Predicting those who will walk after rehabilitation in a specialist stroke unit.
OBJECTIVE
To establish whether the ability to use a wheelchair shortly after a stroke or continence are related to the likelihood of walking by time of discharge.


METHODS
An observational study in patients admitted to a stroke rehabilitation unit for under-65s over a three-year period.


METHODS
Functional Independence Measure (FIM) subscores for walking were examined on all patients at time of admission and discharge. Walking was defined by an FIM > or = 5 in that section. Comparisons were then made between those who could self-propel a wheelchair within a week of admission with those who could not. Continence (defined by an FIM subscore of > or = 6 in that category) was also correlated to walking at discharge.


METHODS
Walking at time of discharge defined by an FIM > or = 5 in that section.


RESULTS
From 393 admissions, 135 were excluded because they could already walk (FIM subscore > or = 5 in that particular section) and three died during their admission. Out of the remaining 255 patients, 108 could self-propel on admission and 147 could not. While 105 (97%) of the self-propellors could walk by time of discharge, only 91 (62%) of the non-propellors could do so (chi2 = 42.237, df = 1, P < 0.001, odds ratio (OR) 21.54 (6.52-71.51)). Although continence also predicted improved likelihood of walking, this was at a lower level of significance and correspondingly lower odds ratio (chi2=5.894, df = 1, P= 0.015, OR 1.94 (1.13-3.32)).


CONCLUSIONS
The ability to self-propel a wheelchair shortly after a stroke is a significant predictor of eventually being able to walk. Our data suggest that it is even more significant than continence, which is the most consistent predictor previously found.
Singh
Rajiv
R
Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, UK. rajiv.singh@lpct.scot.nhs.uk
Hunter
John
J
Philip
Alistair
A
Todd
Iain
I
D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D020127:Recovery of Function; D012047:Rehabilitation Centers; D012648:Self Care; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation; D013997:Time Factors; D016896:Treatment Outcome; D014549:Urinary Incontinence / Q000209:etiology; D016138:Walking; D014910:Wheelchairs