Predictors of functional walking ability on discharge from inpatient stroke rehabilitation

Abstract

Background: Stroke is a leading cause of disability worldwide and in South Africa. Following stroke, walking is often negatively affected and is consistently reported by patients as the primary goal with improvements directly increasing quality of life and community participation. To the author’s knowledge, this is the first study exploring predictors of walking ability after stroke within South Africa. Aim: To determine predictors of functional walking ability on discharge from inpatient stroke rehabilitation. Methods: A quantitative, retrospective, record review was conducted of patients post-stroke between June 2017 to June 2021 at a private inpatient sub-acute hospital in Gauteng. The inclusion criteria included primary stroke diagnosis, first time stroke and walking speed less than 0.80m/s with the primary outcome measure being the 10 Metre Walk Test (10MWT) The univariate analysis included demographic and clinical variables and following this, a multivariate binary logistic regression was used to build a predictive model. Results: Of the 216 records available, 48 met the inclusion criteria. Three predictors were identified: cognition (measured by the Functional Independence Measure [FIM] category: social cognition, p<0.05, OR=1.687), balance (measured by Berg Balance Scale [BBS], p<0.05, OR=1.655), and length of stay [LOS] in acute hospital (p<0.05, OR=1.067). The predictive model showed excellent discrimination ability (AUC=0.914) and explained 63% of the variance in walking outcomes. Conclusion: Cognition, balance and acute LOS are significant predictors of walking ability on discharge from inpatient stroke rehabilitation. The findings emphasise the importance of early assessment and intervention targeting cognition and balance and supporting the routine use of the standardised outcome measures, FIM and BBS, in post-stroke care. The results provide evidence-based guidance for clinicians to optimise iv rehabilitation and set realistic goals with patients following stroke, within the South African context.