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

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 (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 (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.

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


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