Walking speed and home adaptations are associated with independence after stroke: a population-based prevalence study

Torres, Juliana L.; Andrade, Fabíola B.; Lima-Costa, Maria Fernanda; Nascimento, Lucas R.

doi:10.1590/1413-81232022276.13202021

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ARTICLE • Ciênc. saúde coletiva 27 (06) • June 2022 • https://doi.org/10.1590/1413-81232022276.13202021 copy

Walking speed and home adaptations are associated with independence after stroke: a population-based prevalence study

Velocidade de marcha e adaptações no domicílio estão associadas à independência pós-acidente vascular cerebral: estudo de prevalência de base populacional

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

This study aimed at estimating the prevalence of stroke in older adults in Brazil, and at identifying the sociodemographic, health-related, health service-related, and environmental factors associated with independence in daily activities. Across-sectional, population-based study (Brazilian Longitudinal Study of Aging 2015-2016) was conducted. 536 individuals (≥ 50 years), from 9,412 participants, have had stroke and were included. Prevalence of stroke was 5.3% among individuals aged 50 years and over, increasing up to 8.0% among individuals aged 75 years and over, showing a dissimilar pattern between sex. Independence was associated with walking speed (Prevalence Ratio (PR) 2.72, 95%CI: 1.96 to 3.77), physical activity (PR 1.24; 95%CI: 1.04 to 1.47) and use of walking devices (PR 0.63; 95%CI: 0.41 to 0.96). A significant interaction was found between walking speed plus home adaptations and performance of daily living activities (PR 3.42; 95%CI: 1.04 to 11.29). The probability of independence was 40% among slow walkers (< 0.4 m/s), increasing up to 70% among fast walkers (> 0.8 m/s), and to 90% among those who also have home adaptations. Faster walking speed combined with home adaptations was the main factor associated with long-term independence after stroke.

Key words:
Activities of daily living; Cerebrovascular disease; Gait; Prevalence; Rehabilitation

Stroke Prevalence (%). Age
Sex	50+ years (n = 9,412)	60+ years (n = 5,164)	65+ years (n = 3,592)	75+ years (n = 1,480)
Female	4.7 (3.9 to 5.4)*	5.2 (4.3 to 6.1) *	5.3 (4.0 to 6.6) *	6.6 (3.3 to 9.9)
Male	6.1 (5.2 to 6.9)	7.3 (6.0 to 8.6)	8.6 (6.7 to 10.4)	9.8 (4.3 to 15.2)
Overall	5.3 (4.7 to 5.9)	6.1 (5.4 to 6.9)	6.8 (5.6 to 8.0)	8.0 (4.0 to 12.0)

Factors, by groups	Performance on activities of daily living (n = 536)		Prevalence ratio (95% CI); p value
Factors, by groups	Independent (n = 353)	Dependent (n = 183)
Sociodemographic characteristics
Sex, %
Female	48	50	Reference
Male	52	50	1.00 (0.84 to 1.18); p = 0.99
Age (years), mean (SD)	66 (12)	70 (16)	1.00 (0.99 to 1.00); p = 0.25
Education, %
0 to 3 years	42	53	Reference
4 to 7 years	32	24	1.16 (1.00 to 1.36); p = 0.05
≥ 8 years	26	23	1.10 (0.94 to 1.28); p = 0.25
Marital status, %
Married	61	52	Reference
Not married	39	48	0.90 (0.77 to 1.05); p = 0.18
Health-related characteristics
Time since stroke (years), mean (SD)	10 (11)	10 (13)	1.00 (0.99 to 1.00); p = 0.42
Walking speed (m/s), mean (SD)	0.61 (0.37)	0.29 (0.37)	2.11 (1.58 to 2.82); p < 0.01
Falls in the past 12 months, %
No	70	52	Reference
Yes	30	48	0.91 (0.78 to 1.06); p = 0.22
Chronic conditions (number), mean (SD)	2 (2)	2 (2)	0.98 (0.94 to 1.03); p = 0.46
Body mass index, %
Normal	33	22	Reference
Altered	67	78	0.95 (0.84 to 1.08); p = 0.45
Physical activity, %
Sedentary	33	74	Reference
Active	67	26	1.18 (1.00 to 1.40); p = 0.06
Health services
Hospitalizations in the past 12 months, %
No	79	64	Reference
Yes	21	36	0.70 (0.55 to 0.90); p < 0.01
Medical visits in the past 12 months, %
No	26	33	Reference
Yes	74	67	1.17 (0.99 to 1.40); p = 0.07
Private health plan, %
No	82	80	Reference
Yes	18	20	0.99 (0.84 to 1.17); p = 0.93
Use of physical rehabilitation services, %
No	97	95	Reference
Yes	3	5	0.83 (0.50 to 1.39); p = 0.48
Environment assistance
Home adaptations, %
No	91	76	Reference
Yes	9	24	0.75 (0.56 to 1.00); p = 0.05
Use of walking devices, %
No	92	55	Reference
Yes	8	45	0.35 (0.25 to 0.50); p < 0.01

Factors	Fully adjusted model (n = 407)
Factors	Prevalence ratio	95% CI
Age (years)	1.00	0.99 to 1.01
Education
0 to 3 years	Reference
4 to 7 years	1.05	0.91 to 1.22
≥ 8 years	0.99	0.83 to 1.18
Marital status
Married	Reference
Not married	0.97	0.83 to 1.12
Walking speed (m/s)	2.72*	1.96 to 3.77
Falls in the past 12 months
No	Reference
Yes	0.91	0.76 to 1.08
Physical Activity
Sedentary	Reference
Active	1.24*	1.04 to 1.47
Hospitalizations in the past 12 months
No	Reference
Yes	0.88	0.73 to 1.07
Medical visits in the past 12 months
No	Reference
Yes	1.01	0.87 to 1.16
Home adaptations
No	Reference
Yes	0.98	0.80 to 1.20
Use of walking devices
No	Reference
Yes	0.63*	0.41 to 0.96

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E-mail: cienciasaudecoletiva@fiocruz.br

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[1] Collaborations

JL Torres and LR Nascimento: conceptualization, methodology, statistical analysis and first draft preparation. MF Lima-Costa and FB Andrade: funding acquisition, edited and wrote the final version. All authors critical reviewed, commented on subsequent drafts and approved the final manuscript.