Predicting caregiver assistance required for sit-to-stand following rehabilitation for acute stroke

The objective of this case series was to determine the relationship between impairments identified at hospital admission and a reduced need for sit-to-stand (STS) assistance during an inpatient rehabilitation hospital stay. Fifty- five inpatients with a diagnosis of acute stroke were retrospectively studied. Demographic information and the following admission and discharge measures were collected from a chart review: bilateral dorsiflexion PROM, strength of the unaffected leg, Motricity Index (MI), presence of hemi-neglect, gait velocity, and Functional Independence Measure (FIM) scores for STS, ambulation, and cognition. Sit to stand improvement was determined by a change of at least one Caregiver Assistance Level (CAL) in STS performance between hospital admission and discharge. CAL 1 = STS FIM score of 7 or 6; CAL 2 = STS FIM score of 5; CAL 3 = STS FIM score of 4, 3, 2, or 1.

Unaffected knee extension strength, Motricity Index (MI) score, FIM cognition scores, and bilateral ankle dorsiflexion PROM were each univariate, age-adjusted predictors of improvement in STS CAL. A multivariate, 3 main-effect model that included admission FIM cognitive scores and ankle PROM correctly predicted 90.6% (48 out of 53) of the possible sit to stand improvement outcomes. Admission gait velocity and MI differentiated extent of functional change in those who improved.

Cognition and bilateral ankle dorsiflexion PROM most strongly predicted STS CAL improvement during an inpatient rehabilitation stay. Caregivers of patients with significant impairments may benefit from early and intensive training on how to assist their family member in the STS task.