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Distance-Induced Changes in Walking Speed After Stroke

Relationship to Community Walking Activity

Awad, Louis PT, PhD; Reisman, Darcy PT, PhD; Binder-Macleod, Stuart PT, PhD

Journal of Neurologic Physical Therapy: October 2019 - Volume 43 - Issue 4 - p 220–223
doi: 10.1097/NPT.0000000000000293
Research Articles
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Background and Purpose: Physical inactivity is a major contributing factor to reduced health and quality of life. The total distance walked during the 6-Minute Walk Test is a strong indicator of real-world walking activity after stroke. The purpose of this study was to determine whether measurement of distance-induced changes in walking speed during the 6-Minute Walk Test improves the test's ability to predict community walking activity.

Methods: For 40 individuals poststroke, community walking activity (steps/d), the total distance walked during the 6-Minute Walk Test (6MWTtotal), and the difference between the distances walked during the final and first minutes of the test (Δ6MWTmin6–min1) were analyzed using moderated regression. Self-efficacy, assessed using the Activities-specific Balance Confidence scale, was also included in the model.

Results: Alone, 6MWTtotal explained 41% of the variance in steps/d. The addition of Δ6MWTmin6–min1 increased explanatory power by 29% (ΔR2 = 0.29, P < 0.001). The final model accounted for 71% of steps/d variance (F4,32 = 19.52, P < 0.001). Examination of a significant 6MWTtotal × Δ6MWTmin6–min1 interaction revealed a positive relationship between 6MWTtotal and steps/d, with individuals whose distances declined from minute 1 to minute 6 by 0.10 m/s or more presenting with substantially fewer steps/d than those whose distances did not decline.

Discussion and Conclusions: Coassessment of distance-induced changes in walking speed during the 6-Minute Walk Test and the total distance walked substantially improves the prediction of real-world walking activity after stroke. This study provides new insight into how walking ability after stroke can be characterized to reduce heterogeneity and advance personalized treatments.

Department of Physical Therapy and Athletic Training (L.A.), Boston University, Boston, Massachusetts; Wyss Institute for Biologically Inspired Engineering (L.A.), Harvard University, Cambridge, Massachusetts; and Department of Physical Therapy (D.R., S.B.-M.), University of Delaware, Newark.

Correspondence: Louis Awad, PT, PhD, Department of Physical Therapy and Athletic Training, Boston University, 635 Commonwealth Ave, Rm 546A, Boston, MA 02215 (louawad@bu.edu).

This study was funded by NIH grants R01NR010786 and 1KL2TR001411.

The authors declare no conflict of interest.

© 2019 Academy of Neurologic Physical Therapy, APTA