Is outdoor use of the six-minute walk test with a global positioning system in stroke patients' own neighbourhoods reproducible and valid?

Objective: To examine the reproducibility, responsiveness and concurrent validity of the six-minute walk test (6MWT) when tested outdoors in patients' own neighbourhoods using a global positioning system (GPS) or a measuring wheel. Methods: A total of 27 chronic stroke patients, discharged to their own homes, were tested twice, within 5 consecutive days. The 6MWT was conducted using a GPS and an measuring wheel simultaneously to determine walking distance. Reproducibility was determined as test-retest reliability and agreement, using the intraclass correlation coefficient, standard error of measurement and Bland & Altman plots. Responsiveness was expressed as the smallest real difference and visualized in Bland & Altman plots. Pearson's correlation coefficient (r) was used to study concurrent validity between the GPS and measuring wheel. Results: Intraclass correlation coefficiens were 0.96 for the GPS and 0.98 for the measuring wheel, and standard error of measurement scores were 11.9 m for the measuring wheel and 18.1 m for the GPS, resulting in smallest real differences of 33.0 m and 50.2 m, respectively. Concurrent validity was strong (r = 0.99). Conclusion: These results indicate that the outdoor 6MWT using a GPS or measuring wheel is reproducible, responsive and concurrently valid. This suggests that therapists working in the community can use the outdoor 6MWT as a reliable, responsive and valid test. © 2011 Foundation of Rehabilitation Information

Characteristics of daily life gait in fall and non fall-prone stroke survivors and controls

BACKGROUND: Falls in stroke survivors can lead to serious injuries and medical costs. Fall risk in older adults can be predicted based on gait characteristics measured in daily life. Given the different gait patterns that stroke survivors exhibit it is unclear whether a similar fall-prediction model could be used in this group. Therefore the main purpose of this study was to examine whether fall-prediction models that have been used in older adults can also be used in a population of stroke survivors, or if modifications are needed, either in the cut-off values of such models, or in the gait characteristics of interest. METHODS: This study investigated gait characteristics by assessing accelerations of the lower back measured during seven consecutive days in 31 non fall-prone stroke survivors, 25 fall-prone stroke survivors, 20 neurologically intact fall-prone older adults and 30 non fall-prone older adults. We created a binary logistic regression model to assess the ability of predicting falls for each gait characteristic. We included health status and the interaction between health status (stroke survivors versus older adults) and gait characteristic in the model. RESULTS: We found four significant interactions between gait characteristics and health status. Furthermore we found another four gait characteristics that had similar predictive capacity in both stroke survivors and older adults. CONCLUSION: The interactions between gait characteristics and health status indicate that gait characteristics are differently associated with fall history between stroke survivors and older adults. Thus specific models are needed to predict fall risk in stroke survivors

Predicting mobility outcome one year after stroke: a prospective cohort study.

Contains fulltext : 49252.pdf (publisher's version ) (Open Access)OBJECTIVE: To develop a prognostic model to predict mobility outcome one year post-stroke. DESIGN: Prospective cohort study in patients with a first-ever stroke admitted for inpatient rehabilitation. PATIENTS: A total of 217 patients with stroke (mean age 58 years) following inpatient rehabilitation in 4 rehabilitation centres across the Netherlands. METHODS: Mobility was measured using the Rivermead Mobility Index at one year poststroke. Included independent variables were: patient and stroke characteristics, functional status, urinary incontinence, sitting balance, motor and cognitive function. Univariate and multivariate linear regression analyses were performed in a model-developing set (n=174) and the model was validated in cross-validation set (n=43). RESULTS: Total Rivermead Mobility Index score at one year post-stroke was predicted by functional status, sitting balance, time between stroke onset and measurement, and age. The derived model predicted 48% of the variance, while validation in the cross-validation set resulted in an adjusted R(2) of 0.47. CONCLUSION: The present prospective study shows that outcome of mobility one year after stroke can be predicted validly by including functional status, sitting balance, moment of admission to the rehabilitation centre after stroke onset and age

The shuttle walk test: a new approach to functional walking capacity measurements for patients after stroke?

Item does not contain fulltextOBJECTIVE: To determine the construct validity, test-retest reliability, and measurement error of the shuttle walk test (SWT) for patients after stroke. DESIGN: Clinimetric study. SETTING: Three rehabilitation centers in the Netherlands. PARTICIPANTS: A sample of patients after stroke (N=75; mean age +/- SD, 58.8+/-9.8y) who are capable of walking without physical assistance. Patients were excluded if they had sustained a subarachnoid hemorrhage or a stroke in the cerebellum or brainstem, or had any other conditions that limited their walking capacity more than the current stroke, or had sensory aphasia. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Construct validity (6-minute walk test [6MWT]) and test-retest reliability of the SWT were assessed. Measurement error was determined with the standard error of measurement (SEM), limits of agreement, and smallest detectable differences (SDDs). RESULTS: Construct validity was confirmed by high significant correlations (r(p)>/=.65, P/=0.8m/s). In the small group (n=12) of low-speed walkers (<0.8m/s), no significant correlations and differences between both tests were found except for walking distance in favor of the 6MWT. Test-retest reliability was good (intraclass correlation coefficient model 2,1 [ICC(2,1)]=.961 [.936-.977]). SEM was 6.0%, and the SDDs for individual and group were 302.0m (37%) and 38.7m (5%), respectively. CONCLUSIONS: The SWT is a valid and reliable measure and therefore a feasible instrument to determine functional walking capacity of patients after stroke, especially in high-speed walkers

Walking tests for stroke survivors: a systematic review of their measurement properties

Item does not contain fulltextPURPOSE: To provide an overview of walking tests including their measurement properties that have been used in stroke survivors. METHOD: Electronic databases were searched using specific search strategies. Retrieved studies were selected by using specified inclusion criteria. A modified consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist was applied for methodological quality assessment of the included studies. A quality assessment for statistical outcomes was used to assess measurement properties of the walking tests. Tests that were included were categorized according to the framework of the international classification of functioning, disability and health (ICF). RESULTS: Thirty-two studies, evaluating 23 walking tests, were included. The tests assessed walking using the outcome measures of walking speed, walking distance, functional ambulation and walking on different surfaces. The methodological design and statistical methods of most studies evaluating reliability and criterion validity were sufficient, and found the outcome measures to be reliable and valid. However, data on measurement error, minimal important difference and minimal important change were lacking and responsiveness was correctly evaluated in one study only. CONCLUSIONS: Many walking tests have been clinimetrically evaluated in stroke survivors. Most walking tests were found to be reliable and valid

Thai celebrity culture and the Bangkok teenage audience

This study explores the media reception patterns and impact of celebrity culture on identity construction of Bangkok teenagers. The hypothesis is that audiences do not necessarily decode identical media messages in the same way as encoded. Bangkok teenagers with different ages and genders are likely to read texts regarding celebrities differently. Celebrities may not influence all teenage audiences to a significant degree and, for affected teenagers, the degree of influence may differ. Celebrities may act as good or as bad role models. This study employs a combination of quantitative and qualitative methods including (1) preliminary survey, (2) analysis of media content from quantitative and qualitative points of view, and (3) focus group discussions with different categories of Bangkok teenagers. These evolved around a selection of media items related to issues of fashion, substance abuse, and sexuality. The findings provided evidence that the meanings the young audiences derived from the celebrity coverage did not always coincide with those encoded by the media and that often alternative readings were generated alongside the preferred reading. Cultural ideologies and social environment were found to be the most significant factors impacting the text decoding. This investigation did not corroborate the popular belief that Bangkok teenagers were uncritical victims of media coverage. Data confirmed that they are critical and active media users and the extent to which their behavior is shaped by the media is relatively limited. Celebrity culture did not seem to influence Bangkok youth to an extent that can be regarded as socially harmful or culturally detrimental. On the contrary, it had certain positive effects in areas such as education, music, sports, and lifestyles. Peer groups were found to be more influential than celebrities in areas such as substance abuse and sexuality. This project makes contributions to the area of mass communication; audience reception and media effects in particular, and celebrity and youth culture studies.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Walking tests for stroke survivors: a systematic review of their measurement properties

Item does not contain fulltextPURPOSE: To provide an overview of walking tests including their measurement properties that have been used in stroke survivors. METHOD: Electronic databases were searched using specific search strategies. Retrieved studies were selected by using specified inclusion criteria. A modified consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist was applied for methodological quality assessment of the included studies. A quality assessment for statistical outcomes was used to assess measurement properties of the walking tests. Tests that were included were categorized according to the framework of the international classification of functioning, disability and health (ICF). RESULTS: Thirty-two studies, evaluating 23 walking tests, were included. The tests assessed walking using the outcome measures of walking speed, walking distance, functional ambulation and walking on different surfaces. The methodological design and statistical methods of most studies evaluating reliability and criterion validity were sufficient, and found the outcome measures to be reliable and valid. However, data on measurement error, minimal important difference and minimal important change were lacking and responsiveness was correctly evaluated in one study only. CONCLUSIONS: Many walking tests have been clinimetrically evaluated in stroke survivors. Most walking tests were found to be reliable and valid

Susceptibility to deterioration of mobility long-term after stroke: a prospective cohort study.

Item does not contain fulltextBACKGROUND AND PURPOSE: The aim of the present study was to identify clinical determinants able to predict which individuals are susceptible to deterioration of mobility from 1 to 3 years after stroke. METHODS: Prospective cohort study of stroke patients consecutively admitted for inpatient rehabilitation. A total of 205 relatively young, first-ever stroke patients were assessed at 1 and 3 years after stroke. Mobility status was determined by the Rivermead Mobility Index (RMI), and decline was defined as a deterioration of > or =2 points on the RMI. Univariate and multivariate logistic regression analyses were performed to identify prognostic factors for mobility decline. The discriminating ability of the model was determined using a receiver operating characteristic curve. RESULTS: A decline in mobility status was found in 21% of the patients. Inactivity and the presence of cognitive problems, fatigue, and depression at 1 year after stroke were significant predictors of mobility decline. The multivariate model showed a good fit (Hosmer-Lemeshow test P>0.05), and discriminating ability was good (area under the curve 0.79). CONCLUSIONS: Mobility decline is an essential concern in chronic stroke patients, especially because it might lead to activities of daily living dependence and affects social reintegration. Early recognition of prognostic factors in patients at risk may guide clinicians to apply interventions aimed to prevent deterioration of mobility status in chronic stroke

Effects of exercise training programs on walking competency after stroke: a systematic review.

Contains fulltext : 52602.pdf (publisher's version ) (Closed access)To determine the effectiveness of training programs that focus on lower-limb strengthening, cardiorespiratory fitness, or gait-oriented tasks in improving gait, gait-related activities, and health-related quality of life after stroke. Randomized controlled trials (RCTs) were searched for in the databases of Pubmed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, DARE, Physiotherapy Evidence Database (PEDro), EMBASE, Database of the Dutch Institute of Allied Health Care, and CINAHL. Databases were systematically searched by two independent researchers. The following inclusion criteria were applied: (1) participants were people with stroke, older than 18 yrs; (2) one of the outcomes focused on gait-related activities; (3) the studies evaluated the effectiveness of therapy programs focusing on lower-limb strengthening, cardiorespiratory fitness, or gait-oriented training; and (4) the study was published in English, German, or Dutch. Studies were collected up to November 2005, and their methodological quality was assessed using the PEDro scale. Studies were pooled and summarized effect sizes were calculated. Best-evidence synthesis was applied if pooling was impossible. Twenty-one RCTs were included, of which five focused on lower-limb strengthening, two on cardiorespiratory fitness training (e.g., cycling exercises), and 14 on gait-oriented training. Median PEDro score was 7. Meta-analysis showed a significant medium effect of gait-oriented training interventions on both gait speed and walking distance, whereas a small, nonsignificant effect size was found on balance. Cardiorespiratory fitness programs had a nonsignificant medium effect size on gait speed. No significant effects were found for programs targeting lower-limb strengthening. In the best-evidence synthesis, strong evidence was found to support cardiorespiratory training for stair-climbing performance. Although functional mobility was positively affected, no evidence was found that activities of daily living, instrumental activities of daily living, or health-related quality of life were significantly affected by gait-oriented training. This review shows that gait-oriented training is effective in improving walking competency after stroke

Identification of risk factors related to perceived unmet demands in patients with chronic stroke.

Contains fulltext : 52007.pdf (publisher's version ) (Closed access)PURPOSE: To investigate the prevalence of unmet demands concerning autonomy and participation and to identify risk factors related to these unmet demands in patients with chronic stroke. METHOD: A cross-sectional study of 147 patients three years after stroke. We assessed perceived unmet care demands in relation to problems of participation and autonomy measured by the Impact on Participation and Autonomy Questionnaire (IPAQ). Socio-demographic and health characteristics were analysed as potential risk factors for the prevalence of unmet demands, using multivariate regression analysis. RESULTS: A total of 33% of the patients perceived at least one unmet demand in one of the IPAQ subdomains. Risk factors significantly related to the presence of unmet demands were younger age, motor impairment, fatigue and depressive symptoms. Findings indicate that the model including these factors was fairly accurate in identifying patients having unmet demands and those not having unmet demands. CONCLUSIONS: Unmet care demands were present in a substantial proportion of the stroke patients. The risk factors identified are helpful for clinicians and health care providers to recognize patients who are at risk of perceiving unmet care demands and to optimize care to patients with chronic stroke