Miyata K1,2, Hasegawa S2,3, Iwamoto H4, Otani T5, Kaizu Y5, Shinohara T6, Usuda S2
1Ibaraki Prefectural University of Health Science, Inasiki-gun, Japan, 2Gunma University Graduate School of Health Sciences, Maebashi, Japan, 3Public Nanokaichi Hospital, Tomioka, Japan, 4Hidaka Rehabilitation Hospital, Takasaki, Japan, 5Hidaka Hospital, Takasaki, Japan, 6Takasaki University of Health and Welfare, Takasaki, Japan
Background: Recovery of gait speed is an important goal for people with stroke. One of the key determinants of gait speed is balance. Balance is a composite ability that involves rapid, automatic, anticipatory, reactive integration, and sensory strategies based on information derived from several systems. The Balance Evaluation Systems Test (BESTest) was designed as a comprehensive balance assessment tool aimed at assessing the specific underlying balance impairment. The BESTest comprises 36 items representing six underlying postural control systems: Biomechanical Constraints (I), Stability Limits and Verticality (II), Anticipatory Postural Adjustments (III), Postural Responses (IV), Sensory Orientation (V), and Stability in Gait (VI). However, no comparison of the sections of the BESTest related to gait speed in people with subacute stroke has been reported. A propensity score matching analysis involving adjusted multiple factors was performed to clearly grasp the relationship between gait speed and the postural control system. Understanding this relationship in the subacute stage may provide better guidance for more directed clinical decision-making.
Purpose: The purpose of this study was to compare sections of the BESTest related to gait speed in patients with subacute stroke by propensity score matching.
Methods: This retrospective study included 90 people with subacute stroke (age, 69.2 ± 11.0 years) who were divided into two groups according to their gait speed: a fast-walker group with a gait speed of ≥0.8 m/s and a slow-walker group with a gait speed of 0.8 m/s. The main outcomes was a comparison of the section scores of the BESTest between the fast- and slow-walker groups using the Mann-Whitney U-test. Propensity scores were calculated using binary logistic regression with the fast- and slow-walker groups as dependent variables, and age, type of stroke, Brunnstrom stage of the lower extremity, and functional ambulation category (FAC) as independent variables. One-to-one pairs from the fast-walker and slow-walker groups were randomly matched using a caliper width of 0.25 of a standard deviation of the estimated propensity scores. The level of significance was set at p 0.05.
Results: Before the propensity score matching, a significant difference was observed between the fast- and slow-walker groups in all sections of the BESTest. A group pairs was selected for matching based on their propensity scores. After matching, no significant differences were observed between the two groups adjusted for age, type of stroke, Brunnstrom stage of the lower extremity, and FAC; the mean values were also similar. In the four sections of the BESTest (sections I, III, IV, VI), the fast-walker group showed significantly better scores (p 0.01).
Conclusion(s): The results of the present study suggested that the postural control system involving Biomechanical Constraints, Anticipatory Postural Adjustments, Postural Responses, and Stability in Gait are important for increasing the gait speed. The characteristics of postural control systems related to gait speed became clear using the BESTest.
Implications: In people with subacute stroke, it is necessary to evaluate muscle strength, postural alignment, anticipatory and reactive postural response, and balance during gait as the postural control system involved in gait.
Keywords: subacute stroke, postural balance, gait speed
Funding acknowledgements: This work was supported by the Japan Society for the Promotion of Science KAKENHI Grant Number 18K17724.
Purpose: The purpose of this study was to compare sections of the BESTest related to gait speed in patients with subacute stroke by propensity score matching.
Methods: This retrospective study included 90 people with subacute stroke (age, 69.2 ± 11.0 years) who were divided into two groups according to their gait speed: a fast-walker group with a gait speed of ≥0.8 m/s and a slow-walker group with a gait speed of 0.8 m/s. The main outcomes was a comparison of the section scores of the BESTest between the fast- and slow-walker groups using the Mann-Whitney U-test. Propensity scores were calculated using binary logistic regression with the fast- and slow-walker groups as dependent variables, and age, type of stroke, Brunnstrom stage of the lower extremity, and functional ambulation category (FAC) as independent variables. One-to-one pairs from the fast-walker and slow-walker groups were randomly matched using a caliper width of 0.25 of a standard deviation of the estimated propensity scores. The level of significance was set at p 0.05.
Results: Before the propensity score matching, a significant difference was observed between the fast- and slow-walker groups in all sections of the BESTest. A group pairs was selected for matching based on their propensity scores. After matching, no significant differences were observed between the two groups adjusted for age, type of stroke, Brunnstrom stage of the lower extremity, and FAC; the mean values were also similar. In the four sections of the BESTest (sections I, III, IV, VI), the fast-walker group showed significantly better scores (p 0.01).
Conclusion(s): The results of the present study suggested that the postural control system involving Biomechanical Constraints, Anticipatory Postural Adjustments, Postural Responses, and Stability in Gait are important for increasing the gait speed. The characteristics of postural control systems related to gait speed became clear using the BESTest.
Implications: In people with subacute stroke, it is necessary to evaluate muscle strength, postural alignment, anticipatory and reactive postural response, and balance during gait as the postural control system involved in gait.
Keywords: subacute stroke, postural balance, gait speed
Funding acknowledgements: This work was supported by the Japan Society for the Promotion of Science KAKENHI Grant Number 18K17724.
Topic: Neurology: stroke; Disability & rehabilitation; Outcome measurement
Ethics approval required: Yes
Institution: Gunma University
Ethics committee: Medical Research Involving Human Subjects
Ethics number: 15-73
All authors, affiliations and abstracts have been published as submitted.
