Test-retest reliability and four-week changes in cardiopulmonary fitness in stroke patients: evaluation using a robotics-assisted tilt table.
BACKGROUND
Exercise testing devices for evaluating cardiopulmonary fitness in patients with severe disability after stroke are lacking, but we have adapted a robotics-assisted tilt table (RATT) for cardiopulmonary exercise testing (CPET). Using the RATT in a sample of patients after stroke, this study aimed to investigate test-retest reliability and repeatability of CPET and to prospectively investigate changes in cardiopulmonary outcomes over a period of four weeks.


METHODS
Stroke patients with all degrees of disability underwent 3 separate CPET sessions: 2 tests at baseline (TB1 and TB2) and 1 test at follow up (TF). TB1 and TB2 were at least 24 h apart. TB2 and TF were 4 weeks apart. A RATT equipped with force sensors in the thigh cuffs, a work rate estimation algorithm and a real-time visual feedback system was used to guide the patients' exercise work rate during CPET. Test-retest reliability and repeatability of CPET variables were analysed using paired t-tests, the intraclass correlation coefficient (ICC), the coefficient of variation (CoV), and Bland and Altman limits of agreement. Changes in cardiopulmonary fitness during four weeks were analysed using paired t-tests.


RESULTS
Seventeen sub-acute and chronic stroke patients (age 62.7 ± 10.4 years [mean ± SD]; 8 females) completed the test sessions. The median time post stroke was 350 days. There were 4 severely disabled, 1 moderately disabled and 12 mildly disabled patients. For test-retest, there were no statistically significant differences between TB1 and TB2 for most CPET variables. Peak oxygen uptake, peak heart rate, peak work rate and oxygen uptake at the ventilatory anaerobic threshold (VAT) and respiratory compensation point (RCP) showed good to excellent test-retest reliability (ICC 0.65-0.94). For all CPET variables, CoV was 4.1-14.5 %. The mean difference was close to zero in most of the CPET variables. There were no significant changes in most cardiopulmonary performance parameters during the 4-week period (TB2 vs TF).


CONCLUSIONS
These findings provide the first evidence of test-retest reliability and repeatability of the principal CPET variables using the novel RATT system and testing methodology, and high success rates in identification of VAT and RCP: good to excellent test-retest reliability and repeatability were found for all submaximal and maximal CPET variables. Reliability and repeatability of the main CPET parameters in stroke patients on the RATT were comparable to previous findings in stroke patients using standard exercise testing devices. The RATT has potential to be used as an alternative exercise testing device in patients who have limitations for use of standard exercise testing devices.
Institute for Rehabilitation and Performance Technology, Division of Mechanical Engineering, Department of Engineering and Information Technology, Bern University of Applied Sciences, Burgdorf, Switzerland.|ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Research Group, University of Bern, Bern, Switzerland.|Research Department, Reha Rheinfelden, Rheinfelden, Switzerland.|Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Jittima
J
Saengsuwan
Research Department, Reha Rheinfelden, Rheinfelden, Switzerland.
Lucia
L
Berger
Institute for Rehabilitation and Performance Technology, Division of Mechanical Engineering, Department of Engineering and Information Technology, Bern University of Applied Sciences, Burgdorf, Switzerland.|Research Department, Reha Rheinfelden, Rheinfelden, Switzerland.
Corina
C
Schuster-Amft
ARTORG Center for Biomedical Engineering Research, Gerontechnology and Rehabilitation Research Group, University of Bern, Bern, Switzerland.
Tobias
T
Nef
Institute for Rehabilitation and Performance Technology, Division of Mechanical Engineering, Department of Engineering and Information Technology, Bern University of Applied Sciences, Burgdorf, Switzerland. kenneth.hunt@bfh.ch.|Research Department, Reha Rheinfelden, Rheinfelden, Switzerland. kenneth.hunt@bfh.ch.
Kenneth J
KJ
Hunt
D000072599:Cardiorespiratory Fitness; D006233:Persons with Disabilities / Q000534:rehabilitation; D005080:Exercise Test / Q000295:instrumentation / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012371:Robotics; D020521:Stroke / Q000503:physiopathology*; D018667:Tilt-Table Test / Q000295:instrumentation / Q000379:methods* / Q000592:standards*
Cardiopulmonary exercise testing; Repeatability; Robotics-assisted tilt table; Stroke; Test-retest reliability