Participation in community walking following stroke: subjective versus objective measures and the impact of personal factors

Cynthia A Robinson, Anne Shumway-Cook, Marcia A Ciol, Deborah Kartin
Physical Therapy 2011, 91 (12): 1865-76

BACKGROUND: Mobility, specifically community walking, is important, but often limited among survivors of stroke. The factors that influence the recovery of community walking are not clearly understood.

OBJECTIVE: The purpose of this research was to examine mobility disability following stroke, specifically: (1) the association between subjective and objective measures of participation in community walking and (2) the association between personal factors and participation in community walking.

DESIGN: A cross-sectional study design was used.

METHODS: Fifty community-dwelling survivors of stroke, aged 50 to 79 years, were enrolled in the study. Participation in community walking was measured subjectively (perceived difficulty and satisfaction) and objectively using self-report data (number of trips and walking-related activities) and step data (pedometer). The association between subjective and objective measures of participation was analyzed using Pearson correlation. The association of personal factors (age, sex, number of comorbidities, fatigue, depression, balance and fall self-efficacy, and importance of walking) with measures of participation was analyzed using multiple linear regression.

RESULTS: Subjective and objective measures of participation were weakly associated. Self-efficacy was the only personal factor that was strongly associated with both subjective and objective measures of participation. Personal factors explained 27% to 55% of the variability in participation in community walking.

LIMITATIONS: Limitations included a small sample size and limited diversity among participants. Reliability of the pedometer used in this study has not been established in the stroke population.

CONCLUSIONS: Subjective and objective measures of participation in community walking were only weakly correlated, suggesting that they measure different aspects of mobility; thus, to fully capture participation, it is critical to measure both. Personal factors were associated with subjective and objective measures of participation and are important in explaining variability in community walking following stroke.

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