DISTANCE-LIMITED WALK TESTS POST-STROKE: A SYSTEMATIC REVIEW OF TEST PROTOCOLS AND MEASUREMENT PROPERTIES

D.K. Cheng^1,2, M. Dagenais², K. Alsbury², J.M. Legasto², S. Scodras², G. Aravind¹, P. Takhar¹, N.M. Salbach^1,2,3

Background: Walking limitations are common after stroke, and improving walking capacity is a key objective of rehabilitation. Evidence describing the quality of methods for assessing walking ability is required to promote clinical implementation.

Purpose: The purpose of this systematic review was to synthesize existing literature describing test protocols and measurement properties of distance-limited walk tests in people poststroke.

Methods: Seven electronic databases were searched in 2013 and an updated search was run in 2017. Titles and abstracts were screened independently and in duplicate. One author identified eligible articles, and completed quality appraisal, and data extraction.

Results: The search yielded 24,903 records (12,180 from the original search and 12,723 from the subsequent search), and 43 articles were included in the review. Eleven and 33 articles described evaluations of reliability, and construct validity, respectively. Estimates of measurement error were either reported in or computed from reliability studies. The most common methodological issue for each measurement property was: reliability-lack of description of the intraclass correlation coefficient (ICC) model/formula used (36%); measurement error-lack of mention of consistency in test conditions (29%); and construct validity-lack of details on evaluator position, qualifications, or training (44%). Twelve walk tests were evaluated using 63 unique protocols. Test distance ranged from 3 to 12 metres, and 5 to 10 metres for walk tests administered at a comfortable and fast pace, respectively. The 10-metre walk test at a comfortable pace (10mCWT) was most commonly evaluated (23 articles, 53%). Only 2 articles included participants exclusively in the acute phase (<1 month) post-stroke. Walking pace and walkway surface, but not walkway length comparing distances of 5, 8, and 10 metres, influenced walking speed. ICCs for test-retest reliability ranged from 0.80 to 0.99 across walk tests. Minimal detectable change values at the 90% confidence level ranged from 0.04 to 0.36 for the 3-, 5-, 6-, and 10mCWTs, and 0.06 to 0.24 for the 6- and 10-metre walk test at a fast pace. Across walk tests, performance was most frequently correlated with measures of strength (r=0.31-0.80), balance (r=0.59 to 0.76), and physical activity (r=0.26-0.79; p<0.05).

Conclusion(s): Evidence supporting excellent reliability and construct validity of distance-limited walk tests post-stroke has been reported. Studies applicable to practice in acute-care settings, however, are lacking.

Implications: Given the variation in protocols, and influence of walking pace and walkway surface on performance, a standardized stroke-specific protocol for clinical practice and program evaluation across the care continuum is needed. Quality appraisal findings can be used to improve the design of future research. Estimates of reliability and validity may help to motivate physical therapists to adopt walk tests in clinical practice. Estimates of minimal detectable change can inform interpretation of change in patient performance and are specific to the walk test protocol and stroke population from which they were derived.

Funding, acknowledgements: Funding was provided by the Heart & Stroke Foundation, Canadian Institutes of Health Research, and Canadian Frailty Network.

Keywords: stroke rehabilitation, distance-limited walk tests, assessment

Topic: Neurology: stroke

Did this work require ethics approval? No

Institution: University of Toronto

Committee: Health Sciences

Reason: Study involved systematic review of published articles