Factors affecting community ambulation post-stroke: a mapping review protocol

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Abstract
Background Most stroke survivors consider community ambulation an essential but unmet goal of their recovery. Historically, interventions to enhance community ambulation have focused on improving biomechanical impairments of gait; however, recent evidence suggests that biopsychosocial and environmental factors may impact community ambulation, even beyond more obvious physical impairments. The identification of factors that pose as significant facilitators or barriers to community ambulation may serve to guide stakeholders in designing relevant and evidence-based interventions for improving community ambulation post-stroke. Objective This review aims to map the type and extent of existing evidence on the physical, biopsychosocial, and environmental factors affecting community ambulation post-stroke. Additionally, this review will describe the various methods used to examine the extent to which stroke survivors are restricted to community ambulation. Methods Nine databases will be searched including CINAHL, PubMed, and Web of Science. We will include studies published in English during or after 2001. Studies that examine physical, biopsychosocial, and/or environmental factors affecting community ambulation in ambulatory adults at least six months post-stroke will be considered for inclusion. Studies that assess general physical activity or community mobility through transportation modes other than walking will be excluded. All identified records will be collated in citation management software, followed by steps of deduplication, title/abstract screening, and full-text reviews by at least two independent reviewers. The bibliographies of the extracted studies will also be reviewed for relevant articles. The extracted studies will be analyzed, critically appraised, and presented in tabular, narrative, and evidence map formats. Discussion The evidence gained will be used to build a framework for community ambulation, informing stakeholders to develop meaningful interventions to improve community ambulation. The mapped evidence will motivate future studies to develop holistic approaches that specifically focus on the most vital factors that influence post-stroke community ambulation.

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