Fulk George D, He Ying, Boyne Pierce, Dunning Kari
From the Department of Physical Therapy (G.D.F.) and Department of Mathematics (Y.H.), Clarkson University, Potsdam, NY; and Department of Rehabilitation Sciences, University of Cincinnati, OH (P.B., K.D.).
Stroke. 2017 Feb;48(2):406-411. doi: 10.1161/STROKEAHA.116.015309. Epub 2017 Jan 5.
Walking ability poststroke is commonly assessed using gait speed categories developed by Perry et al. The purpose of this study was to reexamine factors that predict home and community ambulators determined from real-world walking activity data using activity monitors.
Secondary analyses of real-world walking activity from 2 stroke trials. Home (100-2499 steps/d), most limited community (2500-4499 steps/d), least limited community (5000-74 999), and full community (≥7500 steps/d) walking categories were developed based on normative data. Independent variables to predict walking categories were comfortable and fast gait speed, 6-minute walk test, Berg Balance Scale, Fugl Meyer, and Stroke Impact Scale. Data were analyzed using multivariate analyses to identify significant variables associated with walking categories, bootstrap method to select the most stable model and receiver-operating characteristic to identify cutoff values.
Data from 441 individuals poststroke were analyzed. The 6-minute walk test, Fugl Meyer, and Berg Balance Scale combined were the strongest predictors of home versus community and limited versus unlimited community ambulators. The 6-minute walk test was the strongest individual variable in predicting home versus community (receiver-operating characteristic area under curve=0.82) and limited versus full community ambulators (receiver-operating characteristic area under curve=0.76). A comfortable gait speed of 0.49 m/s discriminated between home and community and a comfortable gait speed of 0.93 m/s discriminated between limited community and full community ambulators.
The 6-minute walk test was better able to discriminate among home, limited community, and full community ambulators than comfortable gait speed. Gait speed values commonly used to distinguish between home and community walkers may overestimate walking activity.
卒中后步行能力通常采用佩里等人制定的步态速度类别进行评估。本研究的目的是重新审视根据活动监测器记录的实际步行活动数据预测居家和社区步行者的因素。
对两项卒中试验的实际步行活动进行二次分析。根据标准数据制定了居家（每日100 - 2499步）、最受限社区（每日2500 - 4499步）、最不受限社区（每日5000 - 74999步）和完全社区（每日≥7500步）步行类别。预测步行类别的自变量包括舒适和快速步态速度、6分钟步行试验、伯格平衡量表、Fugl Meyer量表和卒中影响量表。使用多变量分析来确定与步行类别相关的显著变量，采用自助法选择最稳定的模型，并使用受试者工作特征曲线来确定临界值。
分析了441例卒中后患者的数据。6分钟步行试验、Fugl Meyer量表和伯格平衡量表相结合是预测居家与社区以及受限与不受限社区步行者的最强预测因素。6分钟步行试验是预测居家与社区（受试者工作特征曲线下面积 = 0.82）以及受限与完全社区步行者（受试者工作特征曲线下面积 = 0.76）的最强个体变量。舒适步态速度为0.49 m/s可区分居家和社区步行者，舒适步态速度为0.93 m/s可区分受限社区和完全社区步行者。
6分钟步行试验比舒适步态速度更能区分居家、受限社区和完全社区步行者。常用于区分居家和社区步行者的步态速度值可能高估了步行活动。
