Advertisement

The Functional Independence of Patients With Stroke Sequelae: How Important Is the Speed, Oxygen Consumption, and Energy Cost of Walking?

Published:February 19, 2021DOI:https://doi.org/10.1016/j.apmr.2021.01.085

      Highlights

      • The oxygen cost of walking was reported as an independent factor for functional independence.
      • This association appears to be primarily determined by walking speed and not oxygen consumption.
      • These results emphasize the importance of evaluating and acting on self-selected walking speed to improve the functional independence of individuals with stroke.

      Abstract

      Objective

      To evaluate the association between self-selected walking speed (Sfree), oxygen consumption at Sfree (Vo2free), the oxygen cost of walking (Cw) at Sfree, and mobility independence and independence for activities of daily living in individuals poststroke.

      Design

      Cross-sectional study.

      Setting

      Hospital.

      Participants

      Individuals with stroke who were able to walk without human assistance were included. We included 90 individuals (N=90; mean age, 63.5±14.0y).

      Interventions

      Not applicable.

      Main Outcome Measures

      Cw was captured during walking from measurements of Sfree and Vo2free. We assessed mobility independence based on the modified Functional Ambulation Classification (mFAC) and independence in activities of daily living by the Barthel Index (BI). Multiple linear regression analyses were performed to evaluate the independence of Cw, Vo2free, and Sfree from the determination of BI and mFAC among the various characteristics of the population (age, stroke delay, body mass index, motor function, spasticity).

      Results

      We reported Cw=0.36 mL/kg/m (interquartile range [IQR]=0.28 mL/kg/m), Sfree=0.60±0.32 m/s, Vo2free=11.2 mL/kg/min (IQR=1.8 mL/kg/min). The multiple linear regression analyses showed that Cw and Sfree were independently associated with the BI (P<.01) and the mFAC (P<.01) scores. Vo2free was not found to be an explanatory variable of functional independence (P>.05).

      Conclusions

      Cw was independently associated with functional independence. This association appears to be primarily determined by Sfree and not Vo2free, underscoring the importance of evaluating and acting on Sfree to improve the functional independence of individuals with stroke.

      Keywords

      List of abbreviations:

      ADL (activities of daily living), BI (Barthel Index), BMI (body mass index), Cw (oxygen cost of walking), IQR (interquartile range), MAS (modified Ashworth Scale), mFAC (modified Functional Ambulation Classification), Sfree (self-selected walking speed), Vo2 (oxygen consumption), Vo2free (oxygen consumption at self-selected walking speed)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Gadidi V.
        • Katz-Leurer M.
        • Carmeli E.
        • Bornstein N.M.
        Long-term outcome poststroke: predictors of activity limitation and participation restriction.
        Arch Phys Med Rehabil. 2011; 92: 1802-1808
        • Lord S.E.
        • Rochester L.
        Measurement of community ambulation after stroke: current status and future developments.
        Stroke. 2005; 36: 1457-1461
        • Kramer S.
        • Johnson L.
        • Bernhardt J.
        • Cumming T.
        Energy expenditure and cost during walking after stroke: a systematic review.
        Arch Phys Med Rehabil. 2016; 97: 619-632.e1
        • Compagnat M.
        • Mandigout S.
        • Chaparro D.
        • Salle J.Y.
        • Daviet J.C.
        Predicting the oxygen cost of walking in hemiparetic stroke patients.
        Ann Phys Rehabil Med. 2018; 61: 309-314
        • Compagnat M.
        • Mandigout S.
        • David R.
        • Lacroix J.
        • Daviet J.
        • Salle J.
        Compendium of physical activities strongly underestimates the oxygen cost during activities of daily living in stroke patients.
        Am J Phys Med Rehabil. 2019; 98: 299-302
        • Detrembleur C.
        • Dierick F.
        • Stoquart G.
        • Chantraine F.
        • Lejeune T.
        Energy cost, mechanical work, and efficiency of hemiparetic walking.
        Gait Posture. 2003; 18: 47-55
        • Nadeau S.
        • Arsenault A.B.
        • Gravel D.
        • Bourbonnais D.
        Analysis of the clinical factors determining natural and maximal gait speeds in adults with a stroke.
        Am J Phys Med Rehabil. 1999; 78: 123-130
      1. Haute Autorité de Santé - Évaluation fonctionnelle de l’AVC et kinésithérapie [Functional assessment of stroke].
        (Available at:) (Accessed March 15, 2021)
        • Winstein C.J.
        • Stein J.
        • Arena R.
        • et al.
        Guidelines for adult stroke rehabilitation and recovery.
        Stroke. 2016; 47: e98-e169
        • Brun V.
        • Mousbeh Z.
        • Jouet-Pastre B.
        • et al.
        [Clinical assessment of stroke hémiplégic gait: suggestion for a modification of the functional ambulation classification][French].
        Ann Phys Rehabil Med. 2000; 43: 14-20
        • Mahoney F.I.
        • Barthel D.W.
        Functional evaluation: the Barthel Index.
        Md State Med J. 1965; 14: 61-65
        • Yang S.-Y.
        • Kong K.H.
        Level and predictors of participation in patients with stroke undergoing inpatient rehabilitation.
        Singapore Med J. 2013; 54: 564-568
        • 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
        • Gianella M.G.
        • Gath C.F.
        • Bonamico L.
        • Olmos L.E.
        • Russo M.J.
        Prediction of gait without physical assistance after inpatient rehabilitation in severe subacute stroke subjects.
        J Stroke Cerebrovasc Dis. 2019; 28: 104367
        • Craig L.E.
        • Wu O.
        • Bernhardt J.
        • Langhorne P.
        Predictors of poststroke mobility: systematic review.
        Int J Stroke. 2011; 6: 321-327
        • Harvey R.L.
        Predictors of functional outcome following stroke.
        Phys Med Rehabil Clin N Am. 2015; 26: 583-598
        • Patel A.T.
        • Duncan P.W.
        • Lai S.M.
        • Studenski S.
        The relation between impairments and functional outcomes poststroke.
        Arch Phys Med Rehabil. 2000; 81: 1357-1363
        • Kwakkel G.
        • Kollen B.J.
        Predicting activities after stroke: what is clinically relevant?.
        Int J Stroke. 2013; 8: 25-32
        • Ivey F.M.
        • Macko R.F.
        • Ryan A.S.
        • Hafer-Macko C.E.
        Cardiovascular health and fitness after stroke.
        Top Stroke Rehabil. 2005; 12: 1-16
        • Perry J.
        • Garrett M.
        • Gronley J.K.
        • Mulroy S.J.
        Classification of walking handicap in the stroke population.
        Stroke. 1995; 26: 982-989
        • Reisman D.S.
        • Binder-MacLeod S.
        • Farquhar W.B.
        Changes in metabolic cost of transport following locomotor training post-stroke.
        Top Stroke Rehabil. 2013; 20: 161-170
        • Bohannon R.
        The relationship of knee muscle performance and gait in stroke patients.
        Disabil Rehabil. 1996; 18: 638
        • Patterson S.L.
        • Forrester L.W.
        • Rodgers M.M.
        • et al.
        Determinants of walking function after stroke: differences by deficit severity.
        Arch Phys Med Rehabil. 2007; 88: 115-119
        • Collin C.
        • Wade D.
        Assessing motor impairment after stroke: a pilot reliability study.
        J Neurol Neurosurg Psychiatry. 1990; 53: 576-579
        • Demeurisse G.
        • Demol O.
        • Robaye E.
        Motor evaluation in vascular hemiplegia.
        Eur Neurol. 1980; 19: 382-389
        • Bohannon R.W.
        • Smith M.B.
        Interrater reliability of a modified Ashworth Scale of muscle spasticity.
        Phys Ther. 1987; 67: 206-207
        • Reisman D.S.
        • Rudolph K.S.
        • Farquhar W.B.
        Influence of speed on walking economy poststroke.
        Neurorehabil Neural Repair. 2009; 23: 529-534
        • Hendricks H.T.
        • van Limbeek J.
        • Geurts A.C.
        • Zwarts M.J.
        Motor recovery after stroke: a systematic review of the literature.
        Arch Phys Med Rehabil. 2002; 83: 1629-1637
      2. Wasserman K. Principles of exercise testing and interpretation: including pathophysiology and clinical applications. Lippincott Williams & Wilkins; 2005, pp. 530-532.

        • Whipp B.J.
        • Wasserman K.
        Oxygen uptake kinetics for various intensities of constant-load work.
        J Appl Physiol. 1972; 33: 351-356
        • Zamparo P.
        • Francescato M.P.
        • Luca G.
        • Lovati L.
        • Prampera P.E.
        The energy cost of level walking in patients with hemiplegia.
        Scand J Med Sci Sports. 1995; 5: 348-352
        • Hinkle D.E.
        • Wiersma W.
        • Jurs S.G.
        Applied statistics for the behavioral sciences. 5th ed.
        Houghton Mifflin, Boston2002
        • Heinze G.
        • Wallisch C.
        • Dunkler D.
        Variable selection—a review and recommendations for the practicing statistician.
        Biom J. 2018; 60: 431-449
      3. Peck R, Devore JL. Statistics: the exploration & analysis of data. Cengage Learning; 2011, pp. 644-645.

        • Franceschini M.
        • Rampello A.
        • Agosti M.
        • Massucci M.
        • Bovolenta F.
        • Sale P.
        Walking performance: correlation between energy cost of walking and walking participation. New statistical approach concerning outcome measurement.
        PLoS One. 2013; 8e56669
        • Cech D.J.
        • Tink Martin S.
        Evaluation of function, activity, and participation.
        in: Cech D.J. Tink Martin S. Functional movement development across the life span. 3rd ed. W.B. Saunders, St Louis2012: 88-104
        • Kwakkel G.
        • Kollen B.
        • Lindeman E.
        Understanding the pattern of functional recovery after stroke: facts and theories.
        Restor Neurol Neurosci. 2004; 22: 281-299
        • Billinger S.A.
        • Arena R.
        • Bernhardt J.
        • et al.
        Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association.
        Stroke. 2014; 45: 2532-2553
        • Jang M.U.
        • Kang J.
        • Kim B.J.
        • et al.
        In-hospital and post-discharge recovery after acute ischemic stroke: a nationwide multicenter stroke registry-base study.
        J Korean Med Sci. 2019; 34: e240
        • Potter J.M.
        • Evans A.L.
        • Duncan G.
        Gait speed and activities of daily living function in geriatric patients.
        Arch Phys Med Rehabil. 1995; 76: 3
        • Smith A.C.
        • Saunders D.H.
        • Mead G.
        Cardiorespiratory fitness after stroke: a systematic review.
        Int J Stroke. 2012; 7: 499-510
        • Mol V.J.
        • Baker C.A.
        Activity intolerance in the geriatric stroke patient.
        Rehabil Nurs. 1991; 16: 337-343
        • McArdle W.D.
        • Katch F.I.
        • Katch V.L.
        Exercise physiology: energy, nutrition and human performance. 4th rev. ed.
        Lippincott Williams & Wilkins, Baltimore1996
        • Schrack J.A.
        • Simonsick E.M.
        • Ferrucci L.
        The relationship of the energetic cost of slow walking and peak energy expenditure to gait speed in mid-to-late life.
        Am J Phys Med Rehabil. 2013; 92: 28-35
        • Haugen H.A.
        • Chan L.-N.
        • Li F.
        Indirect calorimetry: a practical guide for clinicians.
        Nutr Clin Pract. 2007; 22: 377-388