Published online before print February 28, 2008, doi: 10.1161/STROKEAHA.107.502203
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(Stroke. 2008;39:e75.)
© 2008 American Heart Association, Inc.
Letters to the Editor |
Gait Velocity and Community Ambulation: the Limits of Assessment
Department of Medicine (Rehabilitation), University of Otago, Wellington, New Zealand
HealthQWest, Buchanan House, Glasgow Caledonian University, Glasgow, Scotland
To the Editor:
The contention by Schmid and colleagues1 that gait velocity, measured over 10 months, is sufficient as a single measure of community ambulation is not supported by the results of their study. Rather, their data supports earlier research showing that gait speed predicts functional mobility and social participation,2,3 and also indicates that to some extent levels of community ambulation can be discerned by gait velocity. The authors stratified participants into hierarchical levels of community ambulation based on widely reported but unsubstantiated thresholds of gait speed, and reported on the number of people who transitioned to a higher class of community ambulation following an intervention to improve mobility. Community ambulation as a discrete outcome, using self-report, was not measured.
Functional mobility status and social participation, both multidimensional constructs, were assessed using 2 domains of the Stroke Impact Scale (SIS). A correlation was shown between improved SIS scores and transition to a higher class of community ambulation (inferred through improved gait speed). The supposition that gait speed alone determines community ambulation status is misleading. Community ambulation is a challenging locomotor activity that requires the ability to walk, perform concurrent cognitive and motor tasks, maintain a trajectory and negotiate unpredictable terrain. The theoretical framework of community ambulation proposed by Patla and Shumway-Cook4 provides a basis for task analysis and consideration of requisite skills, and a platform for further research into advanced mobility, community ambulation, and social participation after stroke. We should proceed with caution when interpreting walking speed after stroke until further development of validated outcome measures for community ambulation has taken place.
Acknowledgments
Disclosures
None.
References
1. Schmid A, Duncan P, Studenski S, Min Lai S, Richards L, Perera S, Wu S. Improvements in speed-based gait classifications are meaningful. Stroke. 2007; 38: 2096–2100.
2. Jette A, Keysor J, Coster W, Pengsheng N, Haley S. Beyond function: predicting participation in a rehabilitation cohort. Arch Phys Med Rehabil. 2005; 86: 2087–2094.[CrossRef][Medline] [Order article via Infotrieve]
3. Schepers V, Visser-Meily A, Ketelaar M, Lindeman E. Prediction of social activity 1 year poststroke. Arch Phys Med Rehabil. 2005; 86: 1472–1476.[CrossRef][Medline] [Order article via Infotrieve]
4. Patla A, Shumway-Cook A. Dimensions of mobility: defining the complexity and difficulty associated with community mobility. J Aging Phys Act. 1999; 7: 7–19.[Medline] [Order article via Infotrieve]
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