Association of performance of standing-start turns with physical impairments, balance ability, functional mobility, and activities of daily living in stroke survivors

Turning is one of the most frequent activities leading to falls for stroke patients. They had asymmetrical posture and movement due to hemiparesis, possibly leading to turning difficulties. However, there has been lack of comprehensive clinical assessment of turning strategy after stroke including turn steps, time, type and quality. Investigation of turning after stroke in most previous studies used age-matched healthy subjects as the control group but limited studies compared turning features within stroke subgroups including fallers and non-fallers, acute and chronic stroke, and orthosis wearers and non-wearers. Previous studies reported that turning performance was related to muscle strength and physical impairments of lower limbs, functional balance and walking speed, but it is unknown whether there is a relationship between turning and trunk control, bed mobility and activities of daily living. Therefore, the first aim of the study is to investigate the standing-start turning performance in stroke and subgroups. The secondary aim is to examine the relationship of standing-start turns to physical impairments, balance ability, functional mobility, and activities of daily living in individuals with hemiplegic stroke. Forty stroke participants will aim to be recruited. Inclusion criteria are (1) participants had survived a single stroke with hemiparesis; (2) were able to walk 10 meters without walking aids and orthosis; (3) ability to follow commands; and (4) ability to give informed consent. Exclusion criteria are (1) participants had other musculoskeletal conditions or other comorbid disabilities that could affect assessment; and (2) had cognitive problems or aphasia that could not follow instructions. All participants will be asked their demographic data including age, gender, diagnosis, paretic side, post-stroke duration, use of orthosis, fall history, and self-reported turning difficulties. They will be then evaluated their turning performance by turning time, steps, quality and type. Physical impairments will be assessed by Chedoke-McMaster Stroke Assessment Inventory for legs and foot, trunk control ability by Trunk Impairment Scale, and functional muscle strength by five times sit-to-stand test. Balance ability will be examined by Berg Balance Scale and Falls Efficacy Scale International. Functional mobility will be evaluated by bed mobility, Timed Up and Go test and 10-Meter Walk Test. Frenchay Activity Index will be used for assessing activities of daily living. Independent t test will be used to compare between subgroups and Pearson correlation test will be applied to compare the relationship between turns and physical impairments, balance ability, functional mobility, and activities of daily living. SPSS was used for all statistical analysis with significance assumed at p < 0.05.