Enhanced Street Crossing Features are Associated with Higher Post-Stroke Physical Quality of Life

ABSTRACT

Background

Features of the physical environment may affect post-stroke recovery, but empirical evidence is limited. This study examines associations between features of the physical environment and post-stroke physical quality of life (PH-QOL).

Methods

The study sample included stroke survivors enrolled in the Caring for Adults Recovering from the Effects of Stroke project, a prospective cohort. Features of the physical environment surrounding participants’ home addresses were audited using Google Earth. Audits captured information about crossings (e.g. curb-cuts; range 0-4), street segments (e.g. sidewalks; range 0-17.5), and a route (e.g. parks; range 0-27) near participants’ home. Summary scores were categorized into tertials representing “few,” “some,” and “many” pedestrian-friendly features. Post-stroke PH-QOL was measured by the SF-12 (range 0-100) around 6 to 12-, 18-, 27-, and 36-months post-stroke. Linear mixed models were used to estimate PH-QOL over time. Chained multiple imputation was used to account for missing data.

Results

Two hundred and seventy-five participants were eligible, among whom 210 had complete data. Most participants lived in areas with “few” features to promote outdoor mobility. Participants living in environments with “some” crossing features had a 4.90 (95% CI: 2.32, 7.48) higher PH-QOL score across the observation period in comparison to participants living in environments with “few” crossing features. Features of the physical environment along street segments and routes were not associated with post-stroke PH-QOL.

Conclusion

Crossing features are associated with post-stroke PH-QOL. Modifying features of the physical environment at nearby crossings, such as curb-cuts, may be a promising strategy for increasing PH-QOL.

KEYWORDS:

• Built environment
• residence characteristics
• stroke
• quality of life
• rehabilitation

Disclosure statement

The authors report there are no competing interests to declare.

Additional information

Funding

This work was supported by the National Institute of Neurological Disorders and Stroke [U01 NS041588, 1R01NS092706,,1R01NS045789, 1R01NS075047, 1R01NS061846]; National Institute on Aging [U01 NS041588, 1R01AG049970, 3R01AG049970-0451]; National Institute of Child Health & Human Development [5F31HD098870].