Predictors of the effect of an arm sling on gait efficiency in stroke patients with shoulder subluxation: a pre-post design clinical trial

Abstract

Background: The predictors affecting the gait efficiency were not known for the arm sling, including general and stroke-related characteristics. Purpose: This study investigated the predictors of gait efficiency when walking with and without an arm sling in individuals with hemiplegia with shoulder subluxation. Methods: A total of 57 individuals with shoulder subluxation were recruited. Individuals assigned odd numbers walked with the arm sling first and those with even numbers walked without the arm sling first in a pre-post design. Outcome measures were the energy cost, energy consumption, and heart rate during a 6-min walk test and a 10-m walk test. Gait efficiency is defined as energy consumption divided by the distance walked, with lower energy costs reflecting higher gait efficiency. Age, MMSE scores adjusted for education, and significant variables (p < .01) in the univariate analyses were entered into multiple regression analyses, to identify the predictors of changes of gait efficiency. Results: Energy cost and energy consumption were lower and walking endurance was higher when walking with an arm sling than when without an arm sling. Spasticity (p = .02), shoulder pain (p = .03), consistency of handedness and sling position worn (p = .02), function of upper extremity (p = .03) and walking aids (p = .01) were predictors of gait efficiency. Conclusion: An arm sling may improve gait efficiency in individuals with hemiplegia and shoulder subluxation able to walk with a single cane, who have consistency in handedness and sling position, and with good upper extremity function, including no shoulder pain and reduced spasticity.