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Relationship Between Perceived and Measured Changes in Walking After Stroke

Tang, Ada PT, PhD; Eng, Janice J. PhD, BSc (PT/OT); Rand, Debbie OT, PhD

Journal of Neurologic Physical Therapy: September 2012 - Volume 36 - Issue 3 - p 115–121
doi: 10.1097/NPT.0b013e318262dbd0
Research Articles

Background and Purpose: Examining participant-perceived change in walking provides insight into whether changes were meaningful for participants. This study examined the relationships between change scores in standardized walking outcomes and ratings of perceived change following exercise poststroke.

Methods: Self- and fast-paced gait speed and Six-Minute Walk Test (6MWT) distance were assessed in 22 participants (age 67 ± 10.3 years, 1.8 ± 0.9 years poststroke) before and after a 3-month exercise program. Perceived changes were evaluated using a 15-point Likert scale. Correlation analyses between measured and perceived changes were performed. Subgroups of low and high baseline scores were compared for differences in measured and perceived changes.

Results: Six-Minute Walk Test change was correlated with perceived change (ρ = 0.52, P = 0.01), greater 6MWT change was demonstrated among participants who perceived improvement compared to those who did not (difference 34.4 m, 95% CI: 17.2–51.6, P = 0.04). After controlling for measured change, participants with low baseline 6MWT distances perceived less change than those who walked high distances at baseline (P = 0.006) even when relative change was equivalent.

Discussion and Conclusions: A global rating scale using meaningful and context-specific questions was used to determine the relationship between measured and participant-perceived changes in 6MWT distance. A meaningful difference in 6MWT change was observed between participants who did and those who did not perceive improvement. Individuals with lower baseline scores may require larger changes in walking distance to perceive that a change has occurred. This study contributes to a growing body of evidence about the relationships between perceived and measured changes in function and is a step in determining thresholds for perceived change in walking after stroke.

Department of Physical Therapy, University of British Columbia, GF Strong Rehabilitation Centre, Rehabilitation Research Lab, Vancouver, British Columbia, Canada (A.T., J.E.); and Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel (D.R.).

Correspondence: Janice J. Eng, PhD, BSc (PT/OT), Department of Physical Therapy, University of British Columbia, GF Strong Rehabilitation Centre, Rehabilitation Research Lab, 4255 Laurel Street, Vancouver, BC V5Z 2G9, Canada (

Author contributions: A.T., as primary author, was responsible for writing the manuscript, data analysis, and interpretation. J.J.E. oversaw the data collection, assisted with data analysis and interpretation, and helped draft the manuscript. D.R. assisted with data analysis and interpretation and helped with manuscript preparation. All authors have read and approved the final manuscript.

This work was presented in poster format at the Canadian Stroke Congress, Canadian Stroke Network and Heart and Stroke Foundation of Canada, Québec City, Québec, Canada, June 2010. This study was conducted at Vancouver Coastal Health, Canada.

This project was funded by the Canadian Stroke Network and a grant-in-aid from the Heart and Stroke Foundation of BC and Yukon. A.T. is supported by the Canadian Institutes of Health Research (CIHR MFE-98550) and the Michael Smith Foundation for Health Research (MSFHR) (ST-PDF-03003(11-1)CLIN), J.J.E. is supported by CIHR (CIHR MSH-63617) and the MSFHR, D.R. was supported by the Heart and Stroke Foundation of Canada, the Canadian Stroke Network, CIHR Institute of Circulatory and Respiratory Health and CIHR Institute of Aging/Rx&D Collaborative Research Program with AstraZeneca Canada Inc.

The authors declare no conflict of interest.

© 2012 Neurology Section, APTA