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Gait speed and spasticity are independently associated with estimated failure load in the distal tibia after stroke: an HR-pQCT study

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Abstract

Summary

This HR-pQCT study was conducted to examine bone properties of the distal tibia post-stroke and to identify clinical outcomes that were associated with these properties at this site. It was found that spasticity and gait speed were independently associated with estimated failure load in individuals with chronic stroke.

Purpose

(1) To examine the influence of stroke on distal tibia bone properties and (2) the association between these properties and clinical outcomes in people with chronic stroke.

Methods

Sixty-four people with stroke (age, 60.8 ± 7.7 years; time since stroke, 5.7 ± 3.9 years) and 64 controls (age: 59.4 ± 7.8 years) participated in this study. High-resolution peripheral quantitative computed tomography (HR-pQCT) was used to scan the bilateral distal tibia, and estimated failure load was calculated by automated finite element analysis. Echo intensity of the medial gastrocnemius muscle and blood flow of the popliteal artery were assessed with ultrasound. The 10-m walk test (10MWT), Fugl-Meyer Motor Assessment (FMA), and Composite Spasticity Scale (CSS) were also administered.

Results

The percent side-to-side difference (%SSD) in estimated failure load, cortical area, thickness, and volumetric bone mineral density (vBMD), and trabecular and total vBMD were significantly greater in the stroke group than their control counterparts (Cohen’s d = 0.48–1.51). Isometric peak torque and echo intensity also showed significant within- and between-groups differences (p ≤ 0.01). Among HR-pQCT variables, the %SSD in estimated failure load was empirically chosen as one example of the strong discriminators between the stroke group and control group, after accounting for other relevant factors. The 10MWT and CSS subscale for ankle clonus remained significantly associated with the %SSD in estimated failure load after adjusting for other relevant factors (p ≤ 0.05).

Conclusion

The paretic distal tibia showed more compromised vBMD, cortical area, cortical thickness, and estimated failure load than the non-paretic tibia. Gait speed and spasticity were independently associated with estimated failure load. As treatment programs focusing on these potentially modifiable stroke-related impairments are feasible to administer, future studies are needed to determine the efficacy of such intervention strategies for improving bone strength in individuals with chronic stroke.

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Data availability

The authors agree to deposit the project data on a community-recognized data repository.

Code availability

Post-processing of B-mode ultrasound images involved the use of a custom program written in MATLAB (version R2018a, MathWorks, Natick, MA, USA) for estimating muscle echo intensity (impixel function). MATLAB and SPSS (version 26, IBM Corp., Armonk, NY, USA) are commercially available software.

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Acknowledgements

The authors would like to thank the participants and Sik Cheung Siu for his support and technical assistance during this study.

Funding

Tiev Miller and Charlotte San Lau Tsang were funded by post-graduate research studentships through the Department of Rehabilitation Sciences at The Hong Kong Polytechnic University (Grants RL27, RUNV). This study was substantially supported by a research grant provided to Marco Y. C. Pang by the Research Grants Council (General Research Fund: 151031/18 M).

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Authors and Affiliations

  1. Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong

    Tiev Miller, Charlotte S. L. Tsang, Huixi Ouyang, Raymond C. K. Chung & Marco Y. C. Pang

  2. Bone Quality and Health Centre, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Sha Tin, Hong Kong

    Ling Qin & Vivian W. Y. Hung

  3. Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Hong Kong

    Michael T. C. Ying

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  1. Tiev Miller
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  2. Ling Qin
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  5. Charlotte S. L. Tsang
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  8. Marco Y. C. Pang
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Correspondence to Marco Y. C. Pang.

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Ethical approval was obtained from the Human Research Ethics Review Committee of the University. All of the experimental procedures were conducted in accordance with the Helsinki Declaration for human experiments.

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The details of the study were explained to the participants before informed written consent was obtained.

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Consent to use information and data collected during the course of the study for educational and knowledge dissemination purposes was granted by the participants.

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Miller, T., Qin, L., Hung, V.W.Y. et al. Gait speed and spasticity are independently associated with estimated failure load in the distal tibia after stroke: an HR-pQCT study. Osteoporos Int 33, 713–724 (2022). https://doi.org/10.1007/s00198-021-06191-z

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