Key Influencers of Community Ambulation Post-Stroke: Insights from a Mapping Review

BACKGROUND: Interventions to enhance community ambulation post-stroke have traditionally focused on improving gait-related impairments, but recent evidence indicates that biopsychosocial and environmental factors also significantly influence community ambulation. OBJECTIVE: To map the existing evidence on physical, biopsychosocial, and environmental factors associated with community ambulation based on the assessment tools commonly used to determine limitations in community ambulation. METHODS: Nine databases were searched for studies examining factors affecting community ambulation in adults at least 6 months post-stroke. Studies assessing general physical activity or community mobility through transportation modes other than walking were excluded. Identified records were de-duplicated, screened, and reviewed by 2 independent reviewers. RESULTS: From 1824 titles/abstracts screened and 99 full texts reviewed, 40 studies were included, representing 3915 stroke survivors. Participation in community ambulation was most commonly quantified by daily walking performance using accelerometers or predicted based on clinical gait speed. Other assessments included questionnaires, direct observation, and travel logs. Key physical factors consistently reported to be positively associated with community ambulation were gait-related endurance, balance, and walking performance. Biopsychosocial factors like falls-efficacy and depression showed mixed evidence of association, while age, gender, stroke type, and marital status were not associated with community ambulation. Environmental factors like neighborhood walkability, work status, and driving independence also produced mixed evidence of association. CONCLUSIONS: Multiple factors were identified as key influencers of community ambulation, with gait-related endurance, balance, and walking performance most consistently reported. Severe limitations in community ambulation were reported across all studies, but assessment approaches varied widely and lacked standardization.