CHAPTER 1
 INTRODUCTION

 The American Heart Association reports stroke to be a common diagnosis

occurring in 700,000 people annually. Stroke is the primary cause of disability and the

third leading cause of death for those over 65 [1-4]. Stroke is also classified as the most

disabling chronic disease and the cumulative consequences are often staggering for

individuals, families, and society [5, 6]. Residual motor, sensory, and visual post-stroke

deficits make mobility impairments common. Changes in gait velocity, falls, and fear of

falling are common post-stroke mobility impairments. All may contribute to decreased

performance of activities of daily living (ADLs), instrumental activities of daily living

(IADLs), social participation, and overall declines in quality of life.

 The purpose of this dissertation is to report findings from two studies. Both studies

are secondary analyses of larger studies. The goal of the first study was to evaluate a

clinically meaningful change in post-stroke gait speed and its impact on activity and

participation levels post-stroke. A clinically meaningful change is important to determine

as it is related to patient-valued benefits. Barrett et al. discusses the need to merge

patient-oriented and evidence-based frameworks together by observing an "important

difference" [7]. Such clinical significance can be seen by examining the sufficiently

important difference (SID), the smallest amount of patient-valued benefit required from

an intervention to justify associated costs, risks, and other harms. We observed data on

post-stroke gait speed changes and the existing relationship with ADLs, IADLs, and

social participation to examine a clinically meaningful change in gait velocity.