Abstract
Objective
This cohort investigation identified primary predictors of discharge walking function
of nonambulatory individuals poststroke with high-intensity training (HIT) during
inpatient rehabilitation.
Design
Observational cohort investigation.
Setting
Inpatient rehabilitation.
Participants
Data were collected from individuals (N=257) <6 months poststroke who required assistance
to walk at admission.
Intervention
Clinical physical therapy interventions attempted to maximize stepping practice at
higher intensities.
Main Outcome Measures
Primary outcomes included the discharge level of assistance required during walking
(minimal or no assistance) and attainment of specific gait speed thresholds (0.4 and
0.8 m/s) during the 10-m walk test. Independent predictors were demographics, training
interventions (including steps/day), baseline Berg Balance Scale (BBS), and paretic
leg strength.
Results
Participants performed a median (interquartile range) of 1270 (533-2297) steps per
day throughout inpatient rehabilitation, with significant differences between those
who walked with versus without assistance at discharge. Logistic regressions indicate
steps per day was a primary predictor of unassisted walking recovery; removal of steps
per day resulted in primary predictors of baseline BBS and strength. Receiver operating
characteristic (ROC) analyses indicate significant areas under the curve for BBS and
relatively low cutoff scores of 5.5 points at admission to walk without assistance
at any speed. ROC analyses performed using 1-week outcomes indicate BBS scores of
5-17 points were needed to achieve locomotor thresholds.
Conclusion
Stepping activity, BBS, and paretic leg strength were primary predictors of walking
outcomes in patients performing HIT, and ROC analyses indicated recovery of independent
walking could be achieved in low functioning patients early poststroke.
Keywords
List of abbreviations:
6MWT (6-minute walk test), 10MWT (10-m walk test), AUC (area under the curve), BBS (Berg Balance Scale), HIT (high-intensity training), HRmax (maximum heart rate), LoA (level of assistance), ROC (receiver operating characteristic)To read this article in full you will need to make a payment
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References
- Determinants of walking function after stroke: differences by deficit severity.Arch Phys Med Rehabil. 2007; 88: 115-119
- Walking after stroke. Measurement and recovery over the first 3 months.Scand J Rehabil Med. 1987; 19: 25-30
- Feasibility of focused stepping practice during inpatient rehabilitation poststroke and potential contributions to mobility outcomes.Neurorehabil Neural Repair. 2015; 29: 923-932
- Predicting walking function of patients one month poststroke using modified Rivermead mobility index on admission.J Stroke Cerebrovasc Dis. 2014; 23: 2117-2121
- Longitudinal robustness of variables predicting independent gait following severe middle cerebral artery stroke: a prospective cohort study.Clin Rehabil. 2006; 20: 262-268
- Prediction of independent walking ability for severely hemiplegic stroke patients at discharge from a rehabilitation hospital.J Stroke Cerebrovasc Dis. 2016; 25: 1878-1881
- Prediction of discharge walking ability from initial assessment in a stroke inpatient rehabilitation facility population.Arch Phys Med Rehabil. 2012; 93: 1441-1447
- Berg Balance Scale score at admission can predict walking suitable for community ambulation at discharge from inpatient stroke rehabilitation.J Rehabil Med. 2018; 50: 37-44
- Is accurate prediction of gait in nonambulatory stroke patients possible within 72 hours poststroke? The EPOS study.Neurorehabil Neural Repair. 2011; 25: 268-274
- The TWIST algorithm predicts time to walking independently after stroke.Neurorehabil Neural Repair. 2017; 31: 955-964
- Measures of activity limitation on admission to rehabilitation after stroke predict walking speed at discharge: an observational study.Aust J Physiother. 2009; 55: 265-268
- The Berg balance scale as a predictor of length of stay and discharge destination in an acute stroke rehabilitation setting.Arch Phys Med Rehabil. 1999; 80: 448-452
- Admission ambulation velocity predicts length of stay and discharge disposition following stroke in an acute rehabilitation hospital.Neurorehabil Neural Repair. 2005; 19: 20-26
- Amount of exercise in the first week after stroke predicts walking speed and unassisted walking.Neurorehabil Neural Repair. 2012; 26: 932-938
- Observation of amounts of movement practice provided during stroke rehabilitation.Arch Phys Med Rehabil. 2009; 90: 1692-1698
- Locomotor training improves daily stepping activity and gait efficiency in individuals poststroke who have reached a “plateau” in recovery.Stroke. 2010; 41: 129-135
- Movement repetitions in physical and occupational therapy during spinal cord injury rehabilitation.Spinal Cord. 2017; 55: 172-179
- Exercise dose and mobility outcome in a comprehensive stroke unit: description and prediction from a prospective cohort study.J Rehabil Med. 2012; 44: 824-829
- Cardiovascular stress during inpatient spinal cord injury rehabilitation.Arch Phys Med Rehabil. 2017; 98: 2449-2456
- Cardiovascular responses associated with daily walking in subacute stroke.Stroke Res Treat. 2013; 2013: 612458
- Routine physiotherapy does not induce a cardiorespiratory training effect post-stroke, regardless of walking ability.Physiother Res Int. 2006; 11: 219-227
- Cardiovascular stress during a contemporary stroke rehabilitation program: is the intensity adequate to induce a training effect?.Arch Phys Med Rehabil. 2002; 83: 1378-1383
- Importance of specificity, amount, and intensity of locomotor training to improve ambulatory function in patients poststroke.Top Stroke Rehabil. 2011; 18: 293-307
- Influence of skill and exercise training parameters on locomotor recovery during stroke rehabilitation.Curr Opin Neurol. 2016; 29: 677-683
- Clinical practice guideline to improve locomotor function following chronic stroke, incomplete spinal cord injury, and brain injury.J Neurol Phys Ther. 2020; 44: 49-100
- Variable intensive early walking poststroke (views): a randomized controlled trial.Neurorehabil Neural Repair. 2016; 30: 440-450
- Contributions of stepping intensity and variability to mobility in individuals poststroke.Stroke. 2019; 50: 2492-2499
- Stepwise regression and latent profile analyses of locomotor outcomes poststroke.Stroke. 2020; 51: 3074-3082
- Implementation of high-intensity stepping training during inpatient stroke rehabilitation improves functional outcomes.Stroke. 2020; 51: 563-570
- Predicting activities after stroke: what is clinically relevant?.Int J Stroke. 2013; 8: 25-32
- Validation of a combined comorbidity index.J Clin Epidemiol. 1994; 47: 1245-1251
- Feasibility and potential efficacy of high-intensity stepping training in variable contexts in subacute and chronic stroke.Neurorehabil Neural Repair. 2014; 28: 643-651
- Ratings of perceived exertion and heart rates during short-term cycle exercise and their use in a new cycling strength test.Int J Sports Med. 1982; 3: 153-158
- Reference equations for the six-minute walk in healthy adults.Am J Respir Crit Care Med. 1998; 158: 1384-1387
- The Balance Scale: reliability assessment with elderly residents and patients with an acute stroke.Scand J Rehabil Med. 1995; 27: 27-36
- A clinical prediction rule for ambulation outcomes after traumatic spinal cord injury: a longitudinal cohort study.Lancet. 2011; 377: 1004-1010
Article info
Publication history
Published online: November 19, 2020
Footnotes
Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (grant no. NIDILRR-90RT5027).
Disclosures: none.
This paper is part of a supplement from the American Congress of Rehabilitation Medicine.
Identification
Copyright
© 2022 The Authors. Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery.
