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

Abstract

Purpose: 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.

Implications for Rehabilitation

• Many tests assessing walking in stroke survivors are available in the literature. The Six Minute Walk Test, Ten Metre Comfortable Walk Test, Ten Metre Fast Walk Test, Functional Ambulation Categories and Six Metre Walk Test on parquet and carpet have been most frequently clinimetrically evaluated. These tests amongst others, have been shown to be valid, reliable and feasible for stroke survivors.

• With the wide variety of walking tests, it is important to choose an appropriate walking test suiting the specific aim of the clinician or researcher.

Keywords::

• Stroke
• walking
• measurement

Acknowledgements

We are grateful to everyone who has supported this review in any way, and we would like to specifically thank the following people for their greatly appreciated support: A. M. J. Kokkeler, M.Sc., PT for being the third reviewer during the quality assessment, C. B. Terwee Ph.D. and M. van der Leeden, Ph.D. for their support in designing the quality assessment and A. Beelen, Ph.D. for critical reading the manuscript.

Declaration of Interest: The authors report no declarations of interest and no funding sources.

Appendix 1: Search Strategy PubMed

#1(P): (“stroke”[MeSH] OR stroke[tiab] OR “cerebrovascular accident”[tiab] OR “brain vascular accident”[tiab] OR “cerebrovascular disorders”[tiab] OR CVA*[tiab] OR cerebrovasc*[tiab] OR “cerebral vascular”[tiab] OR cerebrovascular[tiab] OR hemipleg*[tiab] OR hemipar*[tiab] OR ((cerebral[tiab] OR cerebellar[tiab] OR brain*[tiab] OR vertebrobasilar[tiab]) AND (infarct*[tiab] OR ischemi*[tiab] OR thrombosis[tiab] OR emboli*[tiab] OR apoplexy[tiab])) OR ((cerebral[tiab] OR brain*[tiab] OR subarachnoid[tiab] OR intracerebral[tiab] OR intracranial[tiab] OR parenchymal[tiab] OR intraventricular[tiab] OR periventricular[tiab] OR cerebellar[tiab] OR infratentorial[tiab] OR supratentorial[tiab]) AND (haemorrhage[tiab] OR hemorrhage[tiab] OR haematoma[tiab] OR hematoma[tiab] OR bleed*[tiab] OR aneurysm[tiab])) NOT “cerebral palsy”)

#2(I): (“gait”[MeSH] OR gait[tiab] OR walk*[tiab] OR “walking”[MeSH] OR walking[tiab] OR ambulation[tiab] OR mobility[tiab] OR ((minute*[tiab] OR meter*[tiab]) AND walk*[tiab]))

#3(I): (test[tiab] OR tests[tiab] OR instrument*[tiab] OR (performance-based[tiab] AND method*[tiab]) OR measur*[tiab] OR ((performance[tiab] OR observational[tiab]) AND (index[tiab] OR indices[tiab])) OR assessment*[tiab] OR (objective[tiab] AND method*[tiab]) OR “objective evaluation”[tiab] OR (objective[tiab] AND function*[tiab]) OR “objective disability”[tiab] OR (subjective[tiab] AND method*[tiab]) OR “subjective evaluation”[tiab] OR (subjective[tiab] AND function*[tiab]) OR “subjective disability”[tiab] OR (observational[tiab] AND method*[tiab]) OR (observation-based[tiab] AND method*[tiab]) OR “observed disability”[tiab] OR (observed[tiab] AND function*[tiab]) OR scale*[tiab] OR questionnair*[tiab] OR exam*[tiab] OR investigat*[tiab] OR “outcome assessment (health care)”[MeSH] OR “outcome assessment”[tiab])

#4(O): (“validation studies”[pt] OR “reproducibility of results”[MeSH] OR reproducibility[tiab] OR reproducib*[title] OR “measurements”[MeSH] OR psychometr*[title] OR clinimetr*[title] OR clinometr*[title] OR “observer variation”[MeSH] OR observer variation[title] OR reliability[tiab] OR reliab*[title] OR validity[tiab] OR validation[tiab] OR valid*[title] OR ((generaliza*[tiab] OR generalisa*[tiab] OR reliab*[tiab] OR “intraclass correlation”[tiab]) AND coefficient*[tiab]) OR “internal consistency”[tiab] OR (cronbach*[tiab] AND (alpha[tiab] OR alphas[tiab])) OR (item[tiab] AND (correlation*[tiab] OR selection*[tiab] OR reduction*[tiab])) OR agreement[tiab] OR precision[title] OR imprecision[title] OR test-retest[tiab] OR (test[tiab] AND retest[tiab]) OR (reliab*[tiab] AND (test[tiab] OR retest[tiab])) OR ((interrater[tiab] OR inter-rater[tiab] OR intrarater[tiab] OR intra-rater[tiab] OR intertester[tiab] OR inter-tester[tiab] OR intratester[tiab] OR intra-tester[tiab] OR interobserver[tiab] OR inter-observer[tiab] OR intraobserver[tiab] OR intra-observer[tiab] OR intertechnician[tiab] OR intertechnician[tiab] OR intratechnician[tiab] OR intra-technician[tiab] OR interexaminer[tiab] OR inter-examiner[tiab] OR intraexaminer[tiab] OR intra-examiner[tiab] OR interassay[tiab] OR inter-assay[tiab] OR intraassay[tiab] OR intra-assay[tiab] OR interindividual[tiab] OR inter-individual[tiab] OR intraindividual[tiab] OR intra-individual[tiab] OR interparticipant[tiab] OR inter-participant[tiab] OR intraparticipant[tiab] OR intra-participant[tiab]) AND reliab*[tiab]) OR kappa[tiab] OR kappa’s[tiab] OR kappas[tiab] OR “coefficient of variation”[tiab] OR repeatab*[title] OR ((replicab*[tiab] OR repeated[tiab]) AND (measur*[tiab] OR findings[tiab] OR result*[tiab] OR test[tiab] OR tests[tiab])) OR concordance[title] OR discriminative[title] OR “factor analysis”[tiab] OR “factor analyses”[tiab] OR (factor[title] AND structure*[title]) OR dimensionality[title] OR subscale*[title] OR “multitrait scaling analysis”[tiab] OR “multitrait scaling analyses”[tiab] OR “item discriminant”[title] OR “interscale correlation”[tiab] OR “interscale correlations”[tiab] OR ((error[tiab] OR errors[tiab]) AND (measure*[tiab] OR correlat*[tiab] OR evaluat*[tiab] OR accuracy[tiab] OR accurate[tiab] OR precision[tiab] OR mean[tiab])) OR “individual variability”[title] OR “interval variability”[title] OR “rate variability”[title] OR “variability analysis”[tiab] OR (uncertainty[title] AND (measurement[title] OR measuring[title])) OR “standard error of measurement”[tiab] OR sensitiv*[title] OR sensitivity[tiab] OR responsive*[title] OR responsiveness[tiab] OR (limit[title] AND detection[title]) OR “minimal detectable concentration”[tiab] OR interpretab*[title] OR Interpretability[tiab] OR (small*[tiab] AND (real[tiab] OR detectable[tiab]) AND (change[tiab] OR difference[tiab])) OR “meaningful change”[tiab] OR “minimal important change”[tiab] OR “minimal important difference”[tiab] OR “minimally important change”[tiab] OR “minimally important difference”[tiab] OR (minimal*[tiab] AND “detectable change”[tiab]) OR “minimal detectable difference”[tiab] OR “minimally detectable difference”[tiab] OR “ceiling effect”[tiab] OR “floor effect”[tiab] OR “item response model”[tiab] OR Rasch[tiab] OR “differential item functioning”[tiab])

#5:#1 AND #2 AND #3 AND #4

#6:#5 NOT (“review”[pt] OR “addresses”[pt] OR “biography”[pt] OR “case reports”[pt] OR “comment”[pt] OR “directory”[pt] OR “editorial”[pt] OR “festschrift”[pt] OR “interview”[pt] OR “lectures”[pt] OR “legal cases”[pt] OR “legislation”[pt] OR “letter”[pt] OR “news”[pt] OR “newspaper article”[pt] OR “patient education handout”[pt] OR “popular works”[pt] OR “congresses”[pt] OR “consensus development conference”[pt] OR “consensus development conference, nih”[pt] OR “practice guideline”[pt]) NOT (“animals”[MeSH] NOT “humans”[MeSH])