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Suzuki T1, Goto K1, Maruoka M1, Okamoto A2, Maeoka S1, Nishimura S3
1Tenri Hospital, Shirakawa Rehabilitation Center, Nara, Japan, 2Tenri Hospital, Rehabilitation Center, Nara, Japan, 3Tenri Hospital, Shirakawa, Nara, Japan
Background: Regaining independent walking is one of the primary goals in stroke rehabilitation. Soon after admission it is important for stroke patients' management to predict when independent walking will be regained. A number of studies have reported physical and cognitive functions associated with independent walking following strokes. Most of the studies conducted at inpatient rehabilitation facilities used a three to six month study period following the onset of the stroke.
Purpose: The aims of the present study were to investigate what physical and cognitive functions on admission can be associated with regaining independent walking by 7 months (28 weeks) after onset, and also whether the associated functions can be used to predict the regaining independent walking.
Methods: From April 2017 to March 2018, 91 patients after their first stroke who were admitted to the hospital and then discharged were examined. On admission the following were recorded: age, sex, body weight, type of stroke (hemorrhage or infarction), diabetes, pain in the lower extremity, sitting balance, paretic level in lower limb, lower limb strength in non-paretic side, attentional disorder and Functional Independence Measure (FIM). Outcomes of FIM in the study were FIM-Locomotor (FIM-L) and FIM-Cognitive (FIM-C).
The Patients were divided into two groups based on their walking levels at 7 months: those who regained independent walking (more than 6 of FIM-L) and those who did not (less than 5 of FIM-L). After performing bivariate analyses, multivariate logistic regression analyses were performed using the two groups as dependent variables and the significant outcomes by the bivariate analyses to investigate outcomes associated with regaining independent walking. The significant outcomes by multivariate analyses were used to calculate receiver operating characteristics (ROC) curves and the area under each curve (AUC) to find the cut-off values of the outcomes.
Results: The average number of days after onset on admission at the rehabilitation facility was 36days (±18.76) . The average number of weeks that patients took to regain independent walking was 11.75 (±6.67). Of the 91 patients, 34 patients regained independent walking. Logistic regression analyses revealed that FIM-C（odds ratio [OR], 1.21, 95% confidence interval [95% CI], 1.06-1.39）, age（OR, 0.89, 95%CI, 0.82-0.97）, and lower limb strength in non-paretic side (OR, 13.71, 95%CI, 3.2-58）were significantly correlated with regaining independent walking by 7 months.
The ROC curves revealed the cut-off value of >22 points for FIM-C (sensitivity 32% and specificity 26%; AUC 0.79), 68 years old for age (sensitivity 77% and specificity 61%; AUC 0.72), and >MMT 4 for lower limb strength in non-paretic side (sensitivity 49% and specificity 5%; AUC 0.82).
Conclusion(s): The multivariate analyses indicated that FIM-C, age, and lower limb strength in non-paretic side can be factors associated with regaining independent walking for stroke patients. The sensitivity and specificity of the cut-off values using the factors, however, were not sufficient.
Implications: FIM-C, age, and lower limb strength in non-paretic side can be predictive factors whether or not stroke patients are able to regain independent walking by 7 months. Since sufficient predictive values were not found in the study, future studies are needed.
Keywords: stroke, regaining independent walking, physical and cognitive functions
Funding acknowledgements: None
Purpose: The aims of the present study were to investigate what physical and cognitive functions on admission can be associated with regaining independent walking by 7 months (28 weeks) after onset, and also whether the associated functions can be used to predict the regaining independent walking.
Methods: From April 2017 to March 2018, 91 patients after their first stroke who were admitted to the hospital and then discharged were examined. On admission the following were recorded: age, sex, body weight, type of stroke (hemorrhage or infarction), diabetes, pain in the lower extremity, sitting balance, paretic level in lower limb, lower limb strength in non-paretic side, attentional disorder and Functional Independence Measure (FIM). Outcomes of FIM in the study were FIM-Locomotor (FIM-L) and FIM-Cognitive (FIM-C).
The Patients were divided into two groups based on their walking levels at 7 months: those who regained independent walking (more than 6 of FIM-L) and those who did not (less than 5 of FIM-L). After performing bivariate analyses, multivariate logistic regression analyses were performed using the two groups as dependent variables and the significant outcomes by the bivariate analyses to investigate outcomes associated with regaining independent walking. The significant outcomes by multivariate analyses were used to calculate receiver operating characteristics (ROC) curves and the area under each curve (AUC) to find the cut-off values of the outcomes.
Results: The average number of days after onset on admission at the rehabilitation facility was 36days (±18.76) . The average number of weeks that patients took to regain independent walking was 11.75 (±6.67). Of the 91 patients, 34 patients regained independent walking. Logistic regression analyses revealed that FIM-C（odds ratio [OR], 1.21, 95% confidence interval [95% CI], 1.06-1.39）, age（OR, 0.89, 95%CI, 0.82-0.97）, and lower limb strength in non-paretic side (OR, 13.71, 95%CI, 3.2-58）were significantly correlated with regaining independent walking by 7 months.
The ROC curves revealed the cut-off value of >22 points for FIM-C (sensitivity 32% and specificity 26%; AUC 0.79), 68 years old for age (sensitivity 77% and specificity 61%; AUC 0.72), and >MMT 4 for lower limb strength in non-paretic side (sensitivity 49% and specificity 5%; AUC 0.82).
Conclusion(s): The multivariate analyses indicated that FIM-C, age, and lower limb strength in non-paretic side can be factors associated with regaining independent walking for stroke patients. The sensitivity and specificity of the cut-off values using the factors, however, were not sufficient.
Implications: FIM-C, age, and lower limb strength in non-paretic side can be predictive factors whether or not stroke patients are able to regain independent walking by 7 months. Since sufficient predictive values were not found in the study, future studies are needed.
Keywords: stroke, regaining independent walking, physical and cognitive functions
Funding acknowledgements: None
Topic: Neurology: stroke; Neurology
Ethics approval required: Yes
Institution: Tenri hospital.
Ethics committee: Tenri hospital.
Ethics number: 973
All authors, affiliations and abstracts have been published as submitted.
