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. 2021 Sep;30(9):105895.
doi: 10.1016/j.jstrokecerebrovasdis.2021.105895. Epub 2021 Jul 7.

Evaluating Test-Retest Reliability of Fatigability in Chronic Stroke

Alyssa D Stookey  1 , Richard F Macko  2 , Frederick M Ivey  3 , Leslie I Katzel  4
Affiliations

Evaluating Test-Retest Reliability of Fatigability in Chronic Stroke

Alyssa D Stookey et al. J Stroke Cerebrovasc Dis. 2021 Sep.

Abstract

Objectives: The subjective nature of fatigue may contribute to inconsistencies in prevalence rates for post-stroke fatigue. More objective performance fatigue measures may offer a more reliable construct of fatigue. Our goal was to establish test-retest reliability of fatigability in stroke during 6-minute walk (6MW) testing. Relationships between post-stoke fatigability and other constructs were assessed.

Materials and methods: Twenty-three hemiparetic stroke survivors underwent two 6MW tests with portable metabolic monitoring performed at least 48 hours apart. Fatigability was defined as ratio of change in walking speed to distance covered during the 6MW. 6MW oxygen consumption (VO2), peak aerobic capacity (VO2peak), walking speed over-ground, dynamic gait index, fatigue, falls efficacy, and BMI were measured.

Results: Fatigability was highly correlated between both 6MW trials (ICC = 0.99, p < 0.001) with no significant difference between trials (0.08, p = 0.48). The strongest correlation was between fatigability and 6MW VO2 trial 1 and 2 (r = 0.92, p < 0.001 and r = 0.95, p < 0.001, respectively). Moderate-to-strong relationships were observed between fatigability for 6MW and fastest-comfortable walking speed (r = -0.82 and -0.77), self-selected walking speed (r = -7.8 and -0.78), 6MW walking speed (r = -0.80 and 0.80, VO2peak (r = -0.47 and -0.48) (p < 0.001), and DGI (r = -0.70 and -0.68, p < 0.001).

Conclusion: This study establishes test-retest reliability for an objective measure of fatigue in stroke-related disability. The strong correlations between fatigability and other functional measures also provides insight into the contributors underlying fatigability in this population.

Registration: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01322607.

Keywords: Function; Rehabilitation; Stroke; Task performance and analysis.

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Conflict of interest statement

Declaration of Competing Interest There are no conflicts of interest to report.

Figures

Figure 1.
Figure 1.
Bland-Altman Plot of Performance Fatigability. Solid horizontal line represents mean difference between tests. Dotted horizontal lines are reference lines representing 5% and 95% confidence intervals (± 1.96 SD).
Figure 2.
Figure 2.
Ratio of average 6MW speed vs 6MW speed of the first minute and total distance.
Figure 3.
Figure 3.
6 Minute walk speed for each minute with standard error bars. Abbreviations – 6MW: 6-minute walk Straight line: Trial 1; Dotted line: Trial 2 * represents a statistically significant difference from 6MW speed of minute 1
See this image and copyright information in PMC

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