Evaluating the Predictive Validity of Trunk Impairment Scale with Forward Tilt in Stroke Rehabilitation

In this study, we aimed to test whether TIS with FT can predict the prognosis of patients with stroke similar to TIS.

We evaluated trunk performance using TIS and TIS with FT upon admission. The TIS with FT category involved additional tasks such as holding a posture for 10 s with the upper limb of the unaffected side in the 90° flexion position, reaching forward 20 cm, and returning to a sitting position without compensation.  We enrolled 59 patients with stroke who were recovering at the hospital and assessed their age, body mass index (BMI), days to admission to the recovery hospital, and cognitive FIM score.  The predicted outcome was the independent level of walking and toileting, assessed using the FIM at discharge, as these abilities are crucial for discharge from the hospital.  We divided the patients into two groups: those in which both activities were independent (G2) and those with non-independent activities (G1). The binarized groups served as independent variables. The common independent variables included age, BMI, time to admission to the recovery hospital, and cognitive FIM score. An additional variable, TIS or TIS with FT , was selected, and a forced-entry logistic regression analysis was performed. Correlations between TIS and TIS with FT scores were also examined using a significance level 5%.  The study protocol was approved by the Showa University Research Ethics Review Board.

We analyzed data  from 55 participants, with G1 and G2 comprising 19 and 36 individuals, respectively. Significant differences  were observed between the groups in terms of age, BMI, and cognitive FIM scores. A strong correlation was observed between TIS and TIS with FT  (r=0.989, p0.001). In the logistic regression analysis, TIS and TIS with FT were significant when either of them were included alongside four other variables  (TIS: adjusted OR 1.660, 95%CI 1.22–2.25, p=0.001; TIS with FT: adjusted OR 1.158, 95%CI 1.20–2.09, p=0.001).

TIS with FT was slightly less effective in predicting the independent level of toileting and walking. Therefore, the FT items are needed to reconsider the rules for pelvic tilt and improve the accuracy of the assessment .

This result suggests that TIS with FT can be used in a manner similar to that of TIS. FT items are less difficult than the dynamic and cooperative items of the TIS; therefore, the ceiling effect associated with TIS may be reduced.