Measurement properties of a 300-m community-based walking test incorporating environmental walking demands in individuals with subacute stroke.

Abstract

Background Performance-based assessments reflecting environmental walking demands remain limited in subacute stroke rehabilitation. Objective To evaluate the measurement properties of a 300-m Community-Based Walking Test (CBWT) designed to reflect environmental walking demands in individuals with subacute stroke. Methods We retrospectively analyzed prospectively collected clinical data from 26 ambulatory individuals with subacute stroke (13 men and 13 women; mean age, 56.8 years [range, 26-81 years]) who completed the CBWT in both forward and reverse directions during rehabilitation. Assessments were performed at baseline and weeks 1, 2, and 4. Test-retest reliability was evaluated using intraclass correlation coefficients (ICC 2,1 ), standard error of measurement (SEM), minimal detectable change (MDC), and Bland-Altman analysis. Responsiveness was assessed using standardized response mean (SRM) and effect size (ES), and convergent and longitudinal validity using Spearman correlations with gait, balance, and mobility measures. Results CBWT completion time demonstrated excellent test-retest reliability in both directions (ICC = 0.92-0.93; 95% CI = 0.83-0.96). SEM ranged from 30 to 31 s and MDC from 83 to 86 s. Four-week responsiveness was moderate to high (SRM = 0.91-1.01; ES = 0.53-0.55). CBWT completion time showed moderate to high correlations with gait speed ( r = -0.70 to -0.84), walking endurance ( r = -0.76 to -0.81), and mobility ( r = 0.78-0.83). Variability was observed even among independently ambulatory participants. Conclusion The present findings provide preliminary evidence supporting the measurement properties of the CBWT in individuals with subacute stroke. The CBWT may provide complementary clinical information regarding walking performance under structured environmental demands beyond conventional indoor gait assessments, which may support the evaluation of environmental walking adaptation and inform clinical judgment regarding community mobility during rehabilitation and discharge planning.