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Published on: September 30, 2020
ADMISSION VARIABLES ASSOCIATED WITH INDEPENDENT AMBULATION AT TIME OF DISCHARGE FROM A COMPREHENSIVE STROKE UNIT
Yuriy Flomin1, Vitaliy Hurianov2, Larysa Sokolova2
1MEDICAL CENTER «UNIVERSAL CLINIC OBERIG», KYIV, UKRAINE.
Insights
Four admission factors, including age, stroke severity, initial mobility, and delayed comprehensive stroke unit (CSU) admission, predict poor walking ability at discharge. These findings can improve patient outcomes and reduce mobility impairment risks.
Area of Science:
- Neurology
- Rehabilitation Medicine
- Clinical Research
Background:
- Stroke is a leading cause of long-term disability, with impaired ambulation being a significant challenge.
- Early identification of patients at risk for poor functional ambulation is crucial for targeted interventions.
Purpose of the Study:
- To identify key admission variables associated with limited functional ambulation (Functional Ambulation Classification [FAC] 1-4) at discharge from a comprehensive stroke unit (CSU).
Main Methods:
- Retrospective analysis of 442 patients admitted to a CSU between 2012 and 2018.
- Univariate and multivariate logistic regression analyses were used to assess the association between admission variables and discharge FAC score (dFAC<5).
Main Results:
- Four admission variables were significantly associated with dFAC<5: older age (OR=1.07), higher baseline National Institutes of Health Stroke Scale (NIHSS) score (OR=1.15), lower initial FAC score (OR=0.40), and very late CSU admission (>180 days, OR=5.7).
- Univariate analysis identified 28 significant variables, but only these four remained significant in multivariate analysis.
Conclusions:
- Age, baseline stroke severity, initial functional mobility, and delayed admission to a CSU are independent predictors of poor ambulation post-discharge.
- These identified variables can aid in risk stratification and the development of strategies to improve functional outcomes for stroke survivors.
Objective:
The aim: To identify admission variables associated with Functional Ambulation Classif i cation (FAC) 1 to 4 (unable to walk without assistance) at time of discharge (dFAC<5) from a comprehensive stroke unit (CSU).
Patients And Methods:
Materials and methods: Patients admitted to CSU at Oberig Clinic, Kyiv, Ukraine, August 01, 2012 to July 31, 2018, were screened for study selection criteria. Association of qualifying patients' data with FAC score at CSU discharge was retrospectively assessed by univariate and multivariate logistic regression, odds ratios (OR) and 95% conf i dence intervals (95% CI) using MedCalc v. 19.1.
Results:
Results: The study cohort (442 of 492 admitted patients) had median age: 65.8 years, gender: 43% female, stroke-type: 84% ischemic strokes, median baseline NIHSS total score: 10. Estimated time from stroke onset to CSU admission was from less-than-24-hours to over-180-days. The univariate logistic regression analysis, revealed 28 variables signif i cantly (p<0.05) related to dFAC<5; while in multivariate analysis only 4 admission variables were signif i cantly (p<0.05) associated with dFAC<5: age (OR= 1.07; 95% CI 1.03-1.10, on average, for each additional year, p<0.001), baseline NIHSS score (OR= 1.15; 95% CI 1.08-1.22, on average, with a 1-point increase in the total score, p<0.001), initial FAC score (OR= 0.40; 95% CI 0.31-0.52, on average, with a 1-point decrease in the score, p<0.001), and very late CSU admission (over 180 days; OR= 5.7; 95% CI 1.9-17.1, p=0.002).
Conclusion:
Conclusions: Four admission variables may be independently associated with dFAC<5 and provide opportunity for improving CSU outcomes and mitigating risk for inability to ambulate without assistance after CSU discharge.
