Social and physical environmental factors in daily stepping activity in those with chronic stroke.
Allison Miller, Ryan T Pohlig, Darcy S Reisman
PMID 32772823WHAT IT FOUND
In chronic stroke, lower neighborhood deprivation and working were associated with more daily steps.
Social factors also added information, but together these factors explained only 9.2% of differences in steps per day. Walk Score was not associated.
Key findings
01Social environmental factors significantly improved the step model after demographics, and physical environmental factors improved it further, but the full model explained 9.2% of step differences.
02In the full model, higher area deprivation was associated with fewer steps per day, and retired and unemployed status were associated with fewer steps per day relative to working.
03Neighborhood Walk Score was not significantly associated with daily stepping.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study analyzed baseline data from a larger randomized trial, so it did not test whether changing an environmental factor increases steps. Participants had to be at least 6 months after stroke and able to walk without assistance at least 0.3 m/s, so results may not apply to people with more severe walking impairment. The final model explained only 9.2% of variance in steps per day, so many other factors likely matter. FitBit wear time was not collected, and days with doubtful wear were removed, so step averages may still be imperfect. Weather and perceived barriers were not measured, and ADI and Walk Score are address-level proxies, so the environment was only partly captured. Work status may be related to health or stroke severity rather than a cause of lower stepping.
Declared interests
The authors declared no conflicts of interest. The publication types indicate NIH and non-U.S. government research support, but the article text does not say who designed the study or wrote the manuscript.
The easy way to misread this
Do not conclude that moving to a less deprived area or returning to work will raise step counts. This study measured associations at one time point, not the effect of changing those factors, and the final model explained only 9.2% of step differences.