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Table of Contents
Vol. 26, No. 1, 2008
Issue release date: July 2008
Cerebrovasc Dis 2008;26:16–22
(DOI:10.1159/000135648)

Quantification of the Probability of Reaching Mobility Independence at Discharge from a Rehabilitation Hospital in Nonwalking Early Ischemic Stroke Patients: A Multivariate Study

Paolucci S. · Bragoni M. · Coiro P. · De Angelis D. · Fusco F.R. · Morelli D. · Venturiero V. · Pratesi L.
Fondazione IRCCS Santa Lucia, Rome, Italy

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Abstract

Background: This study was designed to quantify the probability of recovery of mobility in admission nonwalking stroke survivors. Methods: We evaluated 437 of 500 consecutive patients admitted for sequelae of first ischemic stroke within the first month. We performed several logistic regressions using mobility status at discharge (independence in stair climbing; walking outside and inside, without aid or supervision; walking with cane or other aid, or need for wheelchair) as dependent variable, and several independent variables, including stratification of patients according to their Barthel Index (BI) score into 6 classes (≤10; 11–20; 21–30; 31–40; 41–50; 51–60). Results: At discharge, 4.58% of patients were independent in stair climbing, 8.70% were able to walk outside, 14.41% to walk inside, and 27.46% to walk with cane or other aid, while 44.85% remained in wheelchair. Very low BI scores at admission were associated with a high risk of need for wheelchair, whereas patients with BI score 51–60 showed a high probability to reach independence in stair climbing (OR = 5.60). Age, severity of neurological impairment, global aphasia, unilateral spatial neglect, male gender and vocational status also played a prognostic role. Conclusions: The probability of potential mobility recovery can be quantified at admission with better accuracy for independence in stair climbing and walking outside without any aid (percentages correctly predicted 95.4 and 91.8%, respectively). Stratification of BI score may be useful to better quantify the risk for each patient.



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References

  1. Teasell RW, Bhogal SK, Foley NC, Speechley MR: Gait retraining post stroke. Top Stroke Rehabil 2003;10:34–65.

    External Resources

  2. Jackson D, Thornton H, Turner-Stokes L: Can young severely disabled stroke patients regain the ability to walk independently more than three months post stroke? Clin Rehabil 2000;14:538–547.
  3. Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS: Recovery of walking function in stroke patients: the Copenhagen Stroke Study. Arch Phys Med Rehabil 1995;76:27–32.
  4. Kollen B, Kwakkel G, Lindeman E: Longitudinal robustness of variables predicting independent gait following severe middle cerebral artery stroke: a prospective cohort study. Clin Rehabil 2006;20:262–268.
  5. Kreisel SH, Hennerici MG, Bazner H: Pathophysiology of stroke rehabilitation: the natural course of clinical recovery, use-dependent plasticity and rehabilitative outcome. Cerebrovasc Dis 2007;23:243–255.
  6. Singh R, Hunter J, Philip A, Todd I: Predicting those who will walk after rehabilitation in a specialist stroke unit. Clin Rehabil 2006;20:149–152.
  7. Meijer R, Ihnenfeldt DS, de Groot IJ, Van Limbeek J, Vermeulen M, de Haan RJ: Prognostic factors for ambulation and activities of daily living in the subacute phase after stroke: a systematic review of the literature. Clin Rehabil 2003;17:119–129.
  8. Wandel A, Jorgensen HS, Nakayama H, Raaschou HO, Olsen TS: Prediction of walking function in stroke patients with initial lower extremity paralysis: the Copenhagen Stroke Study. Arch Phys Med Rehabil 2000;81:736–738.
  9. Sanchez-Blanco I, Ochoa-Sangrador C, Lopez-Munain L, Izquierdo-Sanchez M, Fermoso-Garcia J: Predictive model of functional independence in stroke patients admitted to a rehabilitation programme. Clin Rehabil 1999;13:464–475.
  10. Thornton H, Jackson D, Turner-Stokes L: Accuracy of prediction of walking for young stroke patients by use of the FIM. Physiother Res Int 2001;6:1–14.
  11. Baer G, Smith M: The recovery of walking ability and subclassification of stroke. Physiother Res Int 2001;6:135–144.
  12. Foulkes MA, Wolf PA, Price TR, Mohr JP, Hier DB: The stroke data bank: design, methods, and baseline characteristics. Stroke 1988;19:547–554.
  13. SPREAD – Stroke Prevention and Educational Awareness Diffusion: Trattamento riabilitativo e continuità dell’assistenza; Ictus cerebrale: linee guida italiane di prevenzione e trattamento. Milano, Pubblicazioni Catel – Hyperphar Group SpA, 2005, pp 351–434.
  14. Hack W, Kaste M, Bogousslavsky J, Brainin M, Chamorro A, Lees K, Leys D, Kwiecinski H, Toni P, Langhorne P: European stroke initiative recommendations for stroke management: update 2003. Cerebrovasc Dis 2003;16:311–337.
  15. Coté R, Battista RN, Wolfson C, Boucher J, Adam J, Hachinski V: The Canadian Neurological Scale: validation and reliability assessment. Neurology 1989;39:638–643.
  16. Paolucci S, Antonucci G, Pratesi L, Traballesi M, Grasso MG, Lubich S: Poststroke depression and its role in rehabilitation of inpatients. Arch Phys Med Rehabil 1999;80:985–990.
  17. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C: Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991;337:1521–1526.
  18. Ciurli P, Marangolo P, Basso A: Esame del Linguaggio – II. Firenze, O.S. Organizzazioni Speciali, 2004.
  19. Pizzamiglio L, Judica A, Razzano C, Zoccolotti P: Toward a comprehensive diagnosis of visual-spatial disorders in unilateral brain-damaged patients. Psychol Assess 1989;5:199–218.
  20. Mahoney F, Barthel DW: Functional evaluation: the Barthel Index. Md State Med J 1965;14:61–65.
  21. Collen FM, Wade DT, Robb GF, Bradshaw CM: The Rivermead Mobility Index: a further development of the Rivermead Motor Assessment. Int Disabil Stud 1991;13:50–54.
  22. Shah S, Vanclay F, Cooper B: Efficiency, effectiveness and duration of stroke rehabilitation. Stroke 1990;21:241–246.
  23. Ween JE, Alexander MP, D’Esposito M, Roberts M: Factors predictive of stroke outcome in a rehabilitation setting. Neurology 1996;47:388–392.
  24. Paolucci S, Antonucci G, Pratesi L, Traballesi M, Lubich S, Grasso MG: Functional outcome in stroke inpatient rehabilitation: predicting no, low and high response patients. Cerebrovasc Dis 1998;8:228–234.
  25. Nakayama H, Jorgensen HS, Raaschou HO, Olsen TS: The influence of age on stroke outcome. The Copenhagen Stroke Study. Stroke 1994;25:808–813.
  26. Bagg S, Pombo AP, Hopman W: Effect of age on functional outcomes after stroke rehabilitation. Stroke 2002;33:179–185.
  27. Paolucci S, Antonucci G, Troisi E, Bragoni M, Coiro P, De Angelis D, Pratesi L, Venturiero V, Grasso MG: Aging and stroke rehabilitation: a case-comparison study. Cerebrovasc Dis 2003;15:98–105.
  28. Falconer JA, Naughton BJ, Strasser DC, Sinacore JM: Stroke inpatient rehabilitation: a comparison across age groups. J Am Geriatr Soc 1994;42:39–44.
  29. Katz N, Hartman-Maeir A, Ring H, Soroker N: Functional disability and rehabilitation outcome in right hemisphere damaged patients with and without unilateral spatial neglect. Arch Phys Med Rehabil 1999;80:379–384.
  30. Paolucci S, Antonucci G, Grasso MG, Pizzamiglio L: The role of unilateral spatial neglect in rehabilitation of right brain-damaged ischemic stroke patients: a matched comparison. Arch Phys Med Rehabil 2001;82:743–749.
  31. Paolucci S, Matano A, Bragoni M, Coiro P, De Angelis D, Fusco FR, Morelli D, Pratesi L, Venturiero V, Bureca I: Rehabilitation of left brain-damaged ischemic stroke patients: the role of comprehension language deficits. Cerebrovasc Dis 2005;20:400–406.
  32. Barker-Collo S, Feigin V: The impact of neuropsychological deficits on functional stroke outcomes. Neuropsychol Rev 2006;16:53–64.
  33. Paolucci S, Bragoni M, Coiro P, De Angelis D, Fusco FR, Morelli D, Venturiero V, Pratesi L: Is sex a prognostic factor in stroke rehabilitation? A matched comparison. Stroke 2006;37:2989–2994.
  34. Sinaki M, Nwaogwugwu NC, Phillips BE, Mokri MP: Effect of gender, age, and anthropometry on axial and appendicular muscle strength. Am J Phys Med Rehabil 2001;80:330–338.
  35. Putman K, De Wit L, Schoonacker M, Baert I, Beyens H, Brinkmann N, Dejaeger E, De Meyer AM, De Weerdt W, Feys H: Effect of socioeconomic status on functional and motor recovery after stroke: a European multicentre study. J Neurol Neurosurg Psychiatry 2007;78:593–599.


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