This mapping review aimed to chart the existing evidence on physical, biopsychosocial, and environmental factors associated with community ambulation and describe the methods used to assess any potential limitations in community ambulation.
This mapping review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Nine databases were searched including CINAHL, PubMed, and Web of Science. Studies published in English since 2001 examining factors affecting community ambulation in adults at least six months post-stroke were included. Studies assessing general physical activity or community mobility through transportation modes other than walking were excluded. Identified records were collated, de-duplicated, and screened, with full-text reviews conducted by at least two independent reviewers.
From 1,824 titles/abstracts screened and 99 full texts reviewed, 42 observational studies, two randomized-controlled trials and one pre-postinterventional study were included, all but one representing stroke survivors from high-income countries. The 45 included studies represented 3,980 participants (51% males, mean age: 62±2.4 years, mean time post-stroke: 2.75±0.8years, mean gait speed: 0.76±0.7 m/s). Participation in community ambulation was most commonly quantified by daily walking performance using accelerometers (n=20, mean: 3,361 steps/day) or predicted based on clinical gait speed (n=8). Other assessments included self-reported questionnaires (n=14), direct observation(n=1), and travel logs (n=2). Key physical factors consistently reported to impact community ambulation were gait-related endurance, static and dynamic balance, and walking performance. Biopsychosocial factors like falls-efficacy and depression showed mixed evidence of impact, while age, gender, and marital status were not associated with community ambulation. Environmental factors like neighborhood walkability, work status, and driving independence also produced mixed evidence of influence.
Multiple factors were identified as key influencers of community ambulation, with gait-related endurance, balance, and walking performance most consistently reported. Nevertheless, factors impacting community ambulation in low- and middle-income countries may differ and remain largely unknown, potentially due to the restriction of this review to English-language studies. Severe limitations in community ambulation were reported across all studies, but no consensus exists on the best assessment methods.
The mapped evidence may inform physiotherapists to screen for the most common factors influencing community ambulation post-stroke, enabling the design of holistic, targeted rehabilitation interventions. Clinically, integrating multidimensional assessments—such as accelerometers for walking performance alongside validated biopsychosocial questionnaires—can provide a more comprehensive evaluation and help tailor interventions to individual needs.
Hemiplegia
Systematic Review
