Objective

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.

Design

Cross-sectional, secondary data analysis.

Setting

University/laboratory.

Participants

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

Interventions

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

Results

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.

Conclusions

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.

中文翻译：

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超越身体能力：与中风后真实世界步行活动相关的因素

客观的

确定在多个领域具有相似特征的慢性中风幸存者的同质亚群，并测试这些群体在现实世界的步行活动中是否存在差异。我们假设代表步行能力、社会心理、环境和认知领域的变量将是区分慢性中风幸存者真实世界步行活动的重要因素。

设计

横断面、二级数据分析。

环境

大学/实验室。

参与者

共有 283 名慢性（≥6mo）中风患者（N=238）。

干预措施

不适用。

主要观察指标

包括代表5个领域的13个变量：（1）步行能力：6分钟步行测试（6MWT）、步态自选速度（SSS）；(2) 社会心理：Patient Health Questionnaire-9，活动特定的平衡信心 (ABC) 量表；(3)身体健康：低密度脂蛋白胆固醇、体重指数、查尔森合并症指数(CCI)；（4）认知：蒙特利尔认知评估（MoCA）；（5）环境：生活状况和婚姻状况、工作状况、区域剥夺指数（ADI）、步行得分。混合建模用于识别中风幸存者的潜在类别。在确定潜在类别后，以每天步数 (SPD) 衡量的步行活动作为远端结果包括在内，以了解类别在现实世界的步行中是否存在有意义的不同

结果

选择了具有 3 个潜在类别的模型。6MWT、SSS、ABC 量表和步行得分在所有 3 个班级中都有显着差异。MoCA、ADI 和 CCI 在 3 个类中的 2 个之间也存在差异。重要的是，SPD 的远端结果在所有类别中都显着不同，这表明真实世界的步行活动在混合模型识别的各组中有所不同。

结论

步行能力较低、自我效能较低、认知能力较低和面积剥夺较大的中风幸存者具有较低的 SPD。这些结果表明，在制定干预措施以改善中风后真实世界的步行活动时，还应考虑物理和社会环境（包括社会经济因素）和认知功能。