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Research Reports |
V.S. Mercer, PT, PhD, is Associate Professor, Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, CB#7135, Bondurant Hall, Ste 3022, Chapel Hill, NC 27599-7135 (USA).
J.K. Freburger, PT, PhD, is Research Associate and Fellow, Cecil G. Sheps Center for Health Services Research, and Research Scientist, Institute on Aging, University of North Carolina at Chapel Hill.
S.-H. Chang, PT, PhD, is Postdoctoral Research Scholar, Graduate Program in Physical Therapy and Rehabilitation Science, The University of Iowa, Iowa City, Iowa.
J.L. Purser, PT, PhD, is Assistant Professor, Division of Geriatrics, Department of Medicine, and Division of Physical Therapy, Department of Community and Family Medicine, and Senior Fellow, Center for the Study of Aging and Human Development, Duke University Medical Center, Durham, North Carolina.
Address all correspondence to Dr Mercer at: vmercer{at}med.unc.edu
Background: The Step Test (ST) is a measure of dynamic standing balance and paretic–lower-extremity motor control in patients with stroke. Little is known about the extent to which impairments assessed by the ST relate to activity and participation during stroke recovery.
Objective: The purpose of this study was to determine relationships between ST scores and measures of activity and participation during the first 6 months after stroke.
Design: This was a prospective cohort study.
Methods: Thirty-three individuals (18 men, 15 women) with a diagnosis of a single, unilateral stroke participated in the study. Participants were tested one time per month from 1 to 6 months poststroke. The ST was considered an impairment-level measure. Self-selected gait speed and the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) Physical Function Index (PFI) were used to assess physical function. Three domains (mobility, basic and instrumental activities of daily living, participation) of the Stroke Impact Scale were used to assess self-reported disability. Regression analyses were conducted to examine the bivariate associations between ST scores and each physical function and disability measure at each time point (1–6 months).
Results: The ST scores were positively associated with both physical function measures. The associations were stronger for self-selected gait speeds (R2=.60–.79) than for the PFI scores (R2=.32–.60). During the first 6 months after stroke, each additional step with the paretic lower extremity on the ST corresponded to a 0.07-m/s to 0.09-m/s increase in gait speed, and each additional step with the nonparetic lower extremity was associated with a 0.07-m/s to 0.08-m/s gait speed increase. The impairment-disability associations were weaker than the impairment-physical function associations.
Limitations: Limitations of the study include a relatively small sample size and lack of examiner blinding with regard to participant characteristics.
Conclusions: Impairments in balance and paretic–lower-extremity motor control, as measured by the ST, relate to physical function and disability during the first 6 months following stroke.
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