Test–Retest Reliability of Portable Metabolic Monitoring After Disabling Stroke

And maybe  we are finally getting to some objective measurements of post-stroke deficits. But don't worry it will take 30 years to get to your clinic unless we get a great stroke association to speed up implementation of proven therapies. The Joint Commission and stroke associations are not taking responsibility for this.
http://nnr.sagepub.com/content/27/9/872.abstract?etoc

1. Alyssa D. Stookey, PhD1
2. Michael G. McCusker, MA2
3. John D. Sorkin, MD, PhD1,2
4. Leslie I. Katzel, MD, PhD1,2
5. Marianne Shaughnessy, PhD1,2
6. Richard F. Macko1,2
7. Frederick M. Ivey, PhD1,2

1. ¹Baltimore VA Medical Center, Baltimore, MD, USA
2. ²University of Maryland School of Medicine, Baltimore, MD, USA

1. Alyssa D. Stookey, Baltimore VA Medical Center, Geriatrics Service/GRECC BT(18) GR, 10 North Greene St, Baltimore, MD 21201-1524, USA. Email: alyssa.stookey@va.gov

Abstract

Purpose. Impaired economy of gait, prevalent in chronic stroke secondary to residual gait deficits, is associated with intolerance for performing activities of daily living. Gait economy/efficiency is traditionally assessed by determining the rate of oxygen consumption during submaximal treadmill walking. However, the mechanics and energetics of treadmill versus overground walking are very different in stroke survivors with ambulatory deficits. Clearly, overground cardiopulmonary measures are needed to accurately profile movement economy after stroke. An obstacle to obtaining such measures after stroke has been the absence of reliable portable metabolic monitoring equipment. The purpose of this study was to establish the test–retest reliability of a portable metabolic monitoring device during overground walking in hemiparetic stroke survivors.  

Methods. Twenty-three chronic hemiparetic stroke survivors underwent two 6-minute walk tests while wearing a COSMED K4b² portable metabolic measurement system. Intraclass correlations coefficients (ICC) were calculated for both cardiopulmonary parameters and distance covered to determine test–retest reliability. An ICC of ≥0.85 was considered reliable. Results. ICCs for relative Vo₂ (0.90), absolute Vo₂ (0.93), Vco₂ (0.93), and minute ventilation (0.95) demonstrated high reliability, but not for heart rate (0.76) or respiratory exchange ratio (0.64). There was no significant difference in the distance each participant walked between the first and second tests, eliminating distance as a potential confounder of our analyses (ICC = 0.99).  

Conclusions. Our results strongly support the reliability of the K4b² for quantifying overground gait efficiency after stroke. Use of this device may enable researchers to study how varying poststroke rehabilitation interventions affect this central measure of health and function.