{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:50:49Z","timestamp":1765212649929,"version":"3.46.0"},"reference-count":46,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T00:00:00Z","timestamp":1764979200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/jcm14248649","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:20:29Z","timestamp":1765210829000},"page":"8649","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Predictors of Independent Community Ambulation in Individuals with Chronic Stroke: A Cross-Sectional Study of Gait Speed, Gait Endurance, and Balance Self-Efficacy"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6558-4356","authenticated-orcid":false,"given":"SeungHeon","family":"An","sequence":"first","affiliation":[{"name":"Department of Gait Lab, National Rehabilitation Center, Seoul 01022, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7695-3604","authenticated-orcid":false,"given":"DongGeon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Sinsegae Rehabilitation Hospital, Changwon 51216, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7880-0479","authenticated-orcid":false,"given":"DongMin","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Zenith Rehabilitation Hospital, Seoul 04993, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4969-4018","authenticated-orcid":false,"given":"Kyeongbong","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Physical Therapy, Kangwon National University, Samcheok 25949, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1016\/j.apmr.2003.05.002","article-title":"Community Ambulation after Stroke: How Important and Obtainable Is It and What Measures Appear Predictive?","volume":"85","author":"Lord","year":"2004","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1482","DOI":"10.1161\/STROKEAHA.110.604090","article-title":"Early Prediction of Outcome of Activities of Daily Living After Stroke: A Systematic Review","volume":"42","author":"Veerbeek","year":"2011","journal-title":"Stroke"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1161\/01.STR.0000170698.20376.2e","article-title":"Measurement of Community Ambulation after Stroke: Current Status and Future Developments","volume":"36","author":"Lord","year":"2005","journal-title":"Stroke"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1177\/0269215514546769","article-title":"Factors Describing Community Ambulation After Stroke: A Mixed-Methods Study","volume":"29","author":"Barclay","year":"2015","journal-title":"Clin. Rehabil."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"733","DOI":"10.2522\/ptj.20070214","article-title":"Test-Retest Reliability and Minimal Detectable Change on Balance and Ambulation Tests, the 36-Item Short-Form Health Survey, and the Unified Parkinson Disease Rating Scale in People with Parkinsonism","volume":"88","author":"Steffen","year":"2008","journal-title":"Phys. Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1080\/09593980701588284","article-title":"Clinometric Properties of the Six-Minute Walk Test in Individuals Undergoing Rehabilitation Poststroke","volume":"24","author":"Fulk","year":"2008","journal-title":"Physiother. Theory Pract."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Hosoi, Y., Kamimoto, T., Sakai, K., Yamada, M., and Kawakami, M. (2023). Estimation of Minimal Detectable Change in the 10-Meter Walking Test for Patients with Stroke: A Study Stratified by Gait Speed. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1219505"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1161\/01.STR.26.6.982","article-title":"Classification of Walking Handicap in the Stroke Population","volume":"26","author":"Perry","year":"1995","journal-title":"Stroke"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"413","DOI":"10.3233\/NRE-210026","article-title":"Distance-Limited Walk Tests Post-Stroke: A Systematic Review of Measurement Properties","volume":"48","author":"Cheng","year":"2021","journal-title":"NeuroRehabilitation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"23","DOI":"10.2340\/16501977-0114","article-title":"Community Ambulation in Patients with Chronic Stroke: How Is It Related to Gait Speed?","volume":"40","author":"Kwakkel","year":"2008","journal-title":"J. Rehabil. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1161\/STROKEAHA.116.015309","article-title":"Predicting Home and Community Walking Activity Poststroke","volume":"48","author":"Fulk","year":"2017","journal-title":"Stroke"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1632","DOI":"10.1016\/j.jstrokecerebrovasdis.2018.01.017","article-title":"Safety and Feasibility of the 6-Minute Walk Test in Patients with Acute Stroke","volume":"27","author":"Kubo","year":"2018","journal-title":"J. Stroke Cerebrovasc. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"535","DOI":"10.2340\/16501977-1147","article-title":"Is Gait Speed or Walking Distance a Better Predictor for Community Walking after Stroke?","volume":"45","author":"Kwakkel","year":"2013","journal-title":"J. Rehabil. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"166","DOI":"10.12688\/f1000research.144582.2","article-title":"Factors Affecting Community Ambulation Post-Stroke: A Mapping Review Protocol","volume":"13","author":"Bansal","year":"2024","journal-title":"F1000Research"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1080\/09638280400008982","article-title":"Measurement Properties of the Activities-Specific Balance Confidence Scale among Individuals with Stroke","volume":"27","author":"Botner","year":"2005","journal-title":"Disabil. Rehabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"364","DOI":"10.1016\/j.apmr.2005.11.017","article-title":"Balance Self-Efficacy and Its Relevance to Physical Function and Perceived Health Status After Stroke","volume":"87","author":"Salbach","year":"2006","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1101","DOI":"10.1016\/j.apmr.2012.01.020","article-title":"Balance and Balance Self-Efficacy Are Associated with Activity and Participation After Stroke: A Cross-Sectional Study in People with Chronic Stroke","volume":"93","author":"Schmid","year":"2012","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_18","first-page":"282","article-title":"Determinants of Satisfaction with Community Reintegration in Older Adults with Chronic Stroke: Role of Balance Self-Efficacy. Phys","volume":"87","author":"Pang","year":"2007","journal-title":"Ther."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1428","DOI":"10.1183\/09031936.00150314","article-title":"An Official European Respiratory Society\/American Thoracic Society Technical Standard: Field Walking Tests in Chronic Respiratory Disease","volume":"44","author":"Holland","year":"2014","journal-title":"Eur. Respir. J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1179\/1074935714Z.0000000001","article-title":"Factors Related to Community Ambulation in Patients with Chronic Stroke","volume":"22","author":"Lee","year":"2015","journal-title":"Top. Stroke Rehabil."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"129","DOI":"10.3109\/09638288.2014.911969","article-title":"Fast Gait Speed and Self-Perceived Balance as Valid Predictors and Discriminators of Independent Community Walking at 6 Months Post-Stroke\u2014A Preliminary Study","volume":"37","author":"Rosa","year":"2015","journal-title":"Disabil. Rehabil."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1016\/j.apmr.2007.06.764","article-title":"Predictive Validity and Responsiveness of the Functional Ambulation Category in Hemiparetic Patients After Stroke","volume":"88","author":"Mehrholz","year":"2007","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1641","DOI":"10.1016\/j.apmr.2005.01.011","article-title":"The Timed up & Go Test: Its Reliability and Association with Lower-Limb Impairments and Locomotor Capacities in People with Chronic Stroke","volume":"86","author":"Ng","year":"2005","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_24","first-page":"81","article-title":"Reliability of the Six-Minute Walk Test in Individuals with Stroke: Systematic Review and Meta-Analysis","volume":"42","author":"Macchiavelli","year":"2021","journal-title":"Neurol. Sci. Off. J. Ital. Neurol. Soc. Ital. Soc. Clin. Neurophysiol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"M28","DOI":"10.1093\/gerona\/50A.1.M28","article-title":"The Activities-Specific Balance Confidence (ABC) Scale","volume":"50","author":"Powell","year":"1995","journal-title":"J. Gerontol. A Biol. Sci. Med. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"103","DOI":"10.5535\/arm.240029","article-title":"Outcome Measurement in Balance Problems: Berg Balance Scale","volume":"48","author":"Joa","year":"2024","journal-title":"Ann. Rehabil. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"559","DOI":"10.2522\/ptj.20070205","article-title":"Usefulness of the Berg Balance Scale in Stroke Rehabilitation: A Systematic Review","volume":"88","author":"Blum","year":"2008","journal-title":"Phys. Ther."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1298\/ptr.E10324","article-title":"A Scoping Review of Minimal Important Change and Minimal Detectable Change of the Fugl-Meyer Assessment Lower Extremity Scale in Patients with Stroke","volume":"28","author":"Nakazono","year":"2025","journal-title":"Phys. Ther. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/j.bjpt.2020.12.002","article-title":"Intra- and Inter-Rater Reliability of Fugl-Meyer Assessment of Lower Extremity Early After Stroke","volume":"25","author":"Forero","year":"2021","journal-title":"Braz. J. Phys. Ther."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"S\u00e1nchez-Mart\u00ednez, M.P., Crisostomo, M.J., Mart\u00edn-San Agust\u00edn, R., Montilla-Herrador, J., Escolar-Reina, M.P., Valera-Novella, E., and Medina-Mirapeix, F. (2024). Determination of Five Sit-to-Stand Test Performance at Discharge of Stroke Patients. Diagnostics, 14.","DOI":"10.3390\/diagnostics14050521"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1016\/j.apmr.2009.10.030","article-title":"5-Repetition Sit-to-Stand Test in Subjects with Chronic Stroke: Reliability and Validity","volume":"91","author":"Mong","year":"2010","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1111\/j.1532-5415.1991.tb01616.x","article-title":"The Timed \u201cUp & Go\u201d: A Test of Basic Functional Mobility for Frail Elderly Persons","volume":"39","author":"Podsiadlo","year":"1991","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1080\/16501970410017215","article-title":"Reliability of Gait Performance Tests in Men and Women with Hemiparesis After Stroke","volume":"37","author":"Flansbjer","year":"2005","journal-title":"J. Rehabil. Med."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"89","DOI":"10.2522\/ptj.20080121","article-title":"Walking Skill Can Be Assessed in Older Adults: Validity of the Figure-of-8 Walk Test","volume":"90","author":"Hess","year":"2010","journal-title":"Phys. Ther."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1896","DOI":"10.3109\/09638288.2013.766274","article-title":"The Figure-of-Eight Walk Test: Reliability and Associations with Stroke-Specific Impairments","volume":"35","author":"Wong","year":"2013","journal-title":"Disabil. Rehabil."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1566","DOI":"10.1053\/apmr.2002.35469","article-title":"A Clinical Test of Stepping and Change of Direction to Identify Multiple Falling Older Adults","volume":"83","author":"Dite","year":"2002","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1306","DOI":"10.1016\/j.apmr.2013.01.027","article-title":"Reliability and Concurrent Validity of Four Square Step Test Scores in Subjects with Chronic Stroke: A Pilot Study","volume":"94","author":"Goh","year":"2013","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Lakens, D. (2013). Calculating and Reporting Effect Sizes to Facilitate Cumulative Science: A Practical Primer for t-Tests and ANOVAs. Front. Psychol., 4.","DOI":"10.3389\/fpsyg.2013.00863"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1177\/15459683241257521","article-title":"Speed- and Endurance-Based Classifications of Community Ambulation Post-Stroke Revisited: The Importance of Location in Walking Performance Measurement","volume":"38","author":"Bansal","year":"2024","journal-title":"Neurorehabil. Neural Repair"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1186\/s13643-017-0577-5","article-title":"The Validity and Reliability of the Four Square Step Test in Different Adult Populations: A Systematic Review","volume":"6","author":"Moore","year":"2017","journal-title":"Syst. Rev."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2184","DOI":"10.1589\/jpts.28.2184","article-title":"Clinical Measures as Valid Predictors and Discriminators of the Level of Community Ambulation of Hemiparetic Stroke Survivors","volume":"28","author":"Lee","year":"2016","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1682\/JRRD.2014.04.0112","article-title":"Development of the Modified Four Square Step Test and Its Reliability and Validity in People with Stroke","volume":"53","author":"Roos","year":"2016","journal-title":"J. Rehabil. Res. Dev."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1177\/10538135251366659","article-title":"Functional Performance Tests to Predict Limited Community Ambulation in Stroke Survivors with Supervised Indoor Walking: Discriminative and Predictive Validity","volume":"57","author":"Lee","year":"2025","journal-title":"NeuroRehabilitation"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1080\/10749357.2015.1110306","article-title":"Self-Efficacy Mediates the Relationship Between Balance\/Walking Performance, Activity, and Participation After Stroke","volume":"23","author":"French","year":"2016","journal-title":"Top. Stroke Rehabil."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1168","DOI":"10.1177\/0269215515570380","article-title":"The Effect of Interventions on Balance Self-Efficacy in the Stroke Population: A Systematic Review and Meta-Analysis","volume":"29","author":"Tang","year":"2015","journal-title":"Clin. Rehabil."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Trabassi, D., Castiglia, S.F., Bini, F., Marinozzi, F., Ajoudani, A., Lorenzini, M., Chini, G., Varrecchia, T., Ranavolo, A., and De Icco, R. (2024). Optimizing Rare Disease Gait Classification Through Data Balancing and Generative AI: Insights from Hereditary Cerebellar Ataxia. Sensors, 24.","DOI":"10.3390\/s24113613"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8649\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T16:48:32Z","timestamp":1765212512000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/24\/8649"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,6]]},"references-count":46,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["jcm14248649"],"URL":"https:\/\/doi.org\/10.3390\/jcm14248649","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,6]]}}}