A cross-sectional study to assess an association between upper extremity function and functional walking capacity in chronic stroke survivors
Ameerani Jarbandhan; Jerry Toelsie; Robbert Bipat; Jeannine Freedrik; Luc Vanhees; Roselien Buys; DirkJan H.E.J. Veeger
Abstract
Background: The Six-Minute Walk Test (6MWT) predicts community ambulation in stroke patients. These patients frequently face several disabilities, including upper extremity dysfunction. Since upper extremity (UE) dysfunction is related to walking disability, we expect that the UE function is associated with the 6MWT. So far, no study has directly investigated the association between UE function and the 6MWT. Aims: To examine the association between UE function and the 6MWT in stroke survivors adjusted for balance and gait problems. Methods: Subjects were randomly recruited from the general population and the Academic Hospital Paramaribo. UE function was measured using the handgrip strength (HGS) test, Disabilities of the Arm Shoulder and Hand (DASH) survey and Stroke Impact Scale (SIS) survey. Functional walking capacity was measured by the 6MWT. Functional balance was measured using the Berg Balance Scale (BBS). Step length ratio (SLR) and step width (SW) were used to assess gait. The median (range) or mean±SD are presented. Results: In fifty subjects with a mean age of 58.2±9.5 years, we demonstrated that the mean 6MWT (297.9±19.8m) correlated with the mean paretic HGS (19.1±14.9kg, r=0.77, p<0.001) and non-paretic HGS (31.1±9.7kg, r=0.41, p=0.003), but not with the DASH and SIS surveys. The 6MWT correlated with the BBS (55.0(30.0-56.0), r=0.51, p<0.001), SLR (0.9(1.0-2.0), r= -0.29, p=0.044), but did not correlate with SW. After adjusting for BBS and SLR, paretic HGS explained 62% of the variance in 6MWT. The relationship between non-paretic HGS and 6MWT was influenced by the BBS and SLR (p<0.05, R2 =0.39). Conclusions: Paretic handgrip strength predicts 6MWT performance after adjusting for balance and gait asymmetry. The 6MWT is limited by stroke-related impairments such as handgrip strength, balance control and gait asymmetry. Further studies are warranted for assessment of causal effects between these variables.
Keywords
References
1. van Bloemendaal M, van de Water AT, van de Port IG. Walking tests for stroke survivors: a systematic review of their measurement properties. Disabil Rehabil. 2012;34(26):2207-21. http://dx.doi.org/10.3109/09638288.2012.680649. PMid:22583082.
2. Kim DK, Oh DW. Repeated use of 6-min walk test with immediate knowledge of results for walking capacity in chronic stroke: clinical trial of fast versus slow walkers. J Stroke Cerebrovasc Dis. 2019;28(11):104337. http://dx.doi.org/10.1016/j. jstrokecerebrovasdis.2019.104337. PMid:31522886.
3. Dunn A, Marsden DL, Nugent E, Van Vliet P, Spratt NJ, Attia J, et al. Protocol variations and six-minute walk test performance in stroke survivors: a systematic review with meta-analysis. Stroke Res Treat. 2015;2015:484813. http://dx.doi.org/10.1155/2015/484813. PMid:25685596.
4. Yi Y, Shim JS, Oh BM, Seo HG. Grip strength on the unaffected side as an independent predictor of functional improvement after stroke. Am J Phys Med Rehabil. 2017;96(9):616-20. http://dx.doi.org/10.1097/PHM.0000000000000694. PMid:28085737.
5. Pratama IK, Setiati, S. Correlation between hand grip strength and functional mobility in elderly patients. In: IOP Publishing, editor. The 2nd Physics and Technologies in Medicne and Dentistry Symposium; 2018 July 18; Indonesia: IOP Publishing; 2018. (Journal of Physics: Conf. Series; vol. 1073, no. 4). http://dx.doi.org/10.1088/1742-6596/1073/4/042034.
6. Eng JJ, Dawson AS, Chu KS. Submaximal exercise in persons with stroke: test-retest reliability and concurrent validity with maximal oxygen consumption. Arch Phys Med Rehabil. 2004;85(1):113-8. http://dx.doi.org/10.1016/S0003-9993(03)00436-2. PMid:14970978.
7. Sibley KM, Tang A, Patterson KK, Brooks D, McIlroy WE. Changes in spatiotemporal gait variables over time during a test of functional capacity after stroke. J Neuroeng Rehabil. 2009;6(1):27. http://dx.doi.org/10.1186/1743-0003-6-27. PMid:19594945.
8. Pohl PS, Duncan PW, Perera S, Liu W, Lai SM, Studenski S, et al. Influence of stroke-related impairments on performance in 6-minute walk test. J Rehabil Res Dev. 2002;39(4):439-44. PMid:17638141.
9. Sall J, Eapen BC, Tran JE, Bowles AO, Bursaw A, Rodgers ME. The management of stroke rehabilitation: a synopsis of the 2019 U.S. Department of Veterans Affairs and U.S. Department of Defense Clinical Practice Guideline. Ann Intern Med. 2019;171(12):916-24. http://dx.doi.org/10.7326/M19-1695. PMid:31739317.
10. Meyns P, Bruijn SM, Duysens J. The how and why of arm swing during human walking. Gait Posture. 2013;38(4):555-62. http://dx.doi.org/10.1016/j.gaitpost.2013.02.006. PMid:23489950.
11. Kaupp C, Pearcey GEP, Klarner T, Sun Y, Cullen H, Barss TS, et al. Rhythmic arm cycling training improves walking and neurophysiological integrity in chronic stroke: the arms can give legs a helping hand in rehabilitation. J Neurophysiol. 2018;119(3):1095-112. http://dx.doi.org/10.1152/jn.00570.2017. PMid:29212917.
12. Bovonsunthonchai S, Hiengkaew V, Vachalathiti R, Vongsirinavarat M, Tretriluxana J. Effect of speed on the upper and contralateral lower limb coordination during gait in individuals with stroke. Kaohsiung J Med Sci. 2012;28(12):667-72. http://dx.doi.org/10.1016/j.kjms.2012.04.036. PMid:23217359.
13. Hong SH, Jung SY, Oh HK, Lee SH, Woo YK. Effects of the immobilization of the upper extremities on spatiotemporal gait parameters during walking in stroke patients: a preliminary study. BioMed Res Int. 2020;2020:6157231. http://dx.doi. org/10.1155/2020/6157231. PMid:32596338.
14. Savino E, Martini E, Lauretani F, Pioli G, Zagatti AM, Frondini C, et al. Handgrip strength predicts persistent walking recovery after hip fracture surgery. Am J Med. 2013;126(12):1068-75.
15. Inoue H, Watanabe H, Okami H, Shiraishi Y, Kimura A, Takeshita K. Handgrip strength correlates with walking in lumbar spinal stenosis. Eur Spine J. 2020;29(9):2198-204. http://dx.doi.org/10.1007/s00586-020-06525-1. PMid:32651633.
16. Muren MA, Hütler M, Hooper J. Functional capacity and healthrelated quality of life in individuals post stroke. Top Stroke Rehabil. 2008;15(1):51-8. http://dx.doi.org/10.1310/tsr1501-51. PMid:18250074.
17. Schmidt RT, Toews JV. Grip strength as measured by the Jamar dynamometer. Arch Phys Med Rehabil. 1970;51(6):321-7. PMid:5423802.
18. Hudak PL, Amadio PC, Bombardier C, Beaton D, Cole D, Davis A, et al. Development of an upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). Am J Ind Med. 1996;29(6):602-8. http://dx.doi.org/10.1002/(SICI)1097- 0274(199606)29:6<602::AID-AJIM4>3.0.CO;2-L. PMid:8773720.
19. Margit AM, Resteghini C, Feys P, Lamers I. An overview of systematic reviews on upper extremity outcome measuers after stroke. BMC Neurol. 2015;15:29
20. Stricker M, Hinde D, Rolland A, Salzman N, Watson A, Almonroeder TG. Quantifying step length using two-dimensional video in individuals with Parkinson’s disease. Physiother Theory Pract. 2021;37(1):252-5. PMid:30896266.
21. Patterson KK, Gage WH, Brooks D, Black SE, McIlroy WE. Evaluation of gait symmetry after stroke: a comparison of current methods and recommendations for standardization. Gait Posture. 2010;31(2):241-6. http://dx.doi.org/10.1016/j.gaitpost.2009.10.014. PMid:19932621.
22. Liaw LJ, Hsieh CL, Lo SK, Chen HM, Lee S, Lin JH. The relative and absolute reliability of two balance performance measures in chronic stroke patients. Disabil Rehabil. 2008;30(9):656-61. http://dx.doi.org/10.1080/09638280701400698. PMid:17852318.
23. Macellari V, Giacomozzi C, Saggini R. Spatial-temporal parameters of gait: reference data and a statistical method for normality assessment. Gait Posture. 1999;10(2):171-81. http://dx.doi.org/10.1016/S0966-6362(99)00021-1. PMid:10502651.
24. Akoglu H. User’s guide to correlation coefficients. Turk J Emerg Med. 2018;18(3):91-3. http://dx.doi.org/10.1016/j.tjem.2018.08.001. PMid:30191186.
25. English C, McLennan H, Thoirs K, Coates A, Bernhardt J. Loss of skeletal muscle mass after stroke: a systematic review. Int J Stroke. 2010;5(5):395-402. http://dx.doi.org/10.1111/j.1747-4949.2010.00467.x. PMid:20854624.
26. Zhang Q, Lu H, Pan S, Lin Y, Zhou K, Wang L. 6MWT performance and its correlations with VO(2) and handgrip strength in homedwelling mid-aged and older chinese. Int J Environ Res Public Health. 2017;14(5):473. http://dx.doi.org/10.3390/ijerph14050473.
27. Park JG, Lee KW, Kim SB, Lee JH, Kim YH. Effect of decreased skeletal muscle index and hand grip strength on functional recovery in subacute ambulatory stroke patients. Ann Rehabil Med. 2019;43(5):535-43. http://dx.doi.org/10.5535/arm.2019.43.5.535. PMid:31693843.
28. Shin HI, Kim DK, Seo KM, Kang SH, Lee SY, Son S. Relation between respiratory muscle strength and skeletal muscle mass and hand grip strength in the healthy elderly. Ann Rehabil Med. 2017;41(4):686-92. http://dx.doi.org/10.5535/arm.2017.41.4.686. PMid:28971054.
29. Chen G, Patten C, Kothari DH, Zajac FE. Gait differences between individuals with post-stroke hemiparesis and non-disabled controls at matched speeds. Gait Posture. 2005;22(1):51-6. http://dx.doi.org/10.1016/j.gaitpost.2004.06.009. PMid:15996592.
30. Souissi H, Zory R, Boudarham J, Pradon D, Roche N, Gerus P. Muscle force strategies for poststroke hemiparetic patients during gait. Top Stroke Rehabil. 2019;26(1):58-65. http://dx.doi.org/10.1080/10749357.2018.1536023. PMid:30354914.
31. Molla RY, Sadeghi H, Farahmand F, Azarbayjani MA. Effect of excessive arm swing on speed and cadence of walking. J Men’s Health. 2020;4(1):e5.
32. Takahashi J, Nishiyama T, Matsushima Y. Does grip strength on the unaffected side of patients with hemiparetic stroke reflect the strength of other ipsilateral muscles? J Phys Ther Sci. 2017;29(1):64-6. http://dx.doi.org/10.1589/jpts.29.64. PMid:28210040.
33. Patterson KK, Gage WH, Brooks D, Black SE, Mcllroy WE. Changes in gait symmetry and velocity after stroke: a cross sectional study from weeks to years after stroke. Neurorehabil Neural Repair. 2010;24(9):783-90. http://dx.doi.org/10.1177/1545968310372091. PMid:20841442.
34. Dehno NS, Sarvestani FK, Shariat A, Jaberzadeh S. Relationship of hand strength with paretic upper extremity function and activities of daily living performance in patients with subacute stroke. Physiother Pract Res. 2020;41(1):69-77. http://dx.doi.org/10.3233/PPR-190147.
35. Izawa KP, Kasahara Y, Hiraki K, Hirano Y, Oka K, Watanabe S. Longitudinal changes of handgrip, knee extensor muscle strength, and the disability of the arm, shoulder and hand score in cardiac patients during phase ii cardiac rehabilitation. Diseases. 2019;7(1):32. http://dx.doi.org/10.3390/diseases7010032. PMid:30917524.
36. Patterson MR, Whelan D, Reginatto B, Caprani N, Walsh L, Smeaton AF, et al. Does external walking environment affect gait patterns? Conf Proc IEEE Eng Med Biol Soc. 2014;2014:2981-4. http://dx.doi.org/10.1109/EMBC.2014.6944249. PMid:25570617.
37. Liu J, Drutz C, Kumar R, McVicar L, Weinberger R, Brooks D, et al. Use of the six-minute walk test poststroke: is there a practice effect? Arch Phys Med Rehabil. 2008;89(9):1686-92. http://dx.doi.org/10.1016/j.apmr.2008.02.026. PMid:18760152.
38. Dalton E, Lannin NA, Laver K, Ross L, Ashford S, McCluskey A, et al. Validity, reliability and ease of use of the disabilities of arm, shoulder and hand questionnaire in adults following stroke. Disabil Rehabil. 2017;39(24):2504-11. http://dx.doi.org/10.1080/09638288.2016.1229364. PMid:27767374.
39. Baker K, Barrett L, Playford ED, Aspden T, Riazi A, Hobart J. Measuring arm function early after stroke: is the DASH good enough? J Neurol Neurosurg Psychiatry. 2016;87(6):604-10. http://dx.doi.org/10.1136/jnnp-2015-310557. PMid:26180212.
40. van der Kooi AL, Snijder MB, Peters RJ, van Valkengoed IG. The association of handgrip strength and type 2 diabetes mellitus in six ethnic groups: an analysis of the HELIUS study. PLoS One. 2015;10(9):e0137739. http://dx.doi.org/10.1371/journal.pone.0137739. PMid:26368020.
41. Bertoni AG, Bancks M, Crago, L, Chen H, Barr RG, Smith B, Shah, SJ. Abstract P151: race/ethnic differences in six minute walk distance among older adults: the multi-ethnic study of atherosclerosis. In: AHA, editor. AHA Epidemiology and Prevention-Lifestyle and Cardiometabolic Health 2020 Scientific Sessions; 2020 Mar 2; Arizona,: American Heart Association; 2020. (Circulation; vol. 141, suppl. 1).
Submitted date:
03/19/2021
Accepted date:
09/07/2021
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