Document Type : Original Articles


1 Department of Physiotherapy, Osun State University Teaching Hospital, Osogbo, Nigeria

2 Department of Medical Rehabilitation, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria


Background: The objective of this study was to whether handgrip and
quadriceps strength can predict post-stroke depression (PSD) and post-stroke
anxiety (PSA).
Methods: This cross-sectional study involved sixty-six consenting stroke
patients whose symptoms of depression and anxiety and affected handgrip and
quadriceps strength were assessed by the Hospital Anxiety and Depression Scale
(HADS) and handheld dynamometers. Data was analyzed using descriptive and
inferential statistics. Alpha level was set at P<0.05.
Results: The participants’ mean handgrip and quadriceps strength were 19.03
kg and 20.70 kg, respectively, while the prevalence of PSD and PSA were 33.4%
and 42.4%, respectively. PSD was significantly correlated with PSA (r=0.61;
P<0.001), handgrip strength (r=-0.24; P=0.049), functional independence
(r=-0.26; P=0.036), and stroke severity (r=0.26; P=0.039), while PSA was
significantly correlated with stroke severity (r=0.25; P=0.046) and age (r=-
0.25; P=0.048). Multiple linear regression results indicate that handgrip and
quadriceps strength were not independent predictors of PSD and PSA (P>0.05);
however, the presence of PSA was an independent predictor of PSD (B=0.590;
P<0.001), while the presence of PSD (B=0.621; P=0.001) and younger age (B=-
0.307; P<0.001) were independent predictors of PSA.
Conclusion: Handgrip and quadriceps strength are not significant predictors of
PSD and PSA in stroke survivors; however, PSD and PSA can predict each other,
indicating a bi-directional relationship, while age is a negative predictor of PSA.


  1. Murray, C.J, Barber, R.M., Foreman, K.J., Abbasolgu, O.A., Abd-Allah, F., Abera, S.F. et al. Global, regional, and national disability-adjusted life years (DALYs) for 306 diseases and injuries and healthy life expectancy (HALE) for 188 countries, 1990-2013: quantifying the epidemiological transition. Lancet 2015; 386 (10009): 2145–91.
  2.  Mohsen Naghavi, Haidong Wang, Rafael Lozano, Adrian Davis, Xiaofeng Liang, Maigeng Zhou et al. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 2015; 385 (9963): 117–71.
  3. da Silva, R.S., da Silva, S.T., de Souza, J.M. de Figueiredo M.C., Mendes T. A., Cardoso D.C. et al. Effects of inclined treadmill training on functional and cardiovascular parameters of stroke patients: study protocol for a randomized controlled trial. Trials 2019; 20: 252.
  4. Hackett, M.L., Yapa, C., Parag, V., Anderson, C.S. Frequency of Depression after Stroke: A Systematic Review of Observational Studies,” Stroke 2005; 36(6): 1330-1340.
  5. Amytis Towfighi, Bruce Ovbiagele, Nada El Husseini, Maree L. Hackett, Ricardo E. Jorge, Brett M. Kissela et al. Poststroke Depression: A Scientific Statement for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke 2017; 48(2):e30-e43.
  6. Villa RF, Ferrari F, Moretti A. Post-Stroke Depression: Mechanisms and Pharmacological Treatment. Pharmacol Ther 2018; 184:131-44.
  7. Volz M, Voelkle MC, Werheid K. General self-efficacy as a driving factor of post-stroke depression: A longitudinal study. Neuropsychol Rehabil. 2019; 29(9): 1426-1438.
  8. Wright F, Wu S, Chun HY, Mead G. Factors associated with poststroke anxiety: a systematic review and meta-analysis. Stroke Res Treat. 2017; 2017:2124743.
  9. C. A. Campbell Burton, J. Murray, J. Holmes, F. Astin, D. Greenwood, and P. Knapp, “Frequency of anxiety after stroke: a systematic review and meta-analysis of observational studies,” Int J Stroke 2013; 8 (7): 545-559.
  10. N. G. Galligan, D. Hevey, R. F. Coen, and J. A. Harbison, “Clarifying the associations between anxiety, depression and fatigue following stroke,” J Health Psychol. 2016; 21(12): 2863-2871.
  11. Chao Cao, Qinran Liu, Lin Yang, Xiaobin Zheng, Ping Lan, Ai Koyanagi et al. Handgrip strength is associated with suicidal thoughts in men: Cross-sectional analyses from NHANES. Scand J Med Sci Sports 2020; 30(1): 92-99.
  12. Norio Fukumori, Yosuke Yamamoto, Misa Takegami, Shin Yamazaki, Yoshihiro Onishi, Miho Sekiguchi et al. Association between hand-grip strength and depressive symptoms: Locomotive Syndrome and Health Outcomes in Aizu Cohort Study (LOHAS). Age and Ageing 2015; 44(4): 592–598
  13. Marco Bertoni, Stefania Maggi, Enzo Manzato, Nicola Veronese, Guglielmo Weber. Depressive symptoms and muscle weakness: A two-way relation? Exp Gerontol. 2018; 15 (108): 87-91.
  14. John Eng. Sample size estimation: how many individuals should be studied? Radiology 2003; 227(2):309-13.
  15. Wichowicz, H.M., Wieczorek, D.  Screening post-stroke depression using the Hospital Anxiety and Depression Scale. Psychiatr Pol. 2011; 45(4):505-14. PMID: 22232977.
  16. Olsson I, Mykletun A, Dahl AA. The hospital anxiety and depression rating scale: A cross-sectional study of psychometrics and case finding abilities in general practice. BMC Psychiatry 2005; 14(5):46.
  17. Canan Celik, Julide Aksel & Belgin Karaoglan. Comparison of the Orpington Prognostic Scale (OPS) and the National Institute of Health Stroke Scale (NIHSS) for the prediction of the functional status of patients with stroke. Disabil Rehabil. 2006; 28(10):609-612.
  18. Seung Yeol Lee, Deong Young Kim, Min Kyun Sohn, Jongmin Lee, Sam-Gyu Lee, Yong-11 Shin, et al. Determining the cut-off score for the Modified Barthel Index and the Modified Ranking Scale for assessment of functional independence and residual disability after stroke. PLoS One 2020; 15(1):e0226324.
  19. Myoung-Kwon Kim, Yu-Won Choe, Seong-Gil Kim, Eun-Hong Choi. Relationship among Stress, Anxiety-depression, Muscle Tone, and Hand Strength in Patients with Chronic Stroke: Partial Correlation. J Korean Soc Phys Med 2018; 13(4): 27-33.
  20. Jin Gee Park, Kyeong Woo Lee, Sang Beom Kim, Jong Hwa Lee, and Young Hwan Kim. Effect of Decreased Skeletal Muscle Index and Hand Grip Strength on Functional Recovery in Subacute Ambulatory Stroke Patients. Ann Rehabil Med. 2019; 43(5):535-543.
  21.  Larissa T. Aguiar, Julia C. Martins, Eliza M. Lara, Juliana A. Albuquerque, Luci F. Teixeira-Salmela, and Christina D. C. M. Faria. Dynamometry for the measurememnt of grip, pinch, and trunk muscles strength in subjects with subacute stroke: reliability and different number of trials. Braz J Phys Ther. 2016; 20(5):395-404.
  22. Gyagenda JO, Ddumba E, Odokonyero R, Kaddumukasa M, Sajatovic M, Smyth K, et al. Post-stroke depression among stroke survivors attending two hospitals in Kampala Uganda. Afri Health Sci. 2015; 15(4):1220-31.
  23. Oladiji JO, Akinbo SR, Aina OF, Aiyejusunle CB: Risk factors of post-stroke depression among stroke survivors in Lagos, Nigeria. Afr J Psychiatry (Johannesbg) 2009; 12(1):47-51.
  24. J. H. White, J. Attia, J. Sturm, G. Carter, and P. Magin, “Predictors of depression and anxiety in community dwelling stroke survivors: a cohort study,” Disabil  Rehabil. 2014; 36(23):1975-1982.
  25. R. C. Kessler, S. Aguilar-Gaxiola, J. Alonso, Somnath Chatterji, Sing Lee, Johan Ormel et al., “The global burden of mental disorders: an update from the WHO World mental Health (WMH) surveys,” Epidemiol  Psichiatr Soc. 2009; 18(1): 23-33.
  26. Brett R Gordon, Cillian P McDowell, Mark Lyons, Matthew P Herring. Associations between grip strength and generalized anxiety disorder in older adults: results from the Irish longitudinal study on ageing. J Affect Disord. 2019; 255:136-141.
  27. Felipe JA, Dihogo GM, Ricardo JO, Andre LC, Breno GT, Paulo MD et al. Victor MR. Relationship between depression and strength training in survivors of the ischemic stroke. J Hum Kinet. 2014; 43:7-15.
  28. van Milligen B.A., Lamers, F., de Hoop G.T., Smit, J.H., Penninx, B.W. Objective physical functioning in patients with depressive and/or anxiety disorders. J Affect Disord. 2011; 131(1-3): 193–9.
  29. Gerrits, K.H., Beltman, M.J., Koppe, P.A., Konijnenbelt, H., Elich, P.D., de Haan, A. et al. Isometric muscle function of knee extensors and the relation with functional performance in patients with stroke. Arch Phys Med and Rehabil. 2009; 90(3): 480–487.
  30. Borwin Bandelow and Sophie Michaelis. Epidemiology of anxiety disorders in the 21st century. Dialogues Clin Neurosci. 2015; 17(3):327-335.