Community ambulation: environmental impacts and assessment inadequacies.

BACKGROUND: Community ambulation is an important goal for both clients and health professionals yet it is an outcome only variously achieved by clients discharged from rehabilitation settings back into their community. OBJECTIVE: To review the available literature about the assessment tools that are currently used to determine community ambulation status and to determine from an evaluation of these tools the effectiveness of the evaluation when compared to known environmental dimensions that impact on ambulation in the community. METHOD: A review of published papers from English language literature using CINAHL, ProQuest, Medline and other databases was conducted. RESULTS: Only eight papers were found in the literature to inform health professionals about the impact of the environment on community ambulation. No current mobility assessment tools were identified that assess all the environmental demands that can impact on the activity of community ambulation. From the tools reviewed the most frequently evaluated environmental mobility dimensions were walking distance and time constraints. CONCLUSIONS: Health professionals need assessment tools that evaluate the impact of the environment on an individual's mobility in order to determine community ambulation status. The literature to date provides little guidance about the impact of the environment and current evaluation tools are limited in clinical usefulness with respect to the depth and breadth of information gained.