Predicting Activities of Daily Living (ADL) Outcomes in Recovery-Phase Stroke Patients Using the Trunk Impairment Scale: A Validation Study

 Your competent? doctor has created EXACT TRUNK RECOVERY PROTOCOLS ALREADY, RIGHT? NO? What the fuck is your doctor for, if not to get you EXACTLY RECOVERED?

Predictions like this DO NOTHING FOR SURVIVOR RECOVERY! Predictions are currently based on the complete fucking failure of the status quo not getting you to 100% recovery! So do the fucking research that delivers 100% recovery and then predictions are useful. 

Doesn't anyone in stroke know how to think about getting to 100% recovery in stroke?

• Trunk control (19 posts to November 2012)

• 5 posts to August 2015)

Predicting Activities of Daily Living (ADL) Outcomes in Recovery-Phase Stroke Patients Using the Trunk Impairment Scale: A Validation Study | Cureus

Cite this article as: Ishiwatari M, Ogawa A, Hakukawa S, et al. (November 09, 2025) Predicting Activities of Daily Living (ADL) Outcomes in Recovery-Phase Stroke Patients Using the Trunk Impairment Scale: A Validation Study. Cureus 17(11): e96450. doi:10.7759/cureus.96450

 

Abstract

 Trunk function is a key determinant of activities of daily living (ADL) after stroke. While the Trunk Impairment Scale (TIS) has been linked to functional outcomes, its prognostic utility in the recovery phase is less established. This study aimed to develop and validate an ADL prediction model at discharge using the TIS in recovery-phase stroke patients. This prospective cohort study included 80 first-ever stroke patients admitted to Kiminomori Rehabilitation Hospital in Chiba, Japan. Trunk function (TIS), motor function (Stroke Impairment Assessment Set (SIAS)-M), stroke severity (NIH Stroke Scale/Score (NIHSS)), and ADL ( Functional Independence Measure (FIM)-M) were assessed. Three regression models were compared, and predictive validity was tested using cross-validation and bootstrap analysis. The TIS model showed the highest predictive accuracy, outperforming baseline and motor function models. Bootstrap analysis confirmed the independent contribution of one-month TIS to discharge ADL outcomes. The TIS assessed one month after stroke is a reliable predictor of discharge ADL, supporting its use for individualized rehabilitation planning.

Introduction

Trunk function is a key determinant of activities of daily living (ADL) after stroke, as it provides the foundation for postural control and mobility [1-3]. Trunk function, defined as the integrated capacity for coordinated movement, proprioceptive regulation, and trunk muscular strength, plays a key role in supporting postural stability and efficient functional activity after stroke. Impairment of trunk stability can compromise independence, while targeted trunk training has been shown to improve balance, gait, and quality of life [4-5]. Prognostic prediction after stroke depends on multiple factors, among which trunk function plays a particularly critical role [6-7].

In recent years, shorter hospital stays and the need for seamless transition to recovery-phase rehabilitation have increased the importance of reliable prognostic tools [8-11]. During this stage of heightened neuroplasticity [12-14], accurate prediction of functional recovery supports individualized rehabilitation planning and discharge preparation [6,10].

Trunk control is especially important for basic motor tasks, wheelchair-level ADL, and reducing caregiver burden [15-18]. Several assessment tools have been developed, but many focus only on sitting balance or isolated abilities [19-20]. The Trunk Impairment Scale (TIS) overcomes these limitations by evaluating both trunk balance and functional components [21]. While its association with ADL has been reported, evidence for its predictive utility in the recovery phase remains limited.

Recent findings have also demonstrated that early TIS scores can predict gait independence after acute stroke [22], further supporting its potential as a prognostic indicator.

Therefore, the aim of this study was to develop and validate a prediction model for discharge ADL using the TIS in recovery-phase stroke patients. Such a model may enhance prognostic accuracy and support the design of individualized rehabilitation programs.

Materials & Methods

Participants

This prospective cohort study initially included 116 patients who were transferred from acute care hospitals to recovery-phase rehabilitation hospitals (Kiminomori Rehabilitation Hospital, Chiba, Japan) with a diagnosis of cerebral infarction or cerebral hemorrhage between December 2021 and March 2023.

The inclusion criterion was a first-ever unilateral cerebral infarction. At one month after admission to the recovery-phase rehabilitation ward, participants were required to have a level of consciousness classified as awake without stimulation (Glasgow Coma Scale ≥14).

Exclusion criteria included impaired consciousness (Glasgow Coma Scale ≤14), surgical intervention, stroke deterioration, or death. Stroke deterioration was defined as an increase of ≥4 points in the National Institutes of Health Stroke Scale (NIHSS) score between admission and one month after admission to the recovery-phase ward.

Based on these criteria, the final study population consisted of 80 participants (46 men and 34 women).

All participants received a detailed explanation of the study’s purpose, and written informed consent was obtained. For patients unable to provide a signature, consent was obtained from an authorized representative, such as a family member. The study was approved by the Ethics Committee of Kiminomori Rehabilitation Hospital, Chiba, Japan (approval no. 2021-11), and all procedures were conducted in accordance with the principles of the Declaration of Helsinki.

Methods

Demographic data, including age, sex, and length of stay (LOS), were extracted from electronic medical records. Trunk function was assessed using the 7-item Trunk Impairment Scale (TIS; Fujiwara version) [21]. The scale consists of seven performance-based items, with a total score ranging from 0 to 21 points, where higher scores indicate better trunk function.

Two items are adapted from the Stroke Impairment Assessment Set (SIAS) and assess abdominal muscle strength and postural verticality, while the remaining five items uniquely evaluate trunk verticality perception, rotational trunk strength on both the affected and unaffected sides, and bilateral righting reactions.

The Fujiwara version of the TIS has demonstrated high reliability and validity and is widely used in clinical and research settings to quantify trunk impairment after stroke. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) [23]. Motor function on the affected side was evaluated using the motor items of the SIAS (SIAS-M) [24], and ADL were assessed with the motor subscale of the Functional Independence Measure (FIM-M) [25].

Only total scores were analyzed, without reproducing or describing any individual items, in accordance with copyright restrictions.

Although both the motor and cognitive subscales of the FIM were collected, only the motor subscale (FIM-M) was used in the analysis because the study focused on physical ADL performance in relation to trunk function, and the discharge FIM was assessed uniformly on the day before discharge for all participants.

Written confirmations regarding appropriate usage conditions were obtained from Wolters Kluwer (TIS and NIHSS), SAGE Publications (SIAS), and UDSMR/Netsmart (FIM).

To account for variability in physical function, assessments were performed one month after admission and again at discharge.

All evaluations were conducted by the same examiner.

Statistical analysis

The Shapiro-Wilk test was used to examine whether variables followed a normal distribution. To address multicollinearity, Spearman’s rank correlation coefficients were calculated, and variables with |r| ≥ 0.9 were excluded. Variance inflation factors (VIFs) ≥ 10 were also used to identify multicollinearity.

Multiple regression analyses were performed to evaluate the predictive validity of discharge ADL. The baseline model included age, length of stay, and one-month FIM-M as explanatory variables, with discharge FIM-M as the dependent variable. The TIS model additionally included one-month TIS, and the SIAS-M model included one-month SIAS-M. For each model, the coefficient of determination (R²), regression coefficients, and standard errors were calculated to compare predictive accuracy.

To assess generalizability, 10-fold cross-validation was performed, and R² and mean squared error (MSE) were calculated for each fold. In addition, bootstrap analysis (1,000 resamplings) was conducted to further validate model stability and reliability, estimating bias, standard errors, and 95% confidence intervals for regression coefficients and predictive accuracy.

All statistical analyses were conducted using IBM SPSS Statistics for Windows, version 29.0 (released 2022, IBM Corp., Armonk, NY) and R version 4.3.1 (R Foundation for Statistical Computing, Vienna, Austria). Statistical significance was set at p < 0.05.

Results

Participant characteristics

Participant characteristics are summarized in Table 1. The median age of participants was 73 years (interquartile range (IQR): 64-80), and the median length of hospital stay was 139 days (IQR: 97-149). The cohort included 46 males and 34 females, with 41 patients presenting right-sided and 39 left-sided lesions. Stroke type consisted of 50 cerebral infarctions and 30 cerebral hemorrhages.

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.

More at link.

 

Towards better understanding gait performance in people with stroke and the influence of trunk rehabilitation on gait recovery.

 Has your doctor measured your trunk impairment scale and implemented protocols to correct any problems found? Only 6 years to do this; why is your doctor still employed there?

• Trunk Impairment Scale (4 posts to August 2015)

Towards better understanding gait performance in people with stroke and the influence of trunk rehabilitation on gait recovery.

Author:

Thijs, Liselot

Abstract:

Previous work from the stroke rehabilitation research group in the area of trunk rehabilitation delivered the Trunk Impairment Scale, a standardized and globally used clinical measurement tool to assess trunk function after stroke in clinical practice and research. Furthermore, it was established that assessment of trunk function early after stroke is a significant and independent predictor of functional outcome at six months. Although therapeutic approaches for improving trunk function post stroke exist, this research project will focus on novel approaches for trunk rehabilitation in the different phases after stroke. Recent advances in the field of rehabilitation technology provide opportunities for further embedding trunk-oriented therapy in the rehabilitation of people post stroke and will be investigated in this project, aimed at providing proof-of-principle and preliminary evidence towards effectiveness for improving trunk, motor and functional outcome.

 

 

Trunk Impairment as a Predictor of Activities of Daily Living in Acute Stroke

Predictions are worthless, survivors want to know what protocols there are to get 100% recovered. NOT THIS PREDICTION CRAPOLA.

Trunk Impairment as a Predictor of Activities of Daily Living in Acute Stroke

Masahiro Ishiwatari^1,2*, Kaoru Honaga¹, Akira Tanuma¹, Tomokazu Takakura¹, Kozo Hatori¹, Akihiro Kurosu¹ and Toshiyuki Fujiwara^1,3

• ¹Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
• ²Department of Rehabilitation, Kiminomori Rehabilitation Hospital, Chiba, Japan
• ³Department of Physical Therapy, Juntendo University Faculty of Health Science, Tokyo, Japan

Background and purpose: Trunk function plays a key role in performing activities of daily living (ADL) including locomotion and sitting. Sitting and ADL should be performed as early as possible especially during the acute phase of stroke rehabilitation. Therefore, this study aimed to assess trunk function among patients with acute stroke using the Trunk Impairment Scale (TIS) and to predict its functional outcomes.

Methods: Overall, 67 patients with acute stroke (i.e., within 2 days of occurrence of the stroke) were included. The following clinical assessment items were obtained within 48 h after stroke onset and on the day before discharge from the hospital. Trunk function was examined using TIS and Trunk Control Test (TCT). The motor function of the upper and lower extremities was assessed using the stroke impairment assessment set motor (SIAS-M) score, and ADL was assessed using functional independence measure motor (FIM-M) items.

Results: Multiple regression analysis was performed using the stepwise regression method, using the total FIM-M score following discharge as the dependent variable and age, TIS, TCT, SIAS-M, and FIM-M within 48 h after stroke onset as the independent variables. Age, TIS, and FIM-M within 48 h after stroke onset were selected as the input variables and showed a high-adjusted determination coefficient (R² = 0.79; P < 0.001).

Conclusion: TIS is a reliable method for evaluating trunk control function and is an early predictor of ADL among patients with acute stroke.

Introduction

Trunk function is frequently impaired after stroke, affecting balance, gait, and activities of daily living (ADL) (1, 2). In stroke rehabilitation, trunk control is a fundamental motor skill that is essential for performing many functional tasks (3). In fact, the function of the trunk is not just ensuring the balance when sitting but also providing the ability to stabilize the proximal part of the body, allowing the movement of the distal part and selectively initiating trunk movements (4). There are several studies in the literature that investigated muscle strength in the extremities after stroke (5–7). There are also studies that have assessed the trunk muscle strength as the ability to control balance, trunk movement, and trunk muscle strength in the sitting and standing positions (1, 8–12). Verheyden et al. emphasize the importance of trunk performance, particularly that related to the static sitting balance, when predicting functional outcome after stroke (13). In the stroke rehabilitation process, the trunk function is an important predictor of the functional outcome (1, 8, 14). Therefore, the trunk function plays a key role in basic activities, such as sitting, transferring from the supine to the sitting position, and also rolling.

In acute stroke rehabilitation, it is important to prevent the decline of physical activity and to improve ADL. Acquisition of sitting ability and trunk performance are necessary to improve physical activity and ADL (2, 15). Fujiwara et al. developed the seven-item Trunk Impairment Scale (TIS) to assess trunk dysfunction in patients with stroke (3). Validity and reliability have already been examined. The TIS developed by Verheyden et al. was shown to be effective in predicting the functional outcome of subacute stroke (13). According to the Agency for Health Care Policy and Research guidelines, turning, sitting, and other activities should be started within 24–48 h after stroke onset, if medically possible (16). The group that started rehabilitation within 72 h of admission had a shorter length of stay and better walking status at discharge than the group that started rehabilitation >72 h after the admission (2). Although the mortality rate remained the same, the functional outcome tended to be better when patients increased the amount of training in the acute phase by starting sitting and standing rehabilitation within 24 h of the onset of illness (17).

van Nes et al. in their study of balance using individually adjustable chairs placed on a force platform considered 5–6 weeks after the onset as the subacute phase (18). Franchignoni et al. rather focused on patients with subacute stroke, with an average of 46 days between stroke onset and admission for rehabilitation (14). Other studies in the literature have included patients 1–2 weeks after stroke onset (19, 20) and patients who were transferred to a rehabilitation hospital 1–3 months after stroke onset, and these patients were able to maintain a sitting position (4, 9, 13, 18, 21). For the former reasons, we have classified the acute phase as within 2 weeks and the subacute phase as within 1–3 months after stroke onset. In our study, assessing trunk function with TIS within 48 h after stroke onset helped us assess the level of functional impairment in patients with stroke at the bedside in the acute phase, even if the patients were unable to safely maintain a seated position.

The most frequently identified variables predicting ADL after stroke include age and initial severity of motor and functional deficits (22). Trunk performance has also been identified as an important independent predictor of ADL after stroke (3, 9, 13, 22, 23). Fujiwara et al. conducted a multiple regression analysis to predict the Functional Independence Measure (FIM) motor score at discharge and confirmed that adding TIS as one of the predictors improved the explanation of variation in the FIM motor score at discharge from 66 to 75%, which can contribute to the prediction of functional status after stroke (3). Verheyden et al. examined the predictive validity of TIS and its subscales in predicting the Barthel Index score at 6 months after stroke onset in a multicenter study; the best predictors of the Barthel Index score were the TIS total score and the static sitting balance subscale score at admission (13). Collin and Wade (1) developed the Trunk Control Test (TCT) to assess the trunk function in patients with stroke. Franchignoni et al. (14) reported that using the TCT score at admission as one of the predictors better explains the FIM score at discharge than the FIM score at admission alone. The addition of trunk function assessment to ADL at discharge allowed the determination of a strong prognostic value. The clinical tools to assess the trunk performance include TCT (1, 14, 23), the trunk control items of the Postural Assessment Scale for Stroke (PASS) (9), TIS developed by Fujiwara et al. TIS (3), and TIS developed by Verheyden et al. (24). To better understand the recovery of the trunk function after stroke and to develop more effective treatment programs for patients with trunk imbalances, the trunk function needs to be assessed at the level of ability impairment and functional impairment.

A safe and less time-consuming evaluation method is desirable for patients with acute stroke. To the authors' knowledge, no previous study has reported the assessment of the trunk function and its prognosis within 48 h. Therefore, the purpose of this study was to investigate the prognosis prediction of patients with acute stroke using TIS for the assessment of the body trunk function.

 

Sensory Interactions for Head and Trunk Control in Space in Young and Older Adults During Normal and Narrow-Base Walking

I don't give a shit about the investigation. What was learned from here to make survivors lives better? That should be the function of any stroke research if we had any stroke leaders or strategy at all. But we have absolutely NOTHING. You're screwed, your children are screwed, your grandchildren are screwed. 

Sensory Interactions for Head and Trunk Control in Space in Young and Older Adults During Normal and Narrow-Base Walking 

 
Authors: Fang Zhang, Nandini Deshpande

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2016, 20, 21 – 32 http://dx.doi.org/10.1123/mc.2014-0046 15 young (20-30 years) and 15 older (>65 years) healthy participants were recruited to investigate age-related differences in the head and trunk control under suboptimal vestibular (GVS) and vision conditions during the normal and narrow-based walking (NB). Head roll velocity decreased in blurred vision condition and marginally increased with GVS in older but not in young. Head pitch increased, while head roll velocity decreased in NB. Trunk pitch, trunk pitch velocity and gait speed increased with GVS, while trunk pitch velocity and gait speed decreased in NB. Marginally increased head roll velocity in older people possibly suggests decreased integrative ability of the CNS in elderly. The changes in head control during NB may be an attempt to simplify the interpretation of the vestibular signal and increase otoliths sensitivity. The complexity of controlling trunk in M-L direction was suggested by different strategies used for trunk control in different conditions. Nothing on Trunk Impairment Scale. Why wasn't it used?

Trunk Muscle Coordination During Upward and Downward Reaching in Stroke Survivors

I don't give a shit about the analysis. What was learned from here to make survivors lives better? That should be the function of any stroke research if we had any stroke leaders or strategy at all. But we have absolutely NOTHING. You're screwed, your children are screwed, your grandchildren are screwed.
http://journals.humankinetics.com/mc-current-issue/mc-volume-20-issue-1-january/trunk-muscle-coordination-during-upward-and-downward-reaching-in-stroke-survivors
Authors: Geetanjali Gera, Kelsey E. McGlade, Darcy S. Reisman, John P. Scholz

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2016, 20, 50 – 69 http://dx.doi.org/10.1123/mc.2014-0038 This study investigated deficits in trunk muscle modes coordination involved in the stabilization of the trunk’s trajectory for reaching upward and downward beyond functional arm length. Trunk muscle activity from ten stroke survivors (8M, 2F; 64.1±10.5 yrs) and nine healthy control (7M, 2F; 59.3±9.3 yrs) subjects was analyzed. Coordination of trunk muscle modes to stabilize the trunk trajectory was investigated using the uncontrolled manifold analysis (UCM). The UCM analysis decomposes the variability of muscle modes into good and bad variability. The good variability does not affect the control of trunk motion, whereas the bad variability does. In stroke survivors, deficits in the ability to flexibly combine trunk muscle modes was associated with reduced ability to minimize those combinations of trunk muscle modes that led to an error in trunk trajectory (bad variability), more so for reaching upward. This reduced coordination of trunk muscle modes during reaching was correlated with a clinical measure of trunk impairment. Nothing on Trunk Impairment Scale. Why wasn't it used?

Postural alignment is altered in people with chronic stroke and related to motor and functional performance

I don't give a crap about finding another stroke problem. You didn't provide ANY FUCKING SOLUTION. Damn it all, do something useful for survivors.
A great stroke association would not allow trivial stuff like this to be researched.
http://www.ncbi.nlm.nih.gov/pubmed/25198868

Verheyden G¹, Ruesen C, Gorissen M, Brumby V, Moran R, Burnett M, Ashburn A.

Author information

Abstract

BACKGROUND AND PURPOSE:

Trunk control is impaired after stroke but little is known about how changes in posture relate to other deficits. We examined spinal postural alignment in people with chronic stroke and explored the relationship between postural alignment and clinical measures.

METHODS:

Twenty-one subjects with stroke and 22 age-matched healthy comparison subjects participated in this observational, cross-sectional study. Data collection included measurements of thoracic, lumbar, sacral, and overall postural alignment in the sagittal plane in both sitting and standing. Measurements were made in different postures, including: upright, flexed forward, and extended backward. Clinical outcome measures included the Trunk Impairment Scale and its subscales, Fugl-Meyer Scale, Berg Balance Scale, Barthel Index, and Stroke Impact Scale.

RESULTS:

Significant deviations in postural alignment for participants with stroke compared with comparison subjects were apparent in sacral alignment (P < 0.02) and overall postural alignment (P < 0.01) in standing. These measurements were also significantly correlated with clinical outcome measures poststroke. Participants with stroke who had a more forward leaning posture when upright scored worse on the coordination subscale of the Trunk Impairment Scale (r = -0.61) and Berg Balance Scale (r = -0.64). Participants with greater anterior pelvic tilt when flexed forward and more overall inclination when flexed forward and extended backward scored better on the Trunk Impairment Scale, its subscales, and Berg Balance Scale (r = -0.6-0.7).

DISCUSSION AND CONCLUSIONS:

People with chronic stroke have altered postural alignment in standing compared with subjects without neurological deficits. Investigating interventions focusing on increasing anterior and posterior pelvic tilt seem warranted.Video Abstract available. See video (Supplemental Digital Content 1, http://links.lww.com/JNPT/A76) for more insights from the authors.