Predictors of Independent Community Ambulation in Individuals with Chronic Stroke: A Cross-Sectional Study of Gait Speed, Gait Endurance, and Balance Self-Efficacy

Abstract

Background/Objectives: Community ambulation after stroke depends on locomotor capacity and confidence in everyday environments. We compared functional performance across three community walking levels and identified constructs independently associated with being an independent community walker in individuals with chronic stroke. Methods: Adults admitted to an acute-care general hospital or an inpatient rehabilitation hospital were enrolled. Community walking level was classified by a self-reported questionnaire. Primary constructs were gait speed, gait endurance, and balance self-efficacy measured with standard clinical tests. Additional measures described balance, lower-limb motor function, and task-based mobility. Group differences were examined with one-way analysis of variance with Bonferroni comparisons. Community walking status was modeled with binary logistic regression using forward stepwise selection. Results: Fifty-nine individuals were analyzed. Performance differed across levels. Effect sizes were small, medium, or large overall. Independent community walkers showed faster gait speed, longer walking distance, and higher balance self-efficacy, with the same direction for balance and lower-limb motor scores and shorter times on task-based tests. In univariable models, age, sex, and time since stroke were not associated with independence, whereas assistive device use related to lower odds. In the multivariable model, gait speed, gait endurance, and balance self-efficacy retained independent associations with independent community walking. Other measures were not retained after adjustment. Conclusions: Community walking status in chronic stroke relates most closely to gait speed, gait endurance, and balance self-efficacy. Evaluation can emphasize the 10 m Walk Test, 6 Min Walk Test, and Activities-specific Balance Confidence Scale, with impairment and task-based tests used to guide intervention planning.