Gait in persons with chronic stroke: An investigation of overall gait and quality of life
The purposes of this study was to investigate the reliability of as instrumented gait analysis tool, and then to use data obtained by this tool, along with other measures of body functions and structure, activities, and participation, to elucidate the relationships between gait function and health related quality of life (HRQOL) and more specifically the relationships between gait asymmetry, gait function and HRQOL.
Following informed consent and screening for eligibility, participants were given a short mental status exam to establish that the participant had sufficient cognition to complete the study. The Stroke Impact Scale (SIS), a self report questionnaire of HRQOL was completed by the participant, and they underwent the Stroke Rehabilitation Assessment of Movement (STREAM). Lastly, participants then completed two sessions consisting of three walks each on the GAITRite ® , walking at their comfortable pace.
Results revealed good to excellent test-retest reliability for all variables (ICCs= 0.726-0.974). Correlational analysis revealed moderate to good (at best) significant correlations among all the SIS measures and CWH, velocity, and cadence. No relationship was found between QOL as measured by the SIS and temporal symmetry, however, fair correlations were found between step length symmetry and QOL. Only SIS Percent Recovery was correlated with lower extremity voluntary movement, but a moderate correlation was found between QOL and a combined measure of basic mobility function and upper and lower extremity voluntary movement. Regarding gait asymmetry, swing time asymmetry was the most prevalent asymmetry. Stance time had the smallest degree of asymmetry while swing time had the greatest. Step length asymmetry significantly, inversely correlated with the CHW, all STREAM measures, and velocity (rs=0.456-0.708). Likewise, swing time symmetry significantly, inversely correlated with all measures except STREAM basic mobility. Stance time symmetry demonstrated the least association with the dependent variables, correlating significantly with the STREAM lower extremity subscale only. Secondary analyses were completed to determine if there were significant differences in STREAM LE scores between the categories of asymmetry.
The test-retest results suggest that the GAITRite® is a reliable tool for assessing spatial and temporal parameter of gait over time. Information obtained from the HRQOL, gait, and recovery of movement measures suggests that stroke survivors with faster gait velocity, higher cadence, and better overall walking function perceived their overall HRQOL, self-reported physical abilities, and participation to be higher than those with slower velocities and lower cadence. Findings of this study intimate that temporal asymmetry has little relationship to HRQOL, while spatial asymmetry adversely relates to HRQOL. And finally, voluntary movement in the lower extremity appears essentially unrelated to HRQOL, while basic mobility function combined with lower and upper extremity movement does positively correlate with HRQOL. And lastly, gait asymmetry is common in persons with chronic stroke. This study included only those who could walk without assistance; therefore, independence with gait does not seem to preclude substantial gait asymmetries. The strongest correlation was between CWH and step length asymmetry, indicating that the higher overall walking function is associated with more symmetrical step lengths. The current study, and those previously done indicate that motor impairment/recovery is related to gait asymmetry, but the lack of consistent strong correlations signify that other factors are involved in asymmetry. In fact, there were significant differences in the STREAM LE subscale scores in all three of the symmetry measures. However, post-hoc analysis revealed significant differences between the mild and severely asymmetric categories for swing time asymmetry only. These results are surprising, as one would assume there would be significant differences between the normal and severely asymmetric. Although this study found that velocity and symmetries are related, assessment and understanding of gait asymmetry should be considered an important facet of gait evaluation. This work suggests that understanding the presence, type, and degree of gait asymmetry can guide therapists in developing appropriate treatment plans to address all gait deficits