Kinesiophobia, Sarcopenia, Stroke
Conditions
Keywords
Quadriceps Muscle Thickness, Ultrasonography, Sarcopenia, SARC-F, Handgrip Strength, Kinesiophobia, Stroke Rehabilitation
Brief summary
The aim of this study is to evaluate the relationship between ultrasonography-measured quadriceps muscle thickness and the sarcopenia markers SARC-F questionnaire and handgrip strength in patients diagnosed with ischemic stroke. In addition, the relationship between quadriceps muscle thickness and the level of kinesiophobia will be quantitatively assessed. This study is a cross-sectional clinical study conducted between August 1, 2025, and August 1, 2026, at the Physical Medicine and Rehabilitation Clinic of the University of Health Sciences İstanbul Physical Medicine and Rehabilitation Training and Research Hospital. Fifty volunteer participants with ischemic stroke and a lower-extremity Brunnstrom motor stage of 3 or higher, who presented to the clinic during the study period, were included. Bilateral quadriceps femoris muscle thickness, including the rectus femoris and vastus intermedius muscles, was measured using ultrasonography. The SARC-F questionnaire was used to assess sarcopenia risk, handgrip strength measurement was used to evaluate muscle strength, and the Tampa Scale for Kinesiophobia was used to determine the level of kinesiophobia. Motor recovery stage was assessed using the Brunnstrom Staging system; motor and cognitive independence were assessed using the Functional Independence Measure; walking independence was assessed using the Functional Ambulation Scale; and independence in activities of daily living was assessed using the Barthel Index of Activities of Daily Living. Because balance impairment, muscle weakness, and limited mobility are common after stroke, physical performance tests may be difficult to administer safely and consistently in this patient population. Therefore, the relationship between quadriceps muscle thickness and physical performance tests was not evaluated in this study. The Chair Stand Test, which requires repeated sit-to-stand movements as well as adequate balance and lower-extremity muscle strength, was also not included because it may increase the risk of falls in patients with limited mobility. This study aims to demonstrate the clinical potential of ultrasonography in the assessment of post-stroke sarcopenia and to support a more holistic approach to stroke rehabilitation planning that considers both physical and psychological factors.
Detailed description
Sarcopenia is a common consequence of stroke, resulting from immobility, decreased physical activity, and impaired neuromuscular control. This process particularly affects the lower extremity muscles, limiting physical independence and reducing the effectiveness of rehabilitation. The structural properties of lower extremity muscles are considered an important determinant of a patient's functional capacity, and the quadriceps femoris muscle plays a central role in essential motor tasks such as walking and transferring, given its involvement in knee extension and hip flexion. Ultrasonographic assessment of quadriceps muscle thickness offers a non-invasive and practical method for obtaining quantitative and objective data on muscle morphology, providing a clinically valuable advantage over more resource-intensive imaging modalities such as DXA, bioelectrical impedance analysis (BIA), CT, or MRI. While handgrip strength and the SARC-F questionnaire are widely used as initial screening tools for possible sarcopenia, a definitive diagnosis requires muscle mass quantification, for which ultrasonography has become an increasingly used method in recent years. This study does not classify patients according to sarcopenia status; instead, it evaluates the extent to which handgrip strength and SARC-F scores align with ultrasonographically measured quadriceps thickness. This relationship has been studied in other patient populations but remains less explored specifically in stroke survivors, which is why this population was selected. In addition to physical determinants of musculoskeletal health, psychological factors are also considered relevant. Kinesiophobia-an irrational fear of movement-is frequently observed after stroke and may limit participation in physical activity, reinforcing a cycle of inactivity and further muscle deterioration. This study therefore also examines the potential association between kinesiophobia and quadriceps muscle thickness in chronic stroke patients, aiming to provide clinically relevant insight into how muscle structure and psychological status may interact, and to support a more individualized and multidisciplinary approach to post-stroke rehabilitation planning.
Interventions
None listed
Sponsors
Istanbul Physical Medicine Rehabilitation Training and Research Hospital
Study design
Observational model
COHORT
Time perspective
CROSS_SECTIONAL
Eligibility
Sex/Gender
ALL
Age
40 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Chronic stroke duration between 6 months and 2 years * Ischemic stroke type * Age between 40-80 years * Brunnstrom lower extremity motor stage ≥3, ambulatory * Provision of written informed consent
Exclusion criteria
* Hemorrhagic stroke * Stroke onset more than 2 years prior * Inflammatory arthritis or other rheumatologic disease * History of knee trauma * Pre-stroke neurological gait disorder * Recurrent stroke * Lower extremity amputation * Knee joint contracture
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Quadriceps Muscle Thickness | Measured once at the time of study enrollment (baseline, cross-sectional assessment). Within this single session, three consecutive measurements were obtained per participant, and the mean value was recorded as the outcome value | Bilateral quadriceps femoris muscle thickness (rectus femoris and vastus intermedius) measured by ultrasonography |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| SARC-F Score | Measured once at the time of study enrollment | Sarcopenia risk was screened using the SARC-F (Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls) questionnaire, a self-reported 5-item tool. Total score ranges from 0 to 10; higher scores indicate greater risk of sarcopenia. |
| Handgrip Strength | Measured once at the time of study enrollment (baseline, cross-sectional assessment). Within this single session, three consecutive measurements were obtained per participant, and the highest value was recorded as the outcome value | Handgrip strength was measured using a JAMAR hand dynamometer, expressed in kilograms, as an indicator of functional muscle strength. Higher values indicate greater muscle strength. According to EWGSOP2 criteria, low muscle strength is defined as grip strength \<27 kg in men and \<16 kg in women; values at or above these thresholds are considered normal. There is no fixed maximum value, as grip strength is an open-ended continuous measure |
| Tampa Scale for Kinesiophobia Score | Measured once at the time of study enrollment | Kinesiophobia level was assessed using the Tampa Scale for Kinesiophobia (TSK), a self-reported 17-item questionnaire measuring fear of movement/re-injury. Total score ranges from 17 to 68; higher scores indicate greater kinesiophobia. |
Countries
Turkey (Türkiye)
Contacts
CONTACTALPEREN KOLUKISAOĞLU, MD
PRINCIPAL_INVESTIGATORALPEREN KOLUKISAOĞLU, MD
Istanbul Physical Medicine and Rehabilitation Training and Research Hospital
STUDY_CHAIRNUR KESİKTAŞ, MD, Professor
Istanbul Physical Medicine and Rehabilitation Training and Research Hospital
Outcome results
None listed