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S. O'Brien1, J. De La Cruz1, T. Moore1, M. Osgood1, S. Williams1
1Nazareth College, Physical Therapy, Rochester, United States
Background: Patients with severe stroke commonly live with chronic impairments that require ongoing therapies.
Purpose: The purpose of this study was to determine whether patients with severe stroke show functional improvement in gait functional outcomes when participating in a student-run pro bono clinic. A secondary purpose was to compare the clinical application of gait speed cut-offs as described by Perry et al. (1995) and Fulk et al. (2017), with the latter cutoffs developed using community-dwelling post-stroke patient data. The choice of threshold may have clinical implications for practice, which has not been investigated previously.
Methods: Patients received 10 weekly 1-hour PT sessions which were provided by supervised second-year DPT students. Admission and discharge values for the 10 meter walk test (10MWT) and 6 minute walk test (6MWT) were extracted via retrospective chart reviews of the 2019 and 2019 fall and spring clinics. Descriptive statistics for patient characteristics and t-tests to compare differences between admission and discharge values were applied to data. After converting 6MWT distance to meters/sec, comparison of the gait speed cut-offs (Perry vs Fulk) were applied to discharge values to discern clinical relevance for this population. The number of patients who fell within the Perry gait speed cut-offs: household (<0.4m/s), limited community (0.4-0.8 m/s), and community (>0.8 m/s) ambulation were compared to the number of patients who fell within the Fulk gait speed cut-offs: household (<0.49 m/s), limited community (0.49-0.93 m/s) and community (>0.93 m/s) ambulation.
Results: Subjects were considered to have severe stroke if they attended PT and at least one other pro-bono clinic for OT or ST during one semester. There were 16 patients that met this criteria. Subjects had a mean age of 62.2 (12.8) years, were a mean 4.8 (5) years post stroke, with a mean 3.6 (6.4) comorbidities. Mean gait speed (10 MWT) did not change (p=0.449), however, a change was found in mean distance for the 6MWT (p=0.042). Subjects that were initially classified “household” with either cut-off did not improve with PT. At discharge, gait speed categorized more subjects as household ambulators under Fulk cut-offs compared to the Perry cut-offs. However, discharge ambulation distance (6MWT) classified 4 patients into the unlimited community category.
Conclusions: A low dose of PT yielded measurable change in distance walked (6MWT) but not in gait speed (10MWT) in patients with severe, chronic stroke. Slower gait speed thresholds (Perry) allocated patients into each category of gait speed function (10MWT) at discharge, while Fulk cut-offs did not categorize any patients into the unlimited community category, making ambulation distance the better discriminator of gait function.
Implications:
Clinicians working with community dwelling patients with chronic stroke should consider only using the 6MWT for assessment of gait function and apply Fulk’s cut-offs because the threshold is raised for community level ambulation function. If the 10MW was the sole test of ambulation function, gains in endurance function would have been missed. If PTs use the gait speed cut-offs (Perry) for goals, discharge from PT may occur prematurely and with concomitant lasting disability.
Funding acknowledgements: No funding was received for this study.
Keywords:
Chronic stoke
Gait function
Community dwelling
Chronic stoke
Gait function
Community dwelling
Topics:
Neurology: stroke
Disability & rehabilitation
Community based rehabilitation
Neurology: stroke
Disability & rehabilitation
Community based rehabilitation
Did this work require ethics approval? Yes
Institution: Nazareth College
Committee: Human Subjects Research Committee
Ethics number: SP 2021-12
All authors, affiliations and abstracts have been published as submitted.
