Original article
Proposal and Validation of a New Functional Ambulation Classification Scale for Clinical Use

Presented to the II Mediterranean Congress of Physical Medicine and Rehabilitation, May 20–23, 1998, Valencia, Spain, and the XIX Congreso Nacional de la Sociedad Española de Rehabilitación y Medicina Física, May 16–19, 2000, Barcelona, Spain.
https://doi.org/10.1016/j.apmr.2004.11.016Get rights and content

Abstract

Viosca E, Martínez JL, Almagro PL, Gracia A, González C. Proposal and validation of a new functional ambulation classification scale for clinical use. Arch Phys Med Rehabil 2005;86:1234–8.

Objective

To validate a new functional ambulation classification.

Design

Validity study.

Setting

In- and outpatients of a district hospital rehabilitation service.

Participants

Thirty-one patients with poststroke hemiplegic gait disorders compared with a control group of 5 healthy people.

Interventions

Not applicable.

Main Outcome Measures

Three independent examiners assessed the functional ambulation levels of each patient in blind trials. Interrater reliability was analyzed among the examiners. Walking velocity (slow, normal, fast) was measured with a manual chronometer, and the number of steps taken over a 48-hour period was recorded with a step counter. The linear correlation was calculated from among functional level classification, walking velocity, and the number of steps taken.

Results

There was a good interrater reliability among the examiners (κ=.74). A significant association and a linear correlation were found between functional ambulation level, walking velocity, and the number of steps taken.

Conclusions

The proposed classification is reliable and valid for determining the different levels of walking abilities.

Section snippets

Methods

Thirty-one poststroke hemiplegic patients with secondary gait disorders were assessed with this classification system. Patients included in the study had to have had a stroke within the past 2 years, and their gait disorder had to have been a result of the stroke only. Patients whose gait alteration was associated with other health problems, such as cardiac or respiratory insufficiency, fractured hip, and coxarthrosis, were excluded. The patients were diagnosed by a neurologist who followed the

Results

The average age ± standard deviation (SD) of the 31 poststroke hemiplegic patients (20 men, 11 women) was 64±7.8 years. The hemiparesis was on the right side in 18 patients (58%) and on the left in 13 (42%). The type of stroke was ischemic in 29 patients (93.5%) and hemorrhagic in 2 (6.5%). Nine patients (29%) needed assistive devices, such as canes in 1 case (3.2%), crutches in 5 cases (16.1%), and walkers in 3 cases (9.7%). Two patients used ankle-foot orthoses. The average age of the 5

Discussion

The results show that our classification system is reliable and has good agreement among the examiners, both globally and in the different categories, except for level 3 (ambulation about the house and neighborhood). This result is not surprising if we take into account how this particular level is defined. The functional levels 0, 1, 2, and 5 were directly observed by the examiner in the clinic. However, designating a subject as walking at level 3 or 4 (community ambulation) will depend on the

Conclusions

We have shown that our proposed functional ambulation classification is both reliable and valid to assess walking ability at clinical admission and follow-up. It is an adequate, user-friendly tool that is easier to use than measuring walking velocity. It offers wide application possibilities and practical utility.

Acknowledgments

We thank the Foreign Language Co-ordination Office at the Polytechnic University of Valencia for its help in revising this article.

References (21)

  • J.M. Potter et al.

    Gait speed and activities of daily living function in geriatric patients

    Arch Phys Med Rehabil

    (1995)
  • E. Viosca et al.

    Walking recovery following an acute strokeassessment with a new functional classification and the Barthel Index

    Arch Phys Med Rehabil.

    (2005)
  • R.N. Scranton et al.

    Evaluation of functional levels of patients during and following rehabilitation

    Arch Phys Med Rehabil

    (1970)
  • D.T. Wade et al.

    Walking after stroke. Measuring and recovery over the first 3 months

    Scand J Rehabil Med

    (1987)
  • H. Morita

    Rehabilitation of post-stroke hemiplegic patients. II. Restudying functional assessment’s methods

    J UOEH

    (1989)
  • R.W. Bohannon

    Selected determinants of ambulatory capacity in patients with hemiplegia

    Clin Rehabil

    (1989)
  • E.E. Bleck

    Cerebral palsy

  • M.K. Holden et al.

    Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness

    Phys Ther

    (1984)
  • L.J. Volpicelli et al.

    Ambulation levels of bilateral lower-extremity amputees

    J Bone Joint Surg Am

    (1983)
  • M.M. Hoffer et al.

    Functional ambulation in patients with myelomeningocele

    J Bone Joint Surg Am

    (1973)
There are more references available in the full text version of this article.

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