Ability to walk 10 m within the first week of stroke predicts independent outdoor walking and destination
Introduction
Stroke is the most common cause of complex disability and functional impairment.1,2 The number of patients with an initial stroke continues to increase,3 with 50 million stroke survivors worldwide who often require assistance with activities of daily living (ADLs) due to physical, cognitive, and mental impairments.4,5 At the time of admission, two-thirds of patients with stroke have difficulty walking independently,6 and 40% of all patients may have ongoing challenges in walking independently for approximately three months.7 The ability to walk is an essential factor in deciding where to discharge a patient, and assessing the ability to walk independently is a critical factor in the decision to discharge a patient from hospital to home.8 Moreover, the achievement of walking is vital for social participation and quality of life (QOL).9 As the ability to walk is of great concern to patients and their families, achieving independent outdoor walking is the most crucial goal in rehabilitating patients with stroke.
Walking ability at the acute phase of stroke has been reported to be a predictor of walking ability and destination.10, 11, 12 The Functional Independence Measure (FIM) walking category is known to be a predictor of discharge walking ability.10,11 Louie et al. reported that walking about 50 m with or without assistance was associated with discharge home.12 However, these walking abilities were measured at the time of admission, and were not influenced by rehabilitation intervention. Hence, these indicators are unlikely to be apparent targets for rehabilitation intervention. Although patients with stroke have poor walking ability at admission,6 many patients improve their walking ability by gait training from the acute phase onwards.13, 14, 15 Therefore, the prediction based on those indicators measured at admission would not be suitable for patients with stroke. In addition, FIM does not clearly define distance, even though it was used to reflect the assistance level. Furthermore, it is crucial to provide appropriately modified target distances for patients with moderate-to-severe hemiplegia, who have difficulty walking long distances (e.g., 50 m) on admission. We, therefore, set out to investigate whether achieving a 10 m walking target within the first week of stroke was associated with specific walking and destination outcomes.
The 10 m walking test is convenient, does not require extra devices, and has shown reliability and validity in patients with stroke.16,17 It can be utilized in any medical facility and is frequently used to assess walking ability during the acute phase of stroke.18,19 Accordingly, a target distance of 10 m was considered adequate.
The study focused on the first week following a stroke as the time frame. From a neurophysiological perspective, functional and structural plasticity of the brain begins within hours of symptom onset and can continue for the first week. Plastic changes depend on the frequency of use and can lead to relearning.20 In addition, Scrivener et al reported that exercise dose in the first week after admission is an important predictor of walking speed at discharge and the time to achieve unassisted walking.21 Therefore, the effect of rehabilitation in the first week of onset is likely to be significant.
We hypothesized that the walking prognosis after a stroke would be influenced by the patient's ability to walk 10 meters within the first week of onset. Assessing this ability in the early phase of a stroke may indicate the success of acute rehabilitation efforts. Hence, this study aimed to explore whether the ability to walk 10 m within the first week after stroke correlates with the ability to walk outdoors and the discharge destination.
Section snippets
Study design
This retrospective observational study was conducted at a single center in Japan in accordance with the Declaration of Helsinki and was approved by the institutional review board of the Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital (Approval Number 2022-061).
Participants
Data for this study were obtained from records stored in the Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital database. All participants in this study were initially admitted to our hospital which has a
Participants
A flow diagram of patient selection is illustrated in Fig. 1. During the target period, 304 patients were admitted with a diagnosis of IS or HS and transferred to the SRH. Of these, 78 patients were excluded, 39 required assistance or a walking aid to walk before admission, 32 could not be followed up, and 7 were re-admitted to our hospital from the SRH. A total of 226 patients were finally included in the analysis. The demographic data of all patients are presented in Table 1. The median age
Discussion
This study aimed to determine whether 10-m walking ability within the first week of stroke onset is associated with outdoor walking ability and discharge destination after rehabilitation. Results of this study demonstrated that unassisted 10 m walking ability within the first week of stroke was associated with independent outdoor walking at discharge in patients with stroke. Furthermore, unassisted 10 m walking ability and assisted 10 m walking ability were also associated with discharge home.
Conclusions
Unassisted 10 m walking ability within the first week from stroke onset was associated with independent outdoor walking at discharge among patients with acute stroke. Furthermore, the destination at discharge was associated with unassisted and assisted 10 m walking abilities. In gait training for acute stroke, the ability to walk 10 m with assistance may be relevant to discharge destination, even in patients who cannot walk independently. This study suggests that the ability to walk 10m within
Funding
None.
Declaration of Competing Interest
None to declare.
Financial support
This research was funded by Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital Research Grant NFRCH 22-0009.
Acknowledgments
“Editage” provided editing services for this manuscript. We thank them for their support in the writing process.
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