Gains in Distance Walking in a 3-Month Follow-Up Poststroke: What Changes?

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Abstract
Statement of Problem. Distance walking remains compromised for many adults poststroke. The purpose of this study was to examine if the amelioration of strokerelated neuromuscular impairments, improved cardiovascular fitness, or better balance contributed to gains in distance walking. Method of Study. The authors gathered baseline data of 92 adults at an average of 75 days poststroke and again 3 months later. Participants performed a bicycle ergometry stress test, a 6-min walk, and a Fugl-Meyer assessment for motor control, strength, and balance testing. The gain in walk distance was modeled using multiple regression with the variables of gains in peak VO2 lower limb control, plantar flexion strength, and balance. Separate analyses were done for poor performers, that is, participants who walked less than the median distance (213 m) at baseline and good performers, that is, participants who walked more than 213 m. Results. For poor performers, the gain in balance was the only significant predictor of the gain in distance walking and accounted for 16% of the variance. For good performers, gains in peak VO2 and the lower limb Fugl-Meyer score were significant predictors and accounted for 28% of the variance. Discussion. These results suggest that rehabilitation efforts to improve distance walking should focus on different factors depending on initial distance walked.