Ability to walk 10 m within the first week of stroke predicts independent outdoor walking and destination

Abstract

Objectives

We aimed to determine if achieving a 10-m walk target within the first week of stroke onset correlates with independent outdoor walking at discharge and discharge to home for patients with stroke.

Materials and methods

This study included 226 patients transferred to the subacute rehabilitation hospital (SRH) between January 2018 and March 2021. Data obtained from hospital records included age, sex, stroke type, lesion side, body mass index, presence of acute treatment, length of days from onset to physical therapy intervention, National Institutes of Health Stroke Scale, length of hospital stay, Functional Independence Measure score, and the ability to complete the 10 m walk target within the first week of stroke onset. The primary outcomes were independent outdoor walking ability and discharge destination from the SRH. A logistic regression analysis was performed to determine if the 10 m walking ability correlated with the outdoor walking ability and discharge destination.

Results

Compared with the inability to walk 10 m, walking 10 m independently walking within the first week of stroke onset correlated with the ability to walk independently outdoors at discharge (odds ratio [OR]: 4.38, p = 0.003) and being discharged home (OR: 4.52, p = 0.002), whereas, walking 10 m with assistance was associated with being discharged home (OR: 3.09, p = 0.043).

Conclusions

The ability to walk 10 m within the first week of stroke onset may be a helpful marker for prognosis.

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.