Original research| Volume 99, ISSUE 4, P713-719, April 2018

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Do Performance Measures of Strength, Balance, and Mobility Predict Quality of Life and Community Reintegration After Stroke?

Published:January 06, 2018DOI:


      • Paretic lower limb strength and mobility are predictors of physical health-related quality of life.
      • Faster mobility, lower age, and comorbidities predicted better social integration.
      • Poor recovery of strength and mobility affects community reintegration poststroke.



      To investigate the extent to which physical performance measures of strength, balance, and mobility taken at discharge from inpatient stroke rehabilitation can predict health-related quality of life (HRQoL) and community reintegration after 6 months.


      Longitudinal study.


      University laboratory.


      Adults (N=75) recruited within 1 month of discharge home from inpatient stroke rehabilitation.


      Not applicable.

      Main Outcome Measures

      36-Item Short Form Health Survey (SF-36) for HRQoL and Subjective Index of Physical and Social Outcome (SIPSO) for community reintegration. Physical performance measures were the 6-minute walk test, timed Up and Go (TUG) test, Berg Balance Scale, Community Balance and Mobility Scale, and isokinetic torque and power of hip, knee, and ankle on the paretic and nonparetic sides. Other prognostic variables included age, sex, stroke type and location, comorbidities, and motor FIM score.


      Separate stepwise linear regressions were performed using the SF-36 and SIPSO as dependent variables. The total paretic lower limb torque and 6-minute walk test predicted the SF-36 Physical Component Summary (adjusted R2=.30). The total paretic lower limb torque and TUG test predicted the SIPSO physical component (adjusted R2=.47). The total paretic lower limb torque significantly predicted the SF-36 Mental Component Summary, but the adjusted R2 was low (.06). Similarly, the TUG test significantly predicted the SIPSO social component, but again the adjusted R2 was low (.09).


      Measures of physical performance including muscle strength and mobility at discharge can partially predict HRQoL and community reintegration 6 months later. Further research is necessary for more accurate predictions.


      List of abbreviations:

      6MWT (6-minute walk test), BBS (Berg Balance Scale), CB&M (Community Balance and Mobility Scale), HRQoL (Health-related quality of life), MCS (Mental Component Summary), PCS (Physical Component Summary), SF-36 (36-Item Short Form Health Survey), SIPSO (Subjective Index of Physical and Social Outcome), TUG (Timed Up and Go)
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        • Mayo N.E.
        • Wood-Dauphinee S.
        • Ahmed S.
        • et al.
        Disablement following stroke.
        Disabil Rehabil. 1999; 21: 258-268
        • Bagg S.
        • Pombo A.
        • Hopman W.
        Effect of age on functional outcomes after stroke rehabilitation.
        Stroke. 2002; 33: 179-185
        • Tu J.V.
        • Porter J.
        Stroke care in Ontario: hospital survey results.
        Queen’s Printer for Ontario, Ontario1999
        • Langhorne P.
        • Bernhardt J.
        • Kwakkel G.
        Stroke rehabilitation.
        Lancet. 2011; 377: 1693-1702
        • Perry S.B.
        • Woollard J.
        • Little S.
        • Shroyer K.
        Relationships among measures of balance, gait, and community integration in people with brain injury.
        J Head Trauma Rehabil. 2014; 29: 117-124
        • Lord S.E.
        • Rochester L.
        Measurement of community ambulation after stroke.
        Stroke. 2005; 36: 1457-1461
        • Shyu Y.
        • Maa S.H.
        • Chen S.T.
        • Chen M.C.
        Quality of life among older stroke patients in Taiwan during the first year after discharge.
        J Clin Nurs. 2009; 18: 2320-2328
        • Mayo N.E.
        • Wood-Dauphinee S.
        • Côté R.
        • Durcan L.
        • Carlton J.
        Activity, participation, and quality of life 6 months poststroke.
        Arch Phys Med Rehabil. 2002; 83: 1035-1042
        • Kanis J.
        • Oden A.
        • Johnell O.
        Acute and long-term increase in fracture risk after hospitalization for stroke.
        Stroke. 2001; 32: 702-706
        • Jørgensen H.
        • Nakayama H.
        • Raaschou H.O.
        • Olsen T.S.
        Recovery of walking function in stroke patients: the Copenhagen Stroke Study.
        Arch Phys Med Rehabil. 1995; 76: 27-32
        • Perry J.
        • Garrett M.
        • Gronley J.K.
        • Mulroy S.J.
        Classification of walking handicap in the stroke population.
        Stroke. 1995; 26: 982-989
        • Mayo N.E.
        Epidemiology and recovery.
        in: Long-term consequences of stroke: physical medicine and rehabilitation: state of the art reviews. Vol 7. Hanley & Belfus Inc., Philadelphia1993: 1-25
        • Price R.
        • Choy N.
        Does the functional gait assessment differentiate spatiotemporal parameters of gait and quality of life of stroke survivors?.
        Int J Stroke. 2016; 11: 6
        • Torkia C.
        • Best K.L.
        • Miller W.C.
        • Eng J.J.
        Balance confidence: a predictor of perceived physical function, perceived mobility, and perceived recovery 1 year after inpatient stroke rehabilitation.
        Arch Phys Med Rehabil. 2016; 97: 1064-1071
        • Flansbjer U.
        • Downham D.
        • Lexell J.
        Knee muscle strength, gait performance, and perceived participation after stroke.
        Arch Phys Med Rehabil. 2006; 87: 974-980
        • Strupeit S.
        • Wolf-Ostermaann K.
        • Buss A.
        • Dassen T.
        Mobility and quality of life after discharge from a clinical geriatric setting focused on gender and age.
        Rehabil Nurs. 2014; 39: 198-206
        • Schepers V.
        • Visser-Meily A.
        • Ketelaar M.
        • Lindeman E.
        Prediction of social activity 1 year poststroke.
        Arch Phys Med Rehabil. 2005; 86: 1472-1476
        • Lai S.M.
        • Duncan P.W.
        • Keighley J.
        Prediction of functional outcome after stroke.
        Stroke. 1998; 29: 1838-1842
        • Anderson C.
        • Laubscher S.
        • Burns R.
        Validation of the Short Form 36 (SF-36) health survey questionnaire among stroke patients.
        Stroke. 1996; 27: 1812-1816
        • McNaughton H.K.
        • Weatherall M.
        • McPherson K.M.
        Functional measures across neurologic disease states: analysis of factors in common.
        Arch Phys Med Rehabil. 2005; 86: 2184-2188
        • Olney S.J.
        • Nymark J.
        • Brouwer B.
        • et al.
        A randomized controlled trial of supervised versus unsupervised exercise programs for ambulatory stroke survivors.
        Stroke. 2006; 37: 476-481
        • Trigg R.
        • Wood V.A.
        • Hewer R.L.
        Social reintegration after stroke: the first stages in the development of the Subjective Index of Physical and Social Outcome (SIPSO).
        Clin Rehabil. 1999; 13: 341-353
        • Trigg R.
        • Wood V.A.
        The validation of the Subjective Index of Physical and Social Outcome (SIPSO).
        Clin Rehabil. 2003; 17: 283-289
        • Hyndman D.
        • Ashburn A.
        • Stack E.
        Fall events among people with stroke living in the community: circumstances of falls and characteristics of fallers.
        Arch Phys Med Rehabil. 2002; 83: 165-170
        • Novak A.C.
        • Brouwer B.
        Mobility function following stroke: the impact of multiple impairments.
        in: Pelligrino L.T. Handbook of Motor skills: development, impairment and therapy. Nova Science, New York2009: 17-137
        • Jaric S.
        Muscle strength testing.
        Sports Med. 2002; 32: 615-631
        • Knorr S.
        • Brouwer B.
        • Garland S.J.
        Validity of the Community Balance and Mobility Scale in community-dwelling persons after stroke.
        Arch Phys Med Rehabil. 2010; 91: 890-896
        • Kosak M.
        • Smith T.
        Comparison of the 2-, 6-, and 12-minute walk tests in patients with stroke.
        J Rehabil Res Dev. 2005; 42: 103-107
        • Eng J.J.
        • Chu K.S.
        • Dawson A.S.
        • Kim C.M.
        • Hepburn K.E.
        Functional walk tests in individuals with stroke.
        Stroke. 2006; 33: 756-761
        • Bisson E.
        • Contant B.
        • Sveistrup H.
        • Lajoie Y.
        Functional balance and dual-task reaction times in older adults are improved by virtual reality and biofeedback training.
        Cyberpsychol Behav. 2007; 10: 16-23
        • Ng S.S.
        • Hui-Chan C.W.
        The Timed Up & Go test: its reliability and association with lower-limb impairments and locomotor capacities in people with chronic stroke.
        Arch Phys Med Rehabil. 2005; 86: 1641-1647
        • Liston R.
        • Brouwer B.
        Reliability and validity of measures obtained from stroke patients using the Balance Master.
        Arch Phys Med Rehabil. 1996; 77: 425-430
        • Sangha O.
        • Stucki G.
        • Liang M.
        • Fossel A.
        • Katz J.
        The Self-Administered Comorbidity Questionnaire: a new method to assess comorbidity for clinical and health services research.
        Arthritis Rheum. 2003; 49: 156-163
        • Gunaydin R.
        • Karatepe A.G.
        • Kaya T.
        • Ulutas O.
        Determinants of quality of life (QoL) in elderly stroke patients: a short-term follow-up study.
        Arch Gerontol Geriatr. 2011; 53: 19-23
        • American Thoracic Society
        American Thoracic Society statement: guidelines for the six-minute walk test.
        Am J Resp Crit Care Med. 2002; 166: 111-117
        • Faria-Fortini I.
        • Basilio M.L.
        • Polese J.C.
        • et al.
        Strength deficits of the paretic lower extremity muscles were the impairment variables that best explained restrictions in participation after stroke.
        Disabil Rehabil. 2017; 39: 2158-2163
        • Bourbonnais D.
        • Vanden Noven S.
        Weakness in patients with hemiparesis.
        Am J Occup Ther. 1989; 43: 313-319
        • McComas A.J.
        • Sica R.
        • Upton A.
        • Aguilera N.
        Functional changes in motoneurones of hemiparetic patients.
        J Neurol Neurosurg Psychiatry. 1973; 36: 183-193
        • Rosenfalck A.
        • Andreassen S.
        Impaired regulation of force and firing pattern of single motor units in patients with spasticity.
        J Neurol Neurosurg Psychiatry. 1980; 43: 907-916
        • Engardt M.
        • Knutsson E.
        • Jonsson M.
        • Sternhag M.
        Dynamic muscle strength training in stroke patients: effects on knee extension torque, electromyographic activity, and motor function.
        Arch Phys Med Rehabil. 1995; 76: 419-425
        • Lum P.S.
        • Patten C.
        • Kothari D.
        • Yap R.
        Effects of velocity on maximal torque production in poststroke hemiparesis.
        Muscle Nerve. 2004; 30: 732-742
        • Clark D.J.
        • Patten C.
        • Reid K.F.
        • Carabello R.J.
        • Phillips E.M.
        • Fielding R.A.
        Impaired voluntary neuromuscular activation limits muscle power in mobility-limited older adults.
        J Gerontol A Biol Sci Med Sci. 2010; 65: 495-502
        • Schmid A.A.
        • Van Puymbroeck M.
        • Altenburger P.A.
        • et al.
        Balance and balance self-efficacy are associated with activity and participation after stroke: a cross-sectional study in people with chronic stroke.
        Arch Phys Med Rehabil. 2012; 93: 1101-1107
        • Adamit T.
        • Maeir A.
        • Ben Assayag E.
        • Bornstein N.M.
        • Korczyn A.D.
        • Katz N.
        Impact of first-ever mild stroke on participation at 3 and 6 month post-event: the TABASCO study.
        Disabil Rehabil. 2015; 37: 667-673
        • Faria-Fortini I.
        • Basílio M.L.
        • Scianni A.A.
        • Faria C.D.C.M.
        • Teixeira-Salmela L.F.
        Performance and capacity-based measures of locomotion, compared to impairment-based measures, best predicted participation in individuals with hemiparesis due to stroke.
        Disabil Rehabil. 2017; 11: 1-8