Sage Journals: Discover world-class research

Abstract

Objective:

To develop a model of community ambulation after stroke based on: Canadian data from community-dwelling individuals post-stroke; the experiences and opportunities for community ambulation expressed by individuals with stroke; and current literature. The model presents a visual depiction of the relationships between the different factors of community ambulation after stroke.

Design:

A quantitative/qualitative explanatory sequential mixed-methods design was utilized. Secondary data analysis with structural equation modeling resulted in a community ambulation model. Two focus groups of individuals with stroke were conducted to verify and explain the model.

Setting:

Community.

Subjects:

Quantitative data from 227 participants: 142 (63%) male; 63.4 (12.0) years of age and 2.6 (2.5) years post stroke. Eleven individuals participated in the focus groups: 6 (55%) male; 61.4 (6.9) years of age and 5.8 (3.3) years since stroke.

Main measures:

Model variables: items from the EuroQol, Preference Based Stroke Index, gait speed, Reintegration to Normal Living Index, the Community Health Activities Model Program for Seniors, and the Geriatric Depression Scale.

Results:

The model had reasonable fit with three latent variables: ambulation, gait speed, and health perceptions (normed χ² = 1.8, root mean square error of approximation = 0.060 (0.043; 0.075)). Depression was also a component of community ambulation. Participants verified the model and added endurance and the environment as additional components. Participants used self-awareness and knowledge of the environment to engage in cognitive strategies related to community ambulation.

Conclusions

A model of community ambulation after stroke was developed and verified. Recognizing important components of community ambulation may assist physiotherapists in determining community ambulation goals, needs, and opportunities in partnership with clients.

Keywords

Community ambulation participation stroke

Get full access to this article

View all access options for this article.

References

Lord

McPherson

McNaughton

Rochester

Weatherall

. Community ambulation after stroke: how important and obtainable is it and what measures appear predictive? Arch Phys Med Rehabil 2004; 85: 234–239.

Ripat

Redmond

Grabowecky

. The winter walkability project: Occupational therapists’ role in promoting citizen engagement. Can J Occupat Ther 2010; 77(1): 7–14.

Canadian Society of Exercise Physiologists. Canadian Physical Activity Guidelines for older adults – 65 years and older. 2012. wwwcsepca/guidelines

Pohl

Duncan

Perera

Liu

Lai

Studenski

. Influence of stroke-related impairments on performance in 6-minute walk test. J Rehabil Res Dev 2002; 39: 439–444.

Pohl

Perera

Duncan

Maletsky

Whitman

Studenski

. Gains in distance walking in a 3-month follow-up poststroke: what changes? Neurorehabil Neural Repair 2004; 18: 30–36.

Rantakokko

Manty

Iwarsson

. Fear of moving outdoors and development of outdoor walking difficulty in older people. J Am Geriatr Soc 2009; 57: 634–640.

Kerr

Sallis

Salelens

. Outdoor physical activity and self rated health in older adults living in two regions of the US. Int J Behav Nutr Phys Act 2012; 9(89).

Perry

Garrett

Gronley

Mulroy

. Classification of walking handicap in the stroke population. Stroke 1995; 26: 982–989.

Rosa

Marques

Demain

Metcalf

. Fast gait speed and self-perceived balance as valid predictors and discriminators of independent community walking at 6 months post-stroke – a preliminary study. Disabil Rehabil. Epub ahead of print 23 April 2014. DOI: 10.3109/09638288.2014.911969.

10.

Fulk

Reynolds

Mondal

Deutsch

. Predicting home and community walking activity in people with stroke. Arch Phys Med Rehabil 2010; 91: 1582–1586.

11.

Robinson

S-C

Ciol

Kartin

. Participation in community walking following stroke: Subjective versus objective measures and the impact of personal factors. Phys Ther 2011; 91(12): 1865–1876.

12.

Lord

Rochester

Weatherall

McPherson

McNaughton

. The effect of evironment and task on gait parameters after stroke: a randomized comparison of measurement conditions. Arch Phys Med Rehabil 2006; 87: 967–973.

13.

Talkowski

Brach

Studenski

Newman

. Impact of health perception, balance perception, fall history, balance performance, and gait speed on walking activity in older adults. Phys Ther 2008; 88: 1474–1481.

14.

Sakari

Era

Rantanen

Leskinen

Laukkanen

. Mobility performance and its sensory, psychomotor and musculoskeletal determinants from age 75 to age 80. Aging Clin Experi Res 2010; 22: 47–53.

15.

Cardinal

Vuchinich

. Health worry, physical activity participation, and walking difficulty among older adults: A mediation analysis. Res Quart Exerc Sport 2009; 80(1): 12–21.

16.

Andrews

Chinworth

Bourassa

Garvin

Benton

Tanner

. Update on distance and velocity requirements for community ambulation. J Geriatr Phys Ther 2010; 33: 128–134.

17.

Dennett

Taylor

Mulrain

. Community ambulation after hip fracture: completing tasks to enable access to common community venues. Disabil Rehabil 2012; 34: 707–717.

18.

Creswell

. Designing and Conducting Mixed Methods Research. Thousand Oaks, CA: SAGE Publications, 2007.

19.

Barclay-Goddard

Ripat

Mayo

. Developing a model of participation post-stroke: a mixed-methods approach. Qual Life Res 2012; 21(3): 417–426.

20.

Dorman

Slattery

Farrell

Dennis

Sandercock

. Qualitative comparison of the reliability of health status assessments with the EuroQol and the SF-36 questionnaires after stroke. Stroke 1998; 29: 63–68.

21.

Poissant

Mayo

Wood-Dauphinee

Clarke

. The development and preliminary validation of a Preference-Based Stroke Index (PBSI). Health Qual Life Outcomes 2003; 1(43).

22.

Steffen

Hacker

Mollinger

. Age- and gender-related test performance in community-dwelling elderly people: Six-minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Phys Ther 2002; 82: 128–137.

23.

Wood-Dauphinee

Opzoomer

Williams

Marchand

Spitzer

. Assessment of global function: The reintegration to normal living index. Arch Phys Med Rehabil 1988; 69(8): 583–590.

24.

Stewart

Mills

KIng

Haskell

Gillis

Ritter

. CHAMPS Physical Activity Questionnaire for older adults: Outcomes for interventions. Med Sci Sports Exerc 2001; 33(7): 1126–41.

25.

Cinamon

Finch

Miller

Higgins

Mayo

. Preliminary evidence for the development of a stroke specific geriatric depression scale. Int J Geriatr Psychiatry 2011; 26: 188–198.

26.

Enders

. Analyzing structural equation models with missing data. In: Hancock

Mueller

(eds) Structural Equation Modeling – A Second Course. Quantitative Methods in Education and the Behavioural Sciences: Issues, Research, and Teaching. Greenwich: Information Age Publishing, 2006. pp.313–342.

27.

Kline

. Principles and Practice of Structural Equation Modeling. 2nd ed. New York: The Guilford Press, 2005.

28.

Hays

Revicki

Coyne

. Application of structural equation modeling to health outcomes research. Eval Health Prof 2005; 28(3): 295–309.

29.

Patton

. Qualitative Research and Evaluation Methods. 3rd ed. Thousand Oaks, CA: SAGE Publications, 2002.

30.

Hsieh

Shannon

. Three approaches to qualitative content analysis. Qual Health Res 2005; 15(9): 1277–1288.

31.

World Health Organization. International Classification of Functioning, Disability and Health. Geneva: World Health Organization, 2001.

32.

Öberg

Karsznia

Öberg

. Basic gait parameters: Reference data for normal subjects. J Rehabil Res Dev 1993; 30(2): 210–223.

33.

Wilson

Cleary

. Linking clinical variables with health-related quality of life. A conceptual model of patient outcomes. JAMA 1995; 273: 59–65.

34.

Undėn

Andrėasson

Elofsson

. Inflammatory cytokines, behaviour and age as determinants of self-rated health in women. Clin Sci 2007; 112: 363–373.

35.

Liu

Chen

Wang

. Relationship between post-stroke depression and lesion location: a meta-analysis. Kaohsiung J Med Sci 2004; 20(8): 372–380.

36.

Patla

Shumway-Cook

. Dimensions of mobility: Defining the complexity and difficulty associated with community walking. J Aging Phys Act 1999; 7: 7–19.

37.

King

Sallis

Frank

. Aging in neighborhoods differing in walkability and income: Associations with physical activity and obesity in older adults. Social Sci Med 2011; 73: 1525–1533.

38.

Aoyagi

Shaphard

. Steps per day – The road to senior health? Sports Med 2009; 39(6): 423–438.

39.

Sumukadas

Witham

Struthers

McMurdo

. Day length and weather conditions profoundly affect physical activity levels in older functionally impaired people. J Epidemiol Comm Health 2009; 63: 305–309.

40.

Kubina

Dubouloz

Davis

Kessler

Egan

. The process of re-engagement in pesonally valued activities during the two years following stroke. Disabil Rehabil 2013; 35(3): 236–243.

Factors describing community ambulation after stroke: a mixed-methods study

Abstract

Objective:

Design:

Setting:

Subjects:

Main measures:

Results:

Conclusions

Keywords

Get full access to this article

References