Preston E1, Ada L2, Stanton R3, Mahendran N1, Dean C4
1University of Canberra, Physiotherapy, Faculty of Health, ACT, Australia, 2University of Sydney, Physiotherapy, Faculty of Health Sciences, Sydney, Australia, 3ACT Health, Rehabilitation, Aged and Community Care, ACT, Australia, 4Macquarie University, Physiotherapy, Faculty of Medicine and Health Sciences, Sydney, Australia
Background: 40% of initially non-ambulatory stroke survivors are either unable to walk or are dependent on the assistance of a person to walk at 3 months after stroke, and these people have a substantial loss of independence, significant participation restrictions and are more likely to be discharged to residential care. Only one systematic review has evaluated prognostic factors for predicting walking outcome after stroke, and it examined predictors of walking outcome at 1 month after stroke, not in the longer term.
Purpose: To determine, in patients who are non-ambulatory in the first month after stroke, which factors predict independent walking at 3, 6 and 12 months after stroke.
Methods: A systematic review and meta-analysis of prognostic studies of non-ambulatory patients within the first month after stroke was carried out. Any factors included in at least 2 studies and measured within one month after stroke with the aim of predicting walking outcome were included. The associations between factors and walking outcomes at 3, 6 and 12 months after stroke were pooled.
Results: Fifteen studies comprising 2,344 non-ambulatory participants after stroke were included in the review. 7 studies had a low risk of bias, and 8 studies had a moderate risk of bias when assessed using the QUIPs tool for prognostic studies. Age (R=-0.33, p 0.0001), an intact corticospinal tract (OR = 8.3, p=0.009), leg strength (R=0.41, p 0.01), cognitive impairment (OR = 0.29, p 0.001), neglect (OR=0.42, p=0.006), incontinence (OR=0.31, p=0.06), sitting balance (R=0.51, p 0.001), and independence in ADLs (R=0.55, p 0.01) predicted walking outcome at 3 months after stroke. Sex (OR=1.25, p=0.25), side of hemiplegia (OR = 1.13, p=0.61), type of stroke (OR=0.90, p=0.67) and aphasia (OR = 0.79, p = 0.43), did not predict walking outcome at 3 months in patients who were initially non-ambulatory. Age (R=-0.20, p=0.000), incontinence (OR=0.07, p=0.0000) and sitting balance (R=0.64, p=0.000) predicted walking outcome at 6 months after stroke. There were insufficient data to examine predictors of walking outcome at 12 months after stroke.
Conclusion(s): Younger age, an intact corticospinal tract, continence, good cognition, no neglect, some leg strength, good sitting balance and independence in ADLs, predict independent walking in non-ambulatory patients after stroke. Sex, stroke type, stroke side, and aphasia do not predict walking outcome.
Implications: These prognostic factors could be used to guide intervention during rehabilitation, to triage patients to rehabilitation, home or residential care, and to educate the patient, the family and carers about expected outcomes. The patient's sex, type of stroke or side of stroke should not influence the rehabilitation of walking.
Keywords: Prognosis, stroke, walking
Funding acknowledgements: No funding was used for this study.
Purpose: To determine, in patients who are non-ambulatory in the first month after stroke, which factors predict independent walking at 3, 6 and 12 months after stroke.
Methods: A systematic review and meta-analysis of prognostic studies of non-ambulatory patients within the first month after stroke was carried out. Any factors included in at least 2 studies and measured within one month after stroke with the aim of predicting walking outcome were included. The associations between factors and walking outcomes at 3, 6 and 12 months after stroke were pooled.
Results: Fifteen studies comprising 2,344 non-ambulatory participants after stroke were included in the review. 7 studies had a low risk of bias, and 8 studies had a moderate risk of bias when assessed using the QUIPs tool for prognostic studies. Age (R=-0.33, p 0.0001), an intact corticospinal tract (OR = 8.3, p=0.009), leg strength (R=0.41, p 0.01), cognitive impairment (OR = 0.29, p 0.001), neglect (OR=0.42, p=0.006), incontinence (OR=0.31, p=0.06), sitting balance (R=0.51, p 0.001), and independence in ADLs (R=0.55, p 0.01) predicted walking outcome at 3 months after stroke. Sex (OR=1.25, p=0.25), side of hemiplegia (OR = 1.13, p=0.61), type of stroke (OR=0.90, p=0.67) and aphasia (OR = 0.79, p = 0.43), did not predict walking outcome at 3 months in patients who were initially non-ambulatory. Age (R=-0.20, p=0.000), incontinence (OR=0.07, p=0.0000) and sitting balance (R=0.64, p=0.000) predicted walking outcome at 6 months after stroke. There were insufficient data to examine predictors of walking outcome at 12 months after stroke.
Conclusion(s): Younger age, an intact corticospinal tract, continence, good cognition, no neglect, some leg strength, good sitting balance and independence in ADLs, predict independent walking in non-ambulatory patients after stroke. Sex, stroke type, stroke side, and aphasia do not predict walking outcome.
Implications: These prognostic factors could be used to guide intervention during rehabilitation, to triage patients to rehabilitation, home or residential care, and to educate the patient, the family and carers about expected outcomes. The patient's sex, type of stroke or side of stroke should not influence the rehabilitation of walking.
Keywords: Prognosis, stroke, walking
Funding acknowledgements: No funding was used for this study.
Topic: Neurology: stroke
Ethics approval required: No
Institution: University of Canberra
Ethics committee: Human Research Ethics Committee
Reason not required: Systematic reviews do not require ethics approval
All authors, affiliations and abstracts have been published as submitted.
