Allison Miller1, Ryan T Pohlig2, Tamara Wright3, Hyosub Kim4, Darcy S Reisman5. 1. Department of Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware 19713. 2. Department of Biostatistics Core Facility, University of Delaware, Newark, Delaware 19716. 3. Department of Physical Therapy, University of Delaware, Newark, Delaware 19713. 4. Department of Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware 19713; Department of Physical Therapy, University of Delaware, Newark, Delaware 19713. 5. Department of Biomechanics and Movement Science Program, University of Delaware, Newark, Delaware 19713; Department of Physical Therapy, University of Delaware, Newark, Delaware 19713. Electronic address: dreisman@udel.edu.
Abstract
OBJECTIVE: To identify homogeneous subsets of chronic stroke survivors who share similar characteristics across several domains and test if these groups differ in real-world walking activity. We hypothesized that variables representing the domains of walking ability, psychosocial, environment, and cognition would be important contributors in differentiating real-world walking activity in chronic stroke survivors. DESIGN: Cross-sectional, secondary data analysis. SETTING: University/laboratory. PARTICIPANTS: 283 individuals with chronic (≥ 6 months) stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Thirteen variables representing five domains were included: a) walking ability - Six Minute Walk (6MWT), self-selected gait speed (SSS), b) psychosocial - Patient Health Questionnaire-9 (PHQ-9), Activities Specific Balance Confidence Scale (ABC), c) physical health - LDL cholesterol, body mass index (BMI), Charlson Comorbidity Index, (CCI), d) cognition - Montreal Cognitive Assessment (MoCA), and e) environment - living situation and marital status, work status, Area Deprivation Index (ADI), Walk Score. Mixture modeling was used to identify latent classes of stroke survivors. After identifying the latent classes, walking activity, measured as steps per day (SPD), was included as a distal outcome to understand if classes were meaningfully different in their real-world walking RESULTS: A model with three latent classes was selected. 6MWT, SSS, ABC, and Walk Score were significantly different among all three classes. Differences were also seen for the MoCA, ADI, and CCI between two of the three classes. Importantly, the distal outcome of SPD was significantly different in all classes, indicating that real world walking activity differs among the groups identified by the mixture model. CONCLUSIONS: Stroke survivors with lower walking ability, lower self-efficacy, lower cognitive abilities and greater area deprivation had lower SPD. These results demonstrate that the physical and social environment (including socioeconomic factors) and cognitive function should also be considered when developing interventions to improve real-world walking activity after stroke.
OBJECTIVE: To identify homogeneous subsets of chronic stroke survivors who share similar characteristics across several domains and test if these groups differ in real-world walking activity. We hypothesized that variables representing the domains of walking ability, psychosocial, environment, and cognition would be important contributors in differentiating real-world walking activity in chronic stroke survivors. DESIGN: Cross-sectional, secondary data analysis. SETTING: University/laboratory. PARTICIPANTS: 283 individuals with chronic (≥ 6 months) stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Thirteen variables representing five domains were included: a) walking ability - Six Minute Walk (6MWT), self-selected gait speed (SSS), b) psychosocial - Patient Health Questionnaire-9 (PHQ-9), Activities Specific Balance Confidence Scale (ABC), c) physical health - LDL cholesterol, body mass index (BMI), Charlson Comorbidity Index, (CCI), d) cognition - Montreal Cognitive Assessment (MoCA), and e) environment - living situation and marital status, work status, Area Deprivation Index (ADI), Walk Score. Mixture modeling was used to identify latent classes of stroke survivors. After identifying the latent classes, walking activity, measured as steps per day (SPD), was included as a distal outcome to understand if classes were meaningfully different in their real-world walking RESULTS: A model with three latent classes was selected. 6MWT, SSS, ABC, and Walk Score were significantly different among all three classes. Differences were also seen for the MoCA, ADI, and CCI between two of the three classes. Importantly, the distal outcome of SPD was significantly different in all classes, indicating that real world walking activity differs among the groups identified by the mixture model. CONCLUSIONS:Stroke survivors with lower walking ability, lower self-efficacy, lower cognitive abilities and greater area deprivation had lower SPD. These results demonstrate that the physical and social environment (including socioeconomic factors) and cognitive function should also be considered when developing interventions to improve real-world walking activity after stroke.
Authors: T George Hornby; Abbey Plawecki; Jennifer K Lotter; Molly E Scofield; Emily Lucas; Christopher E Henderson Journal: Phys Ther Date: 2022-08-04
Authors: Rodrigo Núñez-Cortés; Constanza Malhue-Vidal; Florencia Gath; Gonzalo Valdivia-Lobos; Rodrigo Torres-Castro; Carlos Cruz-Montecinos; Francisco M Martinez-Arnau; Sofía Pérez-Alenda; Rubén López-Bueno; Joaquín Calatayud Journal: Int J Environ Res Public Health Date: 2022-06-18 Impact factor: 4.614