title: Is accurate prediction of gait in nonambulatory stroke patients possible within 72 hours poststroke? The EPOS study.
abstract: BACKGROUND
  Early prognosis, adequate goal setting, and referral are important for stroke management.
  
  
  OBJECTIVE
  To investigate if independent gait 6 months poststroke can be accurately predicted within the first 72 hours poststroke, based on simple clinical bedside tests. Reassessment on days 5 and 9 was used to check whether accuracy changed over time.
  
  
  METHODS
  In 154 first-ever ischemic stroke patients unable to walk independently, 19 demographic and clinical variables were assessed within 72 hours and again on days 5 and 9 poststroke. Multivariable logistic modeling was applied to identify early prognostic factors for regaining independent gait, defined as ≥4 points on the Functional Ambulation Categories.
  
  
  RESULTS
  Multivariable modeling showed that patients with an independent sitting balance (Trunk Control Test-sitting; 30 seconds) and strength of the hemiparetic leg (Motricity Index leg; eg, visible contraction for all 3 items, or movement against resistance but weaker for 1 item) on day 2 poststroke had a 98% probability of achieving independent gait at 6 months. Absence of these features in the first 72 hours was associated with a probability of 27%, declining to 10% by day 9.
  
  
  CONCLUSIONS
  Accurate prediction of independent gait performance can be made soon after stroke, using 2 simple bedside tests: "sitting balance" and "strength of the hemiparetic leg." This knowledge is useful for making early clinical decisions regarding treatment goals and discharge planning at hospital stroke units.
authors.affiliation: VU University Medical Centre, Amsterdam, the Netherlands. j.veerbeek@vumc.nl
authors.forename: J M
authors.initials: JM
authors.lastname: Veerbeek
authors.forename: E E H
authors.initials: EE
authors.lastname: Van Wegen
authors.forename: B C
authors.initials: BC
authors.lastname: Harmeling-Van der Wel
authors.forename: G
authors.initials: G
authors.lastname: Kwakkel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D020233:Gait Disorders, Neurologic / Q000175:diagnosis* / Q000503:physiopathology; D006429:Hemiplegia / Q000175:diagnosis* / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology; D020521:Stroke / Q000150:complications* / Q000503:physiopathology