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Clin Rehabil. 2008 Jun;22(6):556-63. doi: 10.1177/0269215507085378.

Mobility beyond the clinic: the effect of environment on gait and its measurement in community-ambulant stroke survivors.

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  • 1School of Physiotherapy, Centre for Physiotherapy Research, University of Otago, New Zealand.



To explore the impact of a complex community environment on gait parameters (speed, step length and cadence) for community-dwelling participants with a previous stroke, and compare outcome measures commonly used in a clinical environment.


Repeated measurement of participants in different environments.


One clinic and two community environments (suburban street and shopping mall).


Thirty community-dwelling stroke participants with chronic stroke who were classified according to gait speed (20-50 m/min on 10-metre timed walk) as marginal community walkers.


During a six-minute walk test (6MWT) a step activity monitor (SAM) and odometer were used to calculate gait speed, step length and cadence. The 10-metre timed walk (10MTW) was measured in a clinic environment.


A mixed linear model examined differences in gait measurements in the different environments. Bland-Altman analysis illustrated agreement between gait speed measures (6MWT and 10MTW).


A statistically significant, but not a clinically significant difference in gait speed between some environments was found. Gait speed was slowest in the mall and fastest in the street with a difference of only 2.1 m/min between these environments (95% confidence interval (CI) -3.8 to -0.5, P<0.01). Comparison of clinic 10MTW and street 6MWT showed wide limits of agreement (-18.5 to 16.9 m/min) which improved for clinic 6MWT and street 6MWT comparisons (-5.7 to 8.9 m/min).


Despite residual gait deficit, the gait parameters of these chronic stroke survivors did not deteriorate markedly under challenging conditions. The 6MWT is recommended as a clinical measure for community ambulation.

[PubMed - indexed for MEDLINE]
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