Can gait outcomes be predicted early after a stroke?

Area of Science:

• Neurology
• Rehabilitation Medicine
• Clinical Assessment

Background:

• Predicting independent gait post-stroke is crucial for patient recovery and quality of life.
• Early clinical measures are often used to estimate functional prognosis.
• The predictive value of standard bedside assessments for long-term gait function requires further investigation.

Purpose of the Study:

• To evaluate the ability of clinical measures obtained within 72 hours of neurological insult to predict independent gait at 6 and 12 months post-stroke.
• To identify early predictors of gait recovery and aid utilization after stroke.

Main Methods:

• Prospective cohort study including patients with confirmed stroke diagnosis.
• Clinical assessments within 72 hours included sitting balance, National Institutes of Health Stroke Scale (NIHSS) motor leg and arm scores, and Motricity Index (MI).
• Gait recovery and aid use were assessed at 6 and 12 months post-stroke.

Main Results:

• Sitting balance, NIHSS motor leg, and NIHSS motor arm scores did not significantly predict ambulation or gait aid use at 6 or 12 months.
• A worse MI score correlated with more falls at 6 months, but not with gait aid need.
• Urinary incontinence, NIHSS leg score, and acute care depression/anxiety predicted the number of falls at 6 months.
• Thrombolysis was associated with independent outdoor ambulation at 6 months.

Conclusions:

• Early bedside clinical assessments may have limited predictive power for safe, independent gait post-stroke.
• Addressing urinary incontinence and mental health during acute care is important for fall prevention.
• Increased use of reperfusion therapies might impact functional recovery patterns, necessitating further research.