Return to Employment After Stroke in Young Adults: How Important Is the Speed and Energy Cost of Walking?

Abstract

Background and Purpose- A quarter of individuals who experience a stroke are under the age of 65 years (defined as young adults), and up to 44% will be unable to return to work poststroke, predominantly because of walking difficulties. No research study has comprehensively analyzed walking performance in young adult's poststroke. The primary aim of this study is to investigate how a stroke in young adults affects walking performance (eg, walking speed and metabolic cost) compared with healthy age-matched controls. The secondary aim is to determine the predictive ability of walking performance parameters for return to employment poststroke. Methods- Forty-six individuals (18-40 years: n=6, 41-54 years: n=21, 55-65 years: n=19) who have had a stroke and 15 healthy age-matched able-bodied controls were recruited from 6 hospital sites in Wales, United Kingdom. Type, location, cause of stroke, and demographic factors (eg, employment status) were recorded. Temporal and spatial walking parameters were measured using 3-dimensional gait analysis. Metabolic energy expenditure and metabolic cost of walking were captured during 3 minutes of walking at self-selected speed from measurements of oxygen consumption. Results- Stroke participants walked slower (P<0.004) and less efficiently (P<0.002) than the controls. Only 23% of stroke participants returned to employment poststroke. Walking speed was the strongest predictor (sensitivity, 0.90; specificity, 0.82) for return to work (P=0.004) with a threshold of 0.93 m/s identified: individuals able to walk faster than 0.93 m/s were significantly more likely to return to work poststroke than those who walked slower than this threshold. Conclusions- This study is the first to capture walking performance parameters of young adults who have had a stroke and identifies slower and less efficient walking. Walking speed emerged as the strongest predictor for return to employment. It is recommended that walking speed be used as a simple but sensitive clinical indicator of functional performance to guide rehabilitation and inform readiness for return to work poststroke.

Keywords: adult; return to work; stroke; walking speed; young adult.

Figure 1.

A, Scatter plot of age and walking speed for stroke participants aged 18 to 40 y (circles), 41 to 54 y (squares), and 55 to 65 y (triangles). Solid black line represents the mean, black dashed lines represents 95% CIs. Control participants are presented in gray solid line for the mean and gray dashed line represent 95% CI only. Correlation for stroke participants r^s=0.216 (P=0.145). B, Scatter plot of age and metabolic cost for stroke participants aged 18 to 40 y (circles), 41 to 54 y (squares), and 55 to 65 y (triangles). Solid black line represents the mean, black dashed lines represents 95% CIs. Control participants are presented in gray solid line for mean and gray dashed line represent 95% CI only. Correlation analysis for stroke participants r^s=0.246 (P=0.100).

Figure 2.

Receiver operating characteristic (ROC) curve for self-selected walking speed. The ROC curve demonstrates the sensitivity and specificity for classifying the ability to return to employment at a 0.93 m/s self-selected walking speed threshold.

Figure 3.

Individual data for walking speed and metabolic cost of walking (r=−0.862; P<0.001) for stroke participants. Participants in black were unable to return to work and participants in gray returned to work poststroke. Black dashed horizontal line indicates walking speed threshold (0.93 m/s). Black dotted line represents trendline.