Strength of knee flexors of the paretic limb as an important determinant of functional status in post-stroke rehabilitation

Abstract Objective The purpose of the study was to assess the effectiveness of the multi-modal exercise program (MMEP) in patients after stroke, and to identify muscles that are the best predictors of functional performance and changes in functional status in a 3-week rehabilitation program. Methods Thirty-one post-stroke patients (60.6 ± 12.7 years) participating in a 3-week MMEP took part in the study. Measurements of extensor and flexor strength of the knee ( F ext , F flex ) were done. Functional performance was measured using Timed Up & Go test (TUG), 6-Minute Walk Test (6-MWT) and Tinetti Test. Results The rehabilitation program improved all the results of functional tests, as well as the values of strength in the patients. Both baseline and post-rehabilitation functional status was associated with knee flexor and extensor muscle strength of paretic but not of non-paretic limbs. At baseline examination muscle strength difference between both F flex  kg −1 and F ext  kg −1 had an influence on functional status. After rehabilitation the effect of muscle strength difference on functional status was not evident for F ext  kg −1 and, interestingly, even more prominent for F flex  kg −1 . Conclusions MMEP can effectively increase muscle strength and functional capacity in post-stroke patients. Knee flexor muscle strength of the paretic limb and the knee flexor difference between the limbs is the best predictor of functional performance in stroke survivors.