed, balance confidence, cognitive scores, and lower area deprivation walked significantly more daily steps.
Those in the highest activity class had the fastest speed, highest confidence, and best cognition. Assessing these factors, not just physical capacity, may help target interventions to increase real-world walking.
Key findings
01A 3-class model best fit the data, with Class 1 having the lowest daily steps and Class 3 the highest.
02Walking ability, balance self-efficacy, cognition, and environment (area deprivation, work status) significantly differentiated the classes and their walking activity levels.
03Depression, BMI, LDL, age, gender, and stroke chronicity did not significantly differ between the activity classes.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
This is a cross-sectional analysis of baseline data from an RCT, so it identifies associations, not causes. We cannot say if higher walking ability causes more steps or if more steps maintain ability. Depression was measured with a screening tool (PHQ-9), not a diagnostic interview, which may have missed its true impact on activity. Important factors like fatigue and quality of life were not included in the analysis. The sample was drawn from a specific clinical trial, so results may not generalize to all stroke survivors, particularly those who did not meet the original trial's eligibility criteria.
Declared interests
The authors declare no conflicts of interest. The study was supported by the NIH.
The easy way to misread this
Do not interpret this as evidence that targeting these factors will increase walking. The study shows that patients who already walk more have better cognition, confidence, and environments. It does not prove that improving cognition or confidence will make a patient walk more.