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Test-retest reliability of two measures of energy cost after stroke

Paper i proceeding
Författare Anna Danielsson
Carin Willén
Katharina Stibrant Sunnerhagen
Publicerad i International symposium "Evidence for stroke rehabilitation - bridging into the future", Göteborg, Sweden April 26-28, 2006
Publiceringsår 2006
Publicerad vid Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap och rehabilitering
Språk en
Ämneskategorier Sjukgymnastik, Neurologi

Sammanfattning

Background: After a stroke, many persons walk slowly with increased energy cost which might restrict daily activities. Measurement of energy cost adds valuable information to gait analysis in the evaluation of exercise, orthoses and walking aids. Direct measurement of oxygen uptake (VO2) is the golden standard, but methods clinically practicable are needed. Physiological Cost Index (PCI) is a clinical method based on the relation between VO2 and heart rate. Regulation of heart rate might be affected after stroke, therefore the reliability of PCI in stroke patients needs to be investigated. The aim was to compare VO2 and PCI with respect to test-retest reliability. Methods: 20 persons with stroke 30-63 years of age were included. VO2 was measured by breath-by-breath analysis and heart rate by electrocardiography at rest and during 5 minutes of walking on a treadmill at the individual's self-selected speed. Two measurement sessions were carried out. PCI was calculated as the heart rate difference between rest and walking, divided by gait speed and expressed as heart beats/m. The differences between sessions were analysed with confidence intervals and Bland-Altman plots. Results: Gait speed on the treadmill was mean 0.48 m/s (CI 95% 0.34 - 0.60). The energy cost was mean 0.41 and 0.40 ml/kg/m at 1st and 2nd session, respectively, with a mean test-retest difference of 0.012 (CI 95% -0.008 - 0.033). PCI was mean 0.76 at both sessions with a mean test-retest difference of 0.009 (95% CI -0.142 - 0.125). Conclusion: The energy cost measured by both VO2 and PCI was increased in the stroke group compared to reference values from the literature. Analysis of mean differences between sessions showed a greater dispersion for the PCI than for the VO2-based values. PCI needs further investigation before conclusions about the applicability for stroke patients can be drawn.

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