Community ambulation refers to the ability of a person to walk in their own community, outside of their home and also indoors in private or public locations. Some people choose to walk for exercise or leisure and might walk with other people as an important part of social functioning. Community ambulation is therefore an important skill for stroke survivors living in the community whose walking ability has been affected. The objective of this study was to determine whether interventions improve community ambulation for stroke survivors, and if any specific intervention method improves community ambulation more than other interventions. Five studies involving 266 participants (136 intervention; 130 control) were included. All participants were adult stroke survivors, living in the community or a care home. Programmes to improve community ambulation consisted of walking practice in a variety of settings and environments in the community, or an indoor activity that mimicked community walking (including virtual reality or mental imagery). Three studies were funded by government agencies, and two had no funding.From two studies of 198 people there was low quality evidence for the effect of intervention on participation compared with control (SMD, 0.08, 95% confidence interval (CI) -0.20 to 0.35 (using inverse variance). The CI for the effect of the intervention on gait speed was wide and does not exclude no difference (MD 0.12, 95% CI -0.01 to 0.24; four studies, 98 participants, low quality evidence). The quality of the evidence was considered to be low for all the remaining outcomes in our review: Community Walk Test (MD -6.35, 95% CI -21.59 to 8.88); Walking Ability Questionnaire (MD 0.53, 95% CI -5.59 to 6.66); Six-Minute Walk Test (MD 39.62 metres, 95% CI -8.26 to 87.51) and self-efficacy (SMD 0.32, 95% CI -0.09 to 0.72). The quality of evidence was downgraded because of a high risk of bias and imprecision.
There is currently inadequate evidence to establish the effect of community ambulation interventions or to support a change in clinical practice. More research is required to determine if practicing outdoor or community walking will improve participation and community ambulation skills for stroke survivors living in the community.