The effect of environment and task on gait parameters after stroke: a randomized comparison of measurement conditions

The purpose of this study was to assess the effect of environment and a secondary task on gait parameters in community ambulant stroke survivors and to assess the contribution of clinical symptoms to gait performance. Twenty-seven people with stroke (mean age, 61±11.6y; mean time since stroke onset, 45.8±34.2mo), living at home, were recruited from community stroke groups and from a local rehabilitation unit. Selection criteria included the following: ability to give informed consent, unilateral first ever or recurrent stroke at least 6 months previously, walking independently in the community, a gait speed between 24 and 50m/min, Mini-Mental State Examination score of 24 or higher, and no severe comorbidity. Twenty-seven people with a mean baseline gait speed of 42.2±5.9m/min were randomly allocated to 1 of 9 conditions in which the setting and distraction were manipulated. Analysis of variance showed a significant main effect for environment (P=.046) but not for task (P=.37). The interaction between task and environment was not significant (P=.73). Adjusting for baseline gait speed, people walked on average 8.8m/min faster in the clinic (95% confidence interval, 0.3-17.3m/min) than in the mall. Scores for fatigue, anxiety and depression, and attentional deficit were higher than normative values but did not influence gait performance.