Predicting Home and Community Walking Activity Poststroke
Predicting Home and Community Walking Activity Poststroke
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DOI：
10.1161/strokeaha.116.015309
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发表时间：
2017-02-01
期刊：
影响因子：
8.3
通讯作者：
Dunning, Kari
中科院分区：
文献类型：
--
作者：
Fulk, George D.;He, Ying;Dunning, Kari
背景和目的卒中后的步行能力通常使用Perry等人开发的步态速度分类进行评估。本研究的目的是利用活动监测仪从真实世界的步行活动数据中确定预测家庭和社区步行车的因素。方法对两项脑卒中试验中真实步行活动进行二次分析。根据规范数据划分出居家（100 ~ 2499步/d）、最受限社区（2500 ~ 4499步/d）、最不受限社区（5000 ~ 74999）、全社区（7500步/d） 4个步行类别。预测步行类别的独立变量为舒适和快速步态速度、6分钟步行测试、Berg平衡量表、Fugl Meyer和卒中影响量表。数据分析采用多变量分析来识别与行走类别相关的显著变量，采用自举法选择最稳定的模型和接收器操作特征来识别截止值。结果分析了441例脑卒中患者的资料。6分钟步行测试、Fugl Meyer和Berg平衡量表结合起来是家庭与社区、有限与无限社区步行器的最强预测因子。6分钟步行测试是预测家庭与社区（接受者-操作特征曲线下面积=0.82）和有限与全社区步行车（接受者-操作特征曲线下面积=0.76）的最强个体变量。以0.49 m/s的舒适步速区分家庭和社区，以0.93 m/s的舒适步速区分有限社区和全社区步行车。结论6分钟步行测试能更好地区分家用、有限社区和全社区步行车，而不是舒适的步态速度。通常用于区分家庭步行者和社区步行者的步态速度值可能高估了步行活动。
Background and Purpose 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.Methods 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 (5000-74999), 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.Results 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.Conclusions 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.