Prediction of gait independence using the Trunk Impairment Scale in patients with acute stroke

 My god, is this bad research, and the mentors and senior researchers have to be just as bad in approving it!

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.

Prediction of gait independence using the Trunk Impairment Scale in patients with acute stroke

Masahiro Ishiwatari https://orcid.org/0000-0001-8564-4793 pt-ishi-ishi@tree.odn.ne.jp, Mami Tani, […], and Toshiyuki Fujiwara+8View all authors and affiliations

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https://doi.org/10.1177/17562864221140180

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Abstract

Background:

Gait recovery is one of the primary goals of stroke rehabilitation. Gait independence is a key functional component of independent activities in daily living and social participation. Therefore, early prediction of gait independence is essential for stroke rehabilitation.(WRONG, WRONG, WRONG! Delivering gait recovery is essential for stroke rehab. NOT  a prediction! ARE YOU THAT MUCH OF A BLITHERING IDIOT?) Trunk function is important for recovery of gait, balance, and lower extremity function. The Trunk Impairment Scale (TIS) was developed to assess trunk impairment in patients with stroke.

Objective:

To evaluate the predictive validity of the TIS for gait independence in patients with acute stroke.

Methods:

A total of 102 patients with acute stroke participated in this study. Every participant was assessed using the TIS, Stroke Impairment Assessment Set (SIAS), and Functional Independence Measure (FIM) within 48 h of stroke onset and at discharge. Gait independence was defined as FIM gait scores of 6 and 7. Multiple regression analysis was used to predict the FIM gait score, and multiple logistic regression analysis was used to predict gait independence. Cut-off values were determined using receiver operating characteristic (ROC) curves for variables considered significant in the multiple logistic regression analysis. In addition, the area under the curve (AUC), sensitivity, and specificity were calculated.

Results:

For the prediction of the FIM gait score at discharge, the TIS at admission showed a good-fitting adjusted coefficient of determination (R² = 0.672, p < 0.001). The TIS and age were selected as predictors of gait independence. The ROC curve had a TIS cut-off value of 12 points (sensitivity: 81.4%, specificity: 79.7%) and an AUC of 0.911. The cut-off value for age was 75 years (sensitivity: 74.6%, specificity: 65.1%), and the AUC was 0.709.

Conclusion:

The TIS is a useful early predictor of gait ability in patients with acute stroke.

Introduction

Gait recovery is a primary goal of stroke rehabilitation. Therefore, early prediction of gait independence is important for rehabilitation. Using neuroimaging, clinical studies have shown that the size of the brain lesion in stroke affects gait recovery.^1,2 Studies on the prognostic value of gait have reported effects on lower limb muscle strength, balance, and trunk function.^3–5 Gait disturbances in patients with stroke are caused by weakness (paresis or paralysis), abnormal tone in the limbs or trunk, or by disturbances in the sensory-motor system or central control mechanisms.⁶ Trunk control is an essential component of functional gait.⁷

In stroke rehabilitation, trunk control is a crucial element of motor activity for performing many functional tasks.⁸ A role for compensatory activation of noncrossing pathways in the recovery of trunk function has been suggested.^9,10 Clinical assessment tools to evaluate trunk function after stroke have been the subject of several systematic reviews.^11,12 Fujiwara et al.⁸ developed their Trunk Impairment Scale (TIS) to assess trunk function from a functional perspective and evaluated its psychometric properties. Many previous reports on trunk dysfunction after stroke have analyzed patient outcomes several weeks after stroke onset,^13,14 and not from the acute early onset. This may be due to the lack of an established method for acutely assessing the functional aspects of trunk dysfunction in patients with stroke.

Early inpatient rehabilitation can improve mortality and lessen the severity of disability.^15,16 A study on the length of hospital stays and outcomes of patients with stroke using the Uniform Data System for Medical Rehabilitation database reported that the hospital stay length decreased from an average of 19.6 days (±12.8 days) to 16.5 days (±9.8 days) over an 8-year study period.¹⁷ In the future, early rehabilitation interventions will become more important as the length of hospital stay is further reduced. Hence, early prediction of prognosis is necessary.

Our research question was: what is the predictive validity of the TIS for gait independence at hospital discharge when performed within 48 h of acute stroke onset? Thus, this study aimed to evaluate the predictive validity of the TIS for gait independence in patients with acute stroke.

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