Prediction of discharge walking ability from initial assessment in a stroke inpatient rehabilitation facility population

Abstract

Objectives: To (1) determine which clinical assessments at admission to an inpatient rehabilitation facility (IRF) most simply predict discharge walking ability, and (2) identify a clinical decision rule to differentiate household versus community ambulators at discharge from an IRF.

Design: Retrospective cohort study.

Setting: IRF.

Participants: Two samples of participants (n=110 and 159) admitted with stroke.

Interventions: A multiple regression determined which variables obtained at admission (age, time from stroke to assessment, Motricity Index, somatosensation, Modified Ashworth Scale, FIM, Berg Balance Scale, 10-m walk speed) could most simply predict discharge walking ability (10-m walk speed). A logistic regression determined the likelihood of a participant achieving household (<0.4m/s) versus community (≥0.4-0.8m/s; >0.8m/s) ambulation at the time of discharge. Validity of the results was evaluated on a second sample of participants.

Main outcome measure: Discharge 10-m walk speed.

Results: Admission Berg Balance Scale and FIM walk item scores explained most of the variance in discharge walk speed. The odds ratio of achieving only household ambulation at discharge was 20 (95% confidence interval [CI], 6-63) for sample 1 and 32 (95% CI, 10-96) for sample 2 when the combination of having a Berg Balance Scale score of ≤20 and a FIM walk item score of 1 or 2 was present.

Conclusions: A Berg Balance Scale score of ≤20 and a FIM walk item score of 1 or 2 at admission indicates that a person with stroke is highly likely to only achieve household ambulation speeds at discharge from an IRF.

Fig 1

(A) Of the 227 participants initially screened for sample 1, 110 participants consented and had available clinical assessments for analysis. (B) Of the 288 participants initially screened for sample 2, 159 participants consented and had available clinical assessments for analysis.

Fig 2

Three-dimensional representation of the multiple regression model for sample 1. Each data point is a participant. Data points from participants with the same score across all 3 measures (eg, Berg Balance Scale=10, FIM walk item=1, 10-m walk test=0) are overlaid. The black box represents the cutoff walking speed between household and community ambulation classifications.