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.
Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, UK. rajiv.singh@lpct.scot.nhs.uk
Rajiv
R
Singh
John
J
Hunter
Alistair
A
Philip
Iain
I
Todd
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