Walking performance and muscle strength in the later stage poststroke: a nonlinear relationship

Abstract

Objectives: To evaluate the relation between muscle strength in the lower extremities and walking performance (speed and distance) in subjects in the later stage poststroke and to compare this with normative data.

Design: A cross-sectional observational study.

Setting: University hospital department.

Participants: Subjects poststroke (n=41; 31 men, 10 women) with a mean age of 59±5.8 years and a time from stroke onset of 52±36 months were evaluated. An urban sample (n=144) of 40- to 79-year-olds (69 men, 75 women) formed the healthy reference group.

Interventions: Not applicable.

Main outcome measures: Muscle strength in the lower extremities was measured with an isokinetic dynamometer and combined into a strength index. Values for the 30-meter walk test for self-selected and maximum speed and the 6-minute walk test were measured. A nonlinear regression model was used.

Results: The average strength index was 730±309 in the subjects after stroke compared with 1112±362 in the healthy group. A nonlinear relation between walking performance and muscle strength was evident. The model explained 37% of the variance in self-selected speed in the stroke group and 20% in the healthy group, and 63% and 38%, respectively, in the maximum walking speed. For the 6-minute walk test, the model explained 44% of the variance in the stroke group.

Conclusions: Subjects in the later stage poststroke were weaker than the healthy reference group, and their weakness was associated with walking performance. At the same strength index, subjects walked at lower speeds and shorter distances after stroke, indicating that there are multiple impairments that affect walking ability. Treatments focused on increasing muscle strength thus continue to hold promise.