Contextual factors associated with walking performance after stroke: a systematic review and meta-analysis

Objective To describe the walking performance of patients with stroke and summarize the contextual factors associated with walking performance. Methods PubMed, Web of Science, Embase, and the Cochrane Library were searched from the inception to September 4, 2024. Observational studies on the walking performance of people with stroke and their contextual factors were eligible for inclusion. The relationship between contextual factors and walking performance was evaluated using Fisher’s z -value, which was then converted to correlation values ( r ). Results Thirty studies were included. Walking performance measures included step count, time, distance, and bouts; step count was most common, with pooled results showing a mean 4,296 steps/day after stroke. Guided by the contextual factors classification framework, we stratified the contextual factors of walking performance among subjects with stroke into three dimensions: user context, environmental context, and task context. Meta-analysis showed that walking endurance ( r = 0.60; 95% CI, 0.46 to 0.71) was strongly correlated with the number of daily steps. Moderate correlations were found between daily step counts and gait speed ( r = 0.41; 95% CI, 0.23 to 0.56), quality of life ( r = 0.46; 95% CI, 0.34 to 0.56), self-efficacy ( r = 0.30; 95% CI, 0.21 to 0.39), cardiorespiratory fitness ( r = 0.36; 95% CI, 0.09 to 0.59), balance ( r = 0.37; 95% CI, 0.02 to 0.65), and Rivermead Motor Assessment ( r = 0.49; 95% CI, 0.26 to 0.65). Furthermore, age ( r = −0.10; 95% CI, −0.18 to −0.02) and area deprivation index ( r = −0.15; 95% CI, −0.24 to −0.06) were associated with the number of daily steps after stroke, but effect sizes were small. Conclusion Daily step counts among individuals with stroke were not guideline-compliant. Contextual factors can inform the design of context-aware interventions aimed at increasing daily step counts.