Fast gait speed and self-perceived balance as valid predictors and discriminators of independent community walking at 6 months post-stroke – a preliminary study

Abstract

To determine the validity of walking speed, muscle strength, function of the hemiparetic lower limb and self-perceived balance to predict and discriminate independent community walkers (ICW) within the first 6 months post-stroke. Methods: Inpatients with a first ischemic stroke (<3 months), able to walk, were evaluated (T0) and re-evaluated after 6 months post-stroke (T1). Comfortable, fast speed and the difference between fast and comfortable speed, muscle strength of knee flexors and extensors, sensory-motor function of the hemiparetic lower limb and self-perceived balance were assessed at T0 and T1. At T1, a self-reported question was used to discriminate ICW versus Dependent Community Walkers (DCW). ROC curve analysis was used to determine valid predictive (T0) and discriminative (T1) cut-offs of ICW. Results: Only 25.7% of the 35 participants were ICW at T1. Valid predictive cut-offs at T0 were found for fast speed (0.42m/s) and Falls Efficacy Scale (<57). Valid discriminators were found at T1 for fast speed (>0.84m/s) and FES (<18.50). Conclusion: Fast speed and self-perceived balance appear to be important characteristics of ICW at 6 months and may be useful early predictors of the potential for patients to achieve this. Further research is needed to ensure the precision of these functional cut-offs.Implications for RehabilitationPrognostic information is important for people with stroke and health services. The ability to walk faster than 0.42m/s and a fear of falling on the Falls Efficacy Scale of less than 57 in the first 3 months after stroke predict who will be an independent community walker at 6 months.At 6 months after stroke, people who cannot walk faster than 0.84m/s or who have a have Falls Efficacy Scale score <18.5 are unlikely to be walking independently in the community.Rehabilitation to promote independent walking should focus on walking speed, balance re-education and strategies to reduce fear of falling.