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Measuring Community Mobility in Survivors of Stroke Using Global Positioning System Technology

A Prospective Observational Study

Hanke, Timothy A. PT, PhD; Hwang, Sungsoon PhD; Keller, Sarah PT, DPT, NCS; Zielke, Donna PT, MS; Hailey, Tisha OT; Nathaniel, Krumdick PhD; Evans, Christian C. PT, PhD

Journal of Neurologic Physical Therapy: July 2019 - Volume 43 - Issue 3 - p 175–185
doi: 10.1097/NPT.0000000000000279
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Background and Purpose: Returning to community mobility is important for people recovering from a stroke, yet few studies have directly measured this construct following inpatient rehabilitation. Using global positioning system (GPS) technology, we examined community mobility of survivors of stroke (SS) over the first year after discharge and compared them to an age-matched comparison group without neurological impairment.

Methods: We conducted a prospective observational study that included SS (n = 14) and age- and location-matched comparison subjects (CS; n = 6). All participants identified target locations important to their community mobility goals and wore a GPS unit during the first, fifth and ninth weeks after discharge, or from baseline for CS, and at 26 and 52 weeks' follow up. The 6-minute walk test (SMWT), Berg balance test (BBT), Reintegration to Normal Living (RNLI), and Short Form-36 Quality of Life Survey Physical Functioning domain (SF-36-PF) were collected. Number of trips and percentage of targets visited were extracted from GPS data.

Results: Twelve of 14 SS completed 9 weeks, 7 completed the full year, and no CS withdrew. The SS took fewer trips and attained fewer targets compared with CS at weeks 1 and 9, but not at weeks 5, 26, and 52. All 4 clinical outcome measures were significantly correlated to trips (Spearman r for SMWT = 0.5067, BBT = 0.3841, RNLI = 0.4119, and SF-36-PF = 0.4192).

Discussion and Conclusions: Directly measured community mobility in SS was decreased through 9 weeks following discharge from inpatient rehabilitation. The limited strength of bivariate correlations between clinical measures and number of trips supported the uniqueness of the community mobility construct.

Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A277).

Physical Therapy Program (T.A.H., S.K., C.C.E.) and Behavioral Sciences Program (K.N.), Midwestern University, Downers Grove, Illinois; Geography Department, DePaul University, Chicago, Illinois (S.H.); Physical Therapy, Marianjoy Rehabilitation Hospital, Northwest Medicine, Wheaton, Illinois (S.K., D.Z.); and Rehabilitation Department, Rush Copley Medical Center, Aurora, Illinois (T.H.).

Correspondence: Christian C. Evans, PT, PhD, Physical Therapy Program, Midwestern University, Downers Grove, IL 60515 (cevans@midwestern.edu).

Portions of this work have been published elsewhere.

Supported by Midwestern University, College of Health Science, Research Facilitation Grants 2008, 2009, 2010, and 2011 (CCE).

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.jnpt.org).

© 2019 Academy of Neurologic Physical Therapy, APTA