Recovery of Walking Ability in Stroke Patients Through Postacute Care Rehabilitation

 Useless. Nothing here correlates the interventions done to the walking ability recovered.  DO YOU BLITHERING IDIOTS EVEN KNOW HOW TO DO RESEARCH?

Oops, I'm not playing by the polite rules of Dale Carnegie,  'How to Win Friends and Influence People'. 

Telling supposedly smart stroke medical persons they know nothing about stroke is a no-no even if it is true. 

Politeness will never solve anything in stroke. Yes, I'm a bomb thrower and proud of it. Someday a stroke 'leader' will try to ream me out for making them look bad by being truthful, I look forward to that day.

The latest here:

Recovery of Walking Ability in Stroke Patients Through Postacute Care Rehabilitation

Author links open overlay panelChan-LinChuMD^abTsong-HaiLeeMD, PhD^bcYueh-PengChenPhD^dLong-SunRoMD, PhD^bcJung-LungHsuMD, PhD^bceYu-ChengChuMD^bfChih-KuangChenMD^g

Yu-ChengPeiMD, PhD^bghi

https://doi.org/10.1016/j.bj.2022.07.004Get rights and content

Under a Creative Commons license

Open access

Abstract

Background

Walking entails orchestration of the sensory, motor, balance, and coordination systems, and walking disability is a critical concern after stroke. How and to what extent these systems influence walking disability after stroke and recovery have not been comprehensively studied.

Methods

We retrospectively analyzed patients with stroke in the Post-acute care-Cerebrovascular Diseases program. We compared the characteristics of patient groups stratified by their ability to complete the 5-m walk test across various time points of rehabilitation. We then used stepwise linear regression to examine the degree to which each stroke characteristic and functional ability could predict patient gait performance.

Results

Five hundred seventy-three patients were recruited, and their recovery of walking ability was defined by the timing of recovery in a 5-m walk test. The proportion of patients who could complete the 5-m walk test at admission, at 3 weeks of rehabilitation, at 6 weeks of rehabilitation, between 7 and 12 weeks of rehabilitation, and who could not complete the 5-m walk test after rehabilitation was 52.2%, 21.8%, 8.7%, 8.7%, and 8.6%, respectively. At postacute care discharge, patients who regained walking ability earlier had a higher chance of achieving higher levels of walking activity. Stepwise linear regression showed that Berg Balance Scale (ß: 0.011, P < .001), age (ß: −0.005, P =.001), National Institutes of Health Stroke Scale (6a + 6b; ß: -0.042, P = .018), Mini-Nutritional assessment (ß: −0.007, P < .027), and Fugl–Meyer upper extremity assessment (ß: 0.002, P = .047) scores predicted patient’s gait speed at discharge.

Conclusions

Balance, age, leg strength, nutritional status, and upper limb function before postacute care rehabilitation are predictors of walking performance after stroke.

Keywords

postacute care

stroke rehabilitation

walking ability

gait speed

functional recovery

Abbreviations

BBS

Berg Balance Scale

BI

Barthel Index

FuglUE

Fugl–Meyer upper extremity assessment

FuglSEN

modified Fugl–Meyer sensory assessment

MRS

modified Rankin Scale

MMSE

Mini-Mental State Examination

MNA

Mini-Nutritional assessment

NIHSS

National Institutes of Health Stroke Scale

OT

occupational therapy

PAC

Post-acute care

PAC-CVD

Post-acute Care-Cerebrovascular Diseases

PT

physical therapy

ST

speech and swallowing therapy

Introduction

Walking disability is a major concern among patients undergoing poststroke rehabilitation because the inability to walk considerably compromises their functionality and quality of life.[1] Numerous factors, including ataxia,[2, 3] leg strength,[4] sensory deficits,[5, 6] spasticity, and distal leg strength,[7] and cognitive impairment,[8] may contribute to walking disability. Because regaining walking ability is a major goal of poststroke rehabilitation,[9] assessing how these factors contribute to walking disability is crucial for establishing a tailored rehabilitation strategy to facilitate recovery.

Hornby et al[10] investigated the effects of training intensity on locomotion outcomes by pooling data from 3 randomized controlled trials. Among the 144 patients with subacute or chronic stroke, those who received high-intensity training and completed a high dose of training had the highest gains in locomotion. Hirano et al[11] investigated the factors predicting independent walking at discharge from a rehabilitation program in 72 severely hemiplegic patients with stroke and developed a prediction formula based on age and knee extensor strength to body weight ratio with an accuracy of 91%. Smith et al[12] analyzed the rehabilitation data of 41 patients and developed an algorithm to predict patients’ ability to walk independently at 6 or 12 weeks after a stroke. The algorithm was based on the patients’ trunk control test and leg strength assessed 1 week after stroke and achieved an accuracy of 95%. Kollen et al[13] investigated the factors that contribute to the improvement in walking ability by using sequential assessments for up to 1 year in 101 patients with stroke and found that standing balance control was a more accurate predictor of improvement in walking ability than leg strength or synergism. Park et al[8] investigated the accuracy of poststroke cognitive function at 1 month in predicting walking ability at 6 months in 72 patients with stroke and found that executive function, memory, and visuospatial deficits were predictors of walking ability. In summary, training intensity, actual dose of practice, balance, leg strength, and cognitive function are predictors of poststroke walking ability.

The aforementioned studies, however, were confounded by predefined baseline characteristics (eg, patients were already able to walk at baseline[10] or had better insurance coverage for rehabilitation),[14] small sample size,[8, [10], [11], [12], [13]] limited functional outcome assessment (eg, only cognition,[8] motor, or balance domains), [8, [10], [11], [12], [13]] limited time points of assessments,[8, 10, 11] or the use of only dichotomous outcomes.[10, 11] Additional studies are therefore needed to address the recovery from walking disability in patients with stroke with various neurologic and functional impairments.

The Post-acute Care-Cerebrovascular Diseases (PAC-CVD) program[[15], [16], [17]] provides a unique opportunity to investigate this problem. Eligible patients enrolled in this program underwent high-intensity rehabilitation for 3 hours/day on every weekday and 1 hour/day on Saturday and comprehensive functional evaluation at regular time intervals up to 12 weeks. The rehabilitation program comprised physical therapy (PT), occupational therapy (OT), and speech and swallowing therapy (ST), and the functional assessments evaluated the performance in activities of daily living, quality of life, nutritional status, function of paretic limbs, gait speed and endurance, balance, and cognitive function.

We hypothesized that besides known factors such as age, balance, leg strength, and cognition, other factors can predict poststroke walking performance. In this study, we examined whether patients’ demographics, comorbidities, stroke lesion side and location, limb ataxia, aphasia, leg strength, stroke onset to postacute care (PAC) rehabilitation interval, activities of daily living, upper limb synergism and function, nutritional status, somatosensation, balance, and cognitive function could predict the poststroke gait performance. Accurate prediction of patient ability to recover from walking disability after a stroke can help tailor rehabilitation programs and discharge plans.

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