Citation

Mulder M, Nijland RHM, van de Port IG, van Wegen EEH, Kwakkel G. Arch. Phys. Med. Rehabil. 2019; ePub(ePub): ePub.

Affiliation

Department of Rehabilitation Medicine, Amsterdam Movement Sciences, VU University Medical Center, Amsterdam, Netherlands; Department of Neurorehabilitation, Amsterdam Rehabilitation Research Center, Reade, Amsterdam, Netherlands.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.apmr.2019.04.017

PMID

31153852

Abstract

OBJECTIVE: To classify patients with stroke into subgroups based on their characteristics at the moment of discharge from inpatient rehabilitation in order to predict community ambulation outcome six months later.

DESIGN: Prospective cohort study with a baseline measurement at discharge from inpatient care and final outcome determined after 6 months. SETTING: Community PARTICIPANTS: A cohort of 243 patients with stroke, referred for outpatient physical therapy, after completing inpatient rehabilitation in The Netherlands. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: A classification model was developed using Classification And Regression Tree (CART) analysis. Final outcome was determined using the community ambulation questionnaire. Potential baseline predictors included patient demographics, stroke characteristics, use of assistive devices, comfortable gait speed, balance, strength, motivation, falls efficacy, anxiety and depression.

RESULTS: The CART model accurately predicted independent community ambulation in 181/193 patients with stroke, based on a comfortable gait speed at discharge of 0.5 m/s or faster. In contrast, 27/50 patients with gait speeds below 0.5 m/s were correctly predicted to become non-community walkers.

CONCLUSIONS: We show that comfortable gait speed is a key factor in the prognosis of community ambulation outcome. The CART model may support clinicians in organizing community services at the moment of discharge from inpatient care.

Copyright © 2019. Published by Elsevier Inc.

Language: en

Keywords

community ambulation; gait; prognosis; rehabilitation; stroke