Physiother Res Int. 2026 Jul;31(3):e70287. doi: 10.1002/pri.70287.
ABSTRACT
BACKGROUND AND PURPOSE: Stroke survivors often exhibit reduced walking efficiency, reflected by an increased energy cost of walking (Cw). Although Cw has been associated with walking performance, its relationship with impairment severity and independence in activities of daily living (ADL) remains unclear, particularly across real-life walking conditions. This study aimed to examine the association between impairment severity and Cw across real-life walking tasks. A secondary objective was to assess the association between Cw and independence in ADL.
METHODS: This secondary analysis used data from a cross-sectional study including 30 stroke survivors. Participants performed walking tasks under real-life conditions (overground, irregular surface, slope, and stairs) at self-selected speeds. Oxygen consumption was measured using portable indirect calorimetry, and Cw was calculated as the ratio of oxygen consumption to walking speed. Impairment severity and independence in ADL were assessed using the NIHSS and the Barthel Index. Associations were analyzed using Spearman's correlations, with additional analyses adjusted for walking speed.
RESULTS: Unadjusted analyses showed significant associations between Cw and impairment severity across overground walking, stair descent, irregular terrain walking, and downhill walking (ρ = 0.38-0.59). Cw was also significantly associated with independence in ADL across overground walking, stair descent, irregular terrain walking, uphill, and downhill walking (ρ = -0.38 to -0.59), with the strongest associations generally observed during irregular terrain and downhill walking. After adjustment for walking speed, none of these associations remained statistically significant (all p > 0.05).
DISCUSSION: Cw was associated with both impairment severity and independence in ADL, but these relationships were largely explained by walking speed. These findings suggest that gait velocity is a central factor linking walking energetics to clinical and functional outcomes after stroke. Limitations include the relatively mild impairment level and the cross-sectional design.
TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05477238.
PMID:42446085 | DOI:10.1002/pri.70287