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K. Miyata1, S. Hasegawa2,3, H. Iwamoto4, T. Otani5, Y. Kaizu2,5, T. Shinohara6, S. Usuda2
1Ibaraki Prefectural University of Health Science, Department of Physical Therapy, Ami, Japan, 2Gunma University Graduate School of Health Sciences, Department of Rehabilitation Sciences, Maebashi, Japan, 3Public Nanokaichi Hospital, Department of Rehabilitation, Tomioka, Japan, 4Hidaka Rehabilitation Hospital, Department of Rehabilitation Center, Takasaki, Japan, 5Hidaka Hospital, Department of Rehabilitation Center, Takasaki, Japan, 6Takasaki University of Health and Welfare, Department of Physical Therapy, Faculty of Health Care, Takasaki, Japan
Background: After a stroke, the recovery of aspects of mobility (such as gait speed) is essential to enable the individual to safely perform activities of daily living. Balance is a key determinant of gait speed. However, balance is a complex ability involving several postural control systems, and it is unclear which system relates to gait speed. By clarifying the relationship between gait speed and postural control systems, we may guide the selection of physical therapy interventions to improve gait speed in individuals with subacute stroke.
Purpose: The purpose of this study was to determine which postural control systems are related to walking speed in individuals with subacute stroke.
Methods: This cross-sectional study included 101 individuals with subacute stroke able to walk without physical assistance (age, 70.3 ± 10.8 years). We collected data regarding age, sex, time since stroke onset, type of stroke, affected side, and lower-extremity motor function. We further collected two core assessments of gait speed and balance at the same time point. Both comfortable walking speed (CWS) and the balance evaluation systems test (BESTest) have been shown to be validated and reliable measures in individuals with stroke. Postural control systems were evaluated using sections of the BESTest that categorize balance into six systems: biomechanical constraints, stability limits and verticality, anticipatory postural adjustments, postural response, sensory orientation, and stability in gait.
Multivariate linear regression analysis confirmed the relationship between gait speed and components of the postural control system after influences of the confounding variables of lower-extremity motor function, type of stroke, and age were controlled. Due to the multicollinearity issue of multivariate linear regression, we confirmed the variance inflation factor (VIF) was <5.0. Gait stability was not used as an independent variable as it included both walking speed and dynamic walking ability. P-values <0.05 were considered significant.
Multivariate linear regression analysis confirmed the relationship between gait speed and components of the postural control system after influences of the confounding variables of lower-extremity motor function, type of stroke, and age were controlled. Due to the multicollinearity issue of multivariate linear regression, we confirmed the variance inflation factor (VIF) was <5.0. Gait stability was not used as an independent variable as it included both walking speed and dynamic walking ability. P-values <0.05 were considered significant.
Results: The mean CWS was 0.96 ± 0.4 m/s. Fifty-nine percent of CWS variance was explained by the BESTest biomechanical constraints (β=0.24) and anticipatory postural adjustments sections (β=0.36) after the influences of lower-extremity motor function, type of stroke, and age were controlled (p<0.01). The VIF ranged from 1.146 to 4.880, and the normality of the residuals in the multivariate regression analysis was confirmed.
Conclusion: The findings of this study indicate that the postural control systems of biomechanical constraints and anticipatory postural adjustments are related to the gait speed of individuals with subacute stroke. Biomechanical constraints require muscle strength, suggesting that muscle strength is important for gait speed not only in older adults but also in individuals with stroke.
Conclusion: The findings of this study indicate that the postural control systems of biomechanical constraints and anticipatory postural adjustments are related to the gait speed of individuals with subacute stroke. Biomechanical constraints require muscle strength, suggesting that muscle strength is important for gait speed not only in older adults but also in individuals with stroke.
Conclusion(s): The findings of this study indicate that the postural control systems of biomechanical constraints and anticipatory postural adjustments are related to the gait speed of individuals with subacute stroke. Biomechanical constraints require muscle strength, suggesting that muscle strength is important for gait speed not only in older adults but also in individuals with stroke.
Implications: It is believed that these findings will assist physical therapists assess balance in relation to gait speed in individuals with subacute stroke and help determine which postural control systems should be prioritized in therapeutic interventions.
Funding, acknowledgements: This work was supported by the Japan Society for the Promotion of Science KAKENHI Grant Number 18K17724.
Keywords: stroke, gait speed, BESTest
Topic: Neurology: stroke
Did this work require ethics approval? Yes
Institution: Gunma University
Committee: Ethical Review Board for Medical Research Involving Human Subjects
Ethics number: #15–73
All authors, affiliations and abstracts have been published as submitted.
