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Clinical Rehabilitation, Vol. 20, No. 2, 149-152 (2006)
DOI: 10.1191/0269215506cr887oa
© 2006 SAGE Publications

Predicting those who will walk after rehabilitation in a specialist stroke unit

Rajiv Singh

John Hunter

Alistair Philip

Iain Todd

Department of Rehabilitation Medicine, Astley Ainslie Hospital, Edinburgh, UK

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.

Design and subjects: 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 ≤ 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 ≥ 6 in that category) was also correlated to walking at discharge.

Main outcome measure: Walking at time of discharge defined by an FIM ≥ 5 in that section.

Results: From 393 admissions, 135 were excluded because they could already walk (FIM subscore ≥ 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 ({chi}2=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 ({chi}2=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.


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[Abstract] [PDF]