ORIGINAL RESEARCH| Volume 102, ISSUE 10, P1880-1887.e1, October 2021

Beyond Physical Capacity: Factors Associated With Real-world Walking Activity After Stroke

Published:April 21, 2021DOI:



      To identify homogeneous subsets of survivors of chronic stroke who share similar characteristics across several domains and test if these groups differ in real-world walking activity. We hypothesized that variables representing the domains of walking ability, psychosocial, environment, and cognition would be important contributors in differentiating real-world walking activity in survivors of chronic stroke.


      Cross-sectional, secondary data analysis.




      A total of 283 individuals with chronic (≥6mo) stroke (N=238).


      Not applicable.

      Main Outcome Measures

      Thirteen variables representing 5 domains were included: (1) walking ability: 6-minute walk test (6MWT), self-selected speed (SSS) of gait; (2) psychosocial: Patient Health Questionnaire-9, Activities-specific Balance Confidence (ABC) scale; (3) physical health: low-density lipoprotein cholesterol, body mass index, Charlson Comorbidity Index (CCI); (4) cognition: Montreal Cognitive Assessment (MoCA); and (5) environment: living situation and marital status, work status, Area Deprivation Index (ADI), Walk Score. Mixture modeling was used to identify latent classes of survivors of stroke. After identifying the latent classes, walking activity, measured as steps per day (SPD), was included as a distal outcome to understand if classes were meaningfully different in their real-world walking


      A model with 3 latent classes was selected. The 6MWT, SSS, ABC scale, and Walk Score were significantly different among all 3 classes. Differences were also seen for the MoCA, ADI, and CCI between 2 of the 3 classes. Importantly, the distal outcome of SPD was significantly different in all classes, indicating that real-world walking activity differs among the groups identified by the mixture model.


      Survivors of stroke with lower walking ability, lower self-efficacy, lower cognitive abilities, and greater area deprivation had lower SPD. These results demonstrate that the physical and social environment (including socioeconomic factors) and cognitive function should also be considered when developing interventions to improve real-world walking activity after stroke.


      List of abbreviations:

      ABC (Activities-specific Balance Confidence), AIC (Akaike's information criterion), ADI (Area Deprivation Index), BIC (Bayesian information criterion), BMI (body mass index), CCI (Charlson Comorbidity Index), IQR (interquartile range), LDL (low-density lipoprotein), MoCA (Montreal Cognitive Assessment), PHQ-9 (Patient Health Questionnaire-9), SSS (self-selected speed), 6MWT (6-minute walk test), SPD (steps per day), VLMR (Vuong-Lo-Mendell-Rubin likelihood ratio test)
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