Factors associated with time to independent walking recovery post-stroke

Abstract

BackgroundPast studies have inconsistently identified factors associated with independent walking post-stroke. We investigated the relationship between pre-stroke factors and factors collected acutely after stroke and number of days to walking 50 m unassisted using data from A Very Early Rehabilitation Trial (AVERT).MethodsThe outcome was recovery of 50 m independent walking, tested from 24 hours to 3 months post-stroke. A set of a priori defined factors (participant demographics: age, sex, handedness; pre-stroke: hypertension, ischaemic heart disease, hypercholesterolaemia, diabetes mellitus, atrial fibrillation; stroke-related: stroke severity, stroke type, ischaemic stroke location, stroke hemisphere, thrombolysis) were investigated for association with independent walking using a cause-specific competing risk Cox proportional hazards model. Respective effect sizes are reported as cause-specific adjusted HR (caHR) adjusted for age, stroke severity and AVERT intervention.ResultsA total of 2100 participants (median age 73 years, National Institutes of Health Stroke Scale 7, <1% missing data) with stroke were included. The median time to walking 50 m unassisted was 6 days (IQR 2–63) and 75% achieved independent walking by 3 months. Adjusted Cox regression indicated that slower return to independent walking was associated with older age (caHR 0.651, 95% CI 0.569 to 0.746), diabetes (caHR 0.836, 95% CI 0.740 to 0.945), severe stroke (caHR 0.094, 95% CI 0.072 to 0.122), haemorrhagic stroke (caHR 0.790, 95% CI 0.675 to 0.925) and right hemisphere stroke (caHR 0.796, 95% CI 0.714 to 0.887).ConclusionOur analysis provides robust evidence for important factors associated with independent walking recovery. These findings highlight the need for tailored mobilisation programmes that target subgroups, in particular people with haemorrhagic and severe stroke.

External Validation of the Early Prediction of Functional Outcome After Stroke Prediction Model for Independent Gait at 3 Months After Stroke

“…However, 6-months might be too conservative, as most behavioral change takes place within the first week to the first few months ( 11 ). When looking at gait specifically, Kennedy and colleagues recently showed that the median time needed to walk 50 m without assistance was 6 (Q1 = 2, Q3 = 63) days and that by 3 months, 75% of the patients were able to walk 50 m unassisted ( 12 ). The percentage of 75% did not differ much from the 79% of patients who walked independently at 6 months in the EPOS study in 2011, suggesting that not many patients regained independent gait between 3 and 6 months after stroke.…”

Daily steps are associated with walking ability in hospitalized patients with sub-acute stroke

“…Then, the subjects were divided into two groups according to the FAC score: a walking independence group (FAC ≥ 4) and a walking non-independence group (FAC ≤ 3). Logistic regression analysis was also performed to investigate the association of the daily number of steps (in increments of 1,000 steps) with walking independence adjusted by age, sex, stroke type (cerebral infarction or intracerebral hemorrhage), NIHSS, lower extremity FMA, and 6MWT following previous studies 19 , 20 . Multicollinearity was assessed using the variance inflation factor (VIF) and defined as VIF ≥ 10 21 .…”

Association of Daily Number of Steps with Walking Ability in Hospitalized Patients with Sub-acute Stroke

“…Then, the subjects were divided into two groups according to the FAC score: a walking independence group (FAC ≥ 4) and a walking non-independence group (FAC ≤ 3). Logistic regression analysis was also performed to investigate the association of the daily number of steps with walking independence adjusted by age, sex, stroke type (cerebral infarction or intracerebral hemorrhage), NIHSS, lower extremity FMA, and 6MWT following previous studies [19,20]. The receiver operating characteristic (ROC) curve analysis was conducted to establish the cutoff value of daily number of steps for walking independence.…”