{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T10:48:34Z","timestamp":1777891714861,"version":"3.51.4"},"reference-count":36,"publisher":"SAGE Publications","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["NRE"],"published-print":{"date-parts":[[2023,11,14]]},"abstract":"<jats:p>BACKGROUND: Accurate prediction of recovery is essential to determine whether a knee-ankle-foot orthosis (KAFO) is required in the subacute phase of stroke. However, there are currently no reliable methods to predict such recovery. OBJECTIVE: This study aimed to determine whether muscle strength of the affected lower limb (affected side LL strength) in stroke patients in the subacute phase who cannot walk without a KAFO can be used to predict the continuous need for a KAFO, using a hand-held dynamometer. METHODS: We enrolled patients with severe hemiplegia (n\u200a=\u200a51) who were unable to walk without a KAFO for 10 days after stroke onset. They were divided into two groups depending on the continuous need for a KAFO at 1 month after onset; the KAFO and non-KAFO groups. Logistic regression analysis was used to investigate whether the affected side LL strength was a predictor of the continuous need for a KAFO at 1 month after onset. In addition, significant predictors were analyzed using receiver operating characteristic (ROC) curves. RESULTS: The KAFO and non-KAFO groups included 23 (45.10%) and 28 (54.90%) patients, respectively. The affected side LL strength and pusher syndrome severity were identified as predictors of the continuous need for a KAFO. The predictor with the highest predictive ability was the affected side LL strength, with an area under the ROC curve of 0.80 (95% CI, 0.68\u20130.93). CONCLUSIONS: Affected side LL strength may be a highly accurate predictor of the need for a KAFO in the subacute phase of stroke.<\/jats:p>","DOI":"10.3233\/nre-230057","type":"journal-article","created":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T11:44:38Z","timestamp":1689335078000},"page":"355-366","source":"Crossref","is-referenced-by-count":4,"title":["Lower limb muscle strength of the affected side in stroke patients is an accurate predictor of the need for a KAFO"],"prefix":"10.1177","volume":"53","author":[{"given":"Takashi","family":"Seki","sequence":"first","affiliation":[{"name":"Department of Rehabilitation Medicine, Kohnan Hospital, Sendai, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroaki","family":"Abe","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Fukushima Medical University, Fukushima, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naohide","family":"Tsujimoto","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Nishiyamato Rehabilitation Hospital, Nara, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toru","family":"Okanuka","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Kohnan Hospital, Sendai, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","reference":[{"key":"10.3233\/NRE-230057_ref1","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1298\/ptr.R0015","article-title":"A narrative review of alternate gait training using Knee-ankel-foot orthosis in stroke patients with severe hemiparesis","volume":"24","author":"Abe,","year":"2021","journal-title":"Phys Ther Res"},{"key":"10.3233\/NRE-230057_ref2","doi-asserted-by":"crossref","first-page":"1430.b","DOI":"10.3390\/brainsci11111430","article-title":"Impact of Alternate Gait Training Using Knee\u2013 Ankle\u2013 Foot Orthoses with Oil Damper Ankle Hinge in Patients with Subacute Severe Hemiplegia","volume":"11","author":"Abe,","year":"2021","journal-title":"Brain Sci"},{"key":"10.3233\/NRE-230057_ref3","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.bjpt.2018.08.001","article-title":"Knee extensor muscles strength indicates global lower-limb strength in individuals who have suffered a stroke: A cross-sectional study","volume":"23","author":"Aguiar,","year":"2019","journal-title":"Braz J Phys Ther"},{"key":"10.3233\/NRE-230057_ref4","doi-asserted-by":"crossref","first-page":"765","DOI":"10.2340\/16501977-2279","article-title":"Determining the cut-off value for knee extensor strength for identifying independence in gait in chronic stroke survivors","volume":"49","author":"Akazawa,","year":"2017","journal-title":"J Rehabil Med"},{"key":"10.3233\/NRE-230057_ref5","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1177\/0269215509104172","article-title":"Clinical examination tools for lateropulsion or pusher syndrome following stroke: a systematic review of the literature","volume":"23","author":"Babyar,","year":"2009","journal-title":"Clin Rehabil"},{"key":"10.3233\/NRE-230057_ref6","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1177\/026921558900300107","article-title":"Selected determinants of ambulatory capacity in patients with hemiplegia","volume":"3","author":"Bohannon,","year":"1989","journal-title":"Clin Rehabil"},{"key":"10.3233\/NRE-230057_ref7","doi-asserted-by":"crossref","first-page":"14","DOI":"10.2340\/16501977-0018","article-title":"Muscle strength and muscle training after stroke","volume":"39","author":"Bohannon,","year":"2007","journal-title":"J Rehabil Med"},{"key":"10.3233\/NRE-230057_ref8","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1093\/ptj\/67.2.206","article-title":"Interrater reliability of a modified Ashworth scale of muscle spasticity","volume":"67","author":"Bohannon,","year":"1987","journal-title":"Phys Ther"},{"key":"10.3233\/NRE-230057_ref9","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.clinbiomech.2012.09.007","article-title":"Effects of a knee-ankle-foot orthosis on gait biomechanical characteristics of paretic and non-paretic limbs in hemiplegic patients with genu recurvatum","volume":"28","author":"Boudarham,","year":"2013","journal-title":"Clin Biomech (Bristol, Avon)"},{"key":"10.3233\/NRE-230057_ref10","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1093\/ptj\/46.4.357","article-title":"Motor testing procedures in hemiplegia: based on sequential recovery stages","volume":"46","author":"Brunnstrom,","year":"1966","journal-title":"Phys Ther"},{"key":"10.3233\/NRE-230057_ref11","doi-asserted-by":"crossref","first-page":"119","DOI":"10.2490\/jjrm1963.31.119","article-title":"Stroke Impairment Assessment Set (SIAS): a new evaluation instrument for stroke patients","volume":"31","author":"Chino,","year":"1994","journal-title":"Jpn J Rehabil Med"},{"key":"10.3233\/NRE-230057_ref12","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1136\/jnnp.53.7.576","article-title":"Assessing motor impairment after stroke: a pilot reliability study","volume":"53","author":"Collin,","year":"1990","journal-title":"J Neurol Neurosurg Psychaiatry"},{"key":"10.3233\/NRE-230057_ref13","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1002\/pri.528","article-title":"The relationship of lower limb muscle strength and knee joint hyperextension during the stance phase of gait in hemiparetic stroke patients","volume":"17","author":"Cooper,","year":"2012","journal-title":"Physiother Res Int"},{"key":"10.3233\/NRE-230057_ref14","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.jneumeth.2008.12.016","article-title":"Development and testing of the Gait Assessment and Intervention Tool (G.A.I.T.): a measure of coordinated gait components","volume":"178","author":"Daly,","year":"2009","journal-title":"J Neurosci Methods"},{"key":"10.3233\/NRE-230057_ref15","doi-asserted-by":"crossref","first-page":"2873","DOI":"10.1161\/01.STR.0000147724.83468.18","article-title":"Poststroke \u201cpushing\u201d: natural history and relationship to motor and functional recovery","volume":"35","author":"Danells,","year":"2004","journal-title":"Stroke"},{"key":"10.3233\/NRE-230057_ref16","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.2106\/00004623-199610000-00008","article-title":"Gait pattern in the early recovery period after stroke","volume":"78","author":"De Quervain,","year":"1996","journal-title":"J Bone Joint Surg Am"},{"key":"10.3233\/NRE-230057_ref17","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1161\/01.STR.23.8.1084","article-title":"Measurement of motor recovery after stroke: Outcome assessment and sample size requirements","volume":"23","author":"Duncan,","year":"1992","journal-title":"Stroke"},{"key":"10.3233\/NRE-230057_ref18","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1161\/01.STR.28.7.1382","article-title":"Trunk control test as an early predictor of stroke rehabilitation outcome","volume":"28","author":"Franchignoni,","year":"1997","journal-title":"Stroke"},{"key":"10.3233\/NRE-230057_ref19","doi-asserted-by":"crossref","first-page":"1878","DOI":"10.1016\/j.jstrokecerebrovasdis.2015.12.020","article-title":"Prediction of Independent Walking Ability for Severely Hemiplegic Stroke Patients at Discharge from a Rehabilitation Hospital","volume":"25","author":"Hirano,","year":"2016","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"10.3233\/NRE-230057_ref20","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1093\/ptj\/64.1.35","article-title":"Clinical gait assessment in the neurologically impaired. Reliability and meaningfulness","volume":"64","author":"Holden,","year":"1984","journal-title":"Phys Ther"},{"key":"10.3233\/NRE-230057_ref21","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/S0003-9993(95)80038-7","article-title":"Recovery of walking function in stroke patients: the Copenhagen Stroke Study","volume":"76","author":"J\u00f8rgensen,","year":"1995","journal-title":"Arch Phys Med Rehabil"},{"key":"10.3233\/NRE-230057_ref22","doi-asserted-by":"crossref","first-page":"191","DOI":"10.3109\/03093649609164442","article-title":"Clinical experiences with a convertible thermoplastic knee-ankle-foot orthosis for post-stroke hemiplegic patients","volume":"20","author":"Kakurai,","year":"1996","journal-title":"Prosthet Orthot Int"},{"key":"10.3233\/NRE-230057_ref23","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1007\/s00415-006-0341-6","article-title":"Pusher syndrome - a frequent but little - known disturbance of body orientation perception","volume":"254","author":"Karnath","year":"2007","journal-title":"J Neurol"},{"key":"10.3233\/NRE-230057_ref24","doi-asserted-by":"crossref","first-page":"1298","DOI":"10.1212\/WNL.55.9.1298","article-title":"The origin of contraversive pushing: evidence for a second graviceptive system in humans","volume":"55","author":"Karnath,","year":"2000","journal-title":"Neurology"},{"key":"10.3233\/NRE-230057_ref25","doi-asserted-by":"crossref","first-page":"jrm00290","DOI":"10.2340\/jrm.v54.87","article-title":"Efficacy of Knee-Ankle-Foot Orthosis on functional mobility and activities of daily living in patients with stroke: A systematic review of case reports","volume":"7","author":"Kobayashi,","year":"2022","journal-title":"J Rehabil Med"},{"key":"10.3233\/NRE-230057_ref26","doi-asserted-by":"crossref","first-page":"1312","DOI":"10.1016\/j.jstrokecerebrovasdis.2015.02.003","article-title":"A comparison of knee-ankle-foot orthoses with either metal struts or an adjustable posterior strut in hemiplegic stroke patients","volume":"24","author":"Maeshima,","year":"2015","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"10.3233\/NRE-230057_ref27","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1177\/17474930221090347","article-title":"Committee for Stroke Guideline 2021, the Japan Stroke Society: Japan Stroke Society Guideline 2021 for the Treatment of Stroke","volume":"17","author":"Miyamoto,","year":"2022","journal-title":"Int J Stroke"},{"key":"10.3233\/NRE-230057_ref28","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.1016\/S0003-9993(99)90036-9","article-title":"Strength assessment in postpolio syndrome: validity of a hand-held dynamometer in detecting change","volume":"80","author":"Nollet,","year":"1999","journal-title":"Arch Phys Med Rehabil"},{"key":"10.3233\/NRE-230057_ref29","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1589\/jpts.30.1245","article-title":"Differences in activities of daily living between people with subacute stroke who received knee-ankle-foot and ankle-foot orthoses at admission","volume":"30","author":"Ota,","year":"2018","journal-title":"J Phys Ther Sci"},{"key":"10.3233\/NRE-230057_ref30","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1589\/jpts.31.127","article-title":"Early effects of a knee-ankle-foot orthosis on static standing balance in people with subacute stroke","volume":"31","author":"Ota,","year":"2019","journal-title":"J Phys Ther Sci"},{"key":"10.3233\/NRE-230057_ref31","doi-asserted-by":"crossref","first-page":"106261","DOI":"10.1016\/j.jstrokecerebrovasdis.2021.106261","article-title":"Early wearing of knee-ankle-foot orthosis improves functional prognosis in patients after stroke","volume":"31","author":"Sato,","year":"2022","journal-title":"J Stroke Cerebrovasc Dis"},{"key":"10.3233\/NRE-230057_ref32","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1016\/j.apmr.2012.12.025","article-title":"Effects of an ankle-foot orthosis on balance and walking after stroke. a systematic review and pooled meta-analysis","volume":"94","author":"Tyson,","year":"2013","journal-title":"Arch Phys Med Rehabil"},{"key":"10.3233\/NRE-230057_ref33","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1177\/0269215513486497","article-title":"A systematic review and meta-analysis of the effect of an ankle-foot orthosis on gait biomechanics after stroke","volume":"27","author":"Tyson,","year":"2013","journal-title":"Clin Rehabil"},{"key":"10.3233\/NRE-230057_ref34","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1310\/G8RF-312L-G6FW-A8JW","article-title":"Stroke rehabilitation and long leg brace","volume":"11","author":"Yamanaka,","year":"2004","journal-title":"Top Stroke Rehabil"},{"key":"10.3233\/NRE-230057_ref35","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1177\/1545968310384271","article-title":"Is accurate prediction of gait in nonambulatory stroke patients possible within 72 hours poststroke? The EPOS study","volume":"25","author":"Veerbeek,","year":"2011","journal-title":"Neurorehabil Neural Repair"},{"key":"10.3233\/NRE-230057_ref36","doi-asserted-by":"crossref","first-page":"3227","DOI":"10.1589\/jpts.27.3227","article-title":"The relationship between bilateral knee muscle strength and gait performance after stroke: the predictive value for gait performance","volume":"27","author":"Watanabe,","year":"2015","journal-title":"J Phys Ther Sci"}],"container-title":["NeuroRehabilitation"],"original-title":[],"link":[{"URL":"https:\/\/content.iospress.com\/download?id=10.3233\/NRE-230057","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T06:08:06Z","timestamp":1777615686000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/full\/10.3233\/NRE-230057"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,14]]},"references-count":36,"journal-issue":{"issue":"3"},"URL":"https:\/\/doi.org\/10.3233\/nre-230057","relation":{},"ISSN":["1053-8135","1878-6448"],"issn-type":[{"value":"1053-8135","type":"print"},{"value":"1878-6448","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,14]]}}}