Objective: To establish whether the ability to use a wheelchair shortly after a stroke or continence are related to the likelihood of walking by time of discharge.
Design and subjects: An observational study in patients admitted to a stroke rehabilitation unit for under-65s over a three-year period.
Methods: Functional Independence Measure (FIM) subscores for walking were examined on all patients at time of admission and discharge. Walking was defined by an FIM ≤ 5 in that section. Comparisons were then made between those who could self-propel a wheelchair within a week of admission with those who could not. Continence (defined by an FIM subscore of ≥ 6 in that category) was also correlated to walking at discharge.
Main outcome measure: Walking at time of discharge defined by an FIM ≥ 5 in that section.
Results: From 393 admissions, 135 were excluded because they could already walk (FIM subscore ≥ 5 in that particular section) and three died during their admission. Out of the remaining 255 patients, 108 could self-propel on admission and 147 could not. While 105 (97%) of the self-propellors could walk by time of discharge, only 91 (62%) of the non-propellors could do so (χ2=42.237, df=1, P < 0.001, odds ratio (OR) 21.54 (6.52-71.51)). Although continence also predicted improved likelihood of walking, this was at a lower level of significance and correspondingly lower odds ratio (χ2=5.894, df=1, P=0.015, OR 1.94 (1.13-3.32)).
Conclusions: The ability to self-propel a wheelchair shortly after a stroke is a significant predictor of eventually being able to walk. Our data suggest that it is even more significant than continence, which is the most consistent predictor previously found.
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References
1.
1 Meijer R, Ihnenfeldt DS, de Groot IJM, van Limbeek J, Vermeulen M, Haan RJ. Prognostic factors for ambulation and activities of daily living in the subacute phase after stroke. A systematic review. Clin Rehabil2003; 17: 119–129.
2.
2 Wang Y, Lim LL, Levi C, Heller RF, Fischer J. A prognostic index for 30-day mortality after stroke. J Clin Epidemiol2001; 54: 766–773.
3.
3 Blower PW, Carter LC, Sulch DA. Relationship between wheelchair propulsion and independent walking in hemiplegic stroke. Stroke1995; 26: 606–608.
4.
4 Lennon S, Ashburn A. The Bobath concept in stroke rehabilitation: a focus group study of the experienced physiotherapists' perspective. Disabil Rehabil2000; 22: 665–674.
5.
5 Granger CV, Hamilton BB, Keith RA. Advances in functional assessment for medical rehabilitation. Top Geriatr Rehabil1986; 1:59–74.
6.
6 Hamilton BB, Laughlin JA, Granger CV. Interrater agreement of the seven level functional independence measure (FIM). Arch Phys Med Rehabil1991; 72: 790-790.
7.
7 Fleiss JL. Statistical methods for rates and proportions. J Wiley & Sons, 1981.
8.
8 Barrett JA, Watkins C, Plant R et al. The COSTAR wheelchair study: a two-centre pilot study of self-propulsion in a wheelchair in early stroke rehabilitation. Collaborative Stroke Audit and Research. Clin Rehabil2001; 15:32–41.
9.
9 Lennon S, Baxter D, Ashburn A. Physiotherapy based on the Bobath concept in stroke rehabilitation: a survey within the UK. Disabil Rehabil2001; 23: 254–262.
10.
10 Paci M. Physiotherapy based on the Bobath concept for adults with post-stroke hemiplegia: a review of effectiveness studies. J Rehabil Med2003; 35:2–7.
11.
11 Pomeroy VM, Mickelborough J, Hill E, Rodgers P, Barrett JA. A Hypothesis: self-propulsion in a wheelchair early after stroke might not be harmful. Clin Rehabil2003; 17: 174–180.
