JNNP: Can you walk independently after a stroke depends on those factors?

Acute brain stroke after about two-thirds of people will be difficult to walk independently, most of the survivors of this difficulty is still 3 months after stroke.
Stroke survivors consider walking after a stroke to be a high priority research area.
Compared with distance, appearance, or speed, survivors are most interested in the restoration of walking independence (that is, without the help of the hands of others).
From the perspective of medical services, independent walking is very important for decision-making on rehabilitation goals and discharge destinations.
Therefore, delaying independent walking will place a huge burden on stroke survivors, their families, and the medical system.

Understanding the factors related to recovery from independent walking is very important for establishing recovery goals and formulating a discharge plan.
The direct measurement of walking ability (for example, the 10-meter walking test) reflects walking ability better than the modified Rankin Scale (mRS), which cannot measure walking ability uniformly, but has been used for this purpose in the past.

Both pre-stroke and acute stroke factors seem to be related to independent walking.
Younger age is usually positively correlated with the recovery of walking ability, while gender does not seem to be correlated.
The relationship between stroke severity, stroke type, and pre-stroke comorbidities (such as diabetes ) and walking recovery is inconclusive.

However, there is limited evidence for the association between these factors and direct walking outcomes.
There is little evidence for the association between medical comorbidities that existed before the stroke and unassisted walking after the stroke.
So far, the association between neuroimaging factors (such as stroke type, stroke cerebral hemisphere, lesion volume) and independent walking has not been extensively studied.

In this way, Caitlin Kennedy and others of the University of Melbourne in Australia investigated the relationship between pre-stroke factors and factors collected acutely after stroke and the number of days of walking 50 m without assistance by using data from A Very Early Rehabilitation Trial (AVERT).

The clinical outcome is the recovery from 50-meter independent walking, and the test time is 24 hours to 3 months after the stroke.

Factors priori definitions (priori) include participant demographics: age, gender, hand; before stroke: high blood pressure, ischemic heart disease, high cholesterol, hyperlipidemia, diabetes, atrial fibrillation; stroke-related: severe stroke The degree, stroke type, ischemic stroke location, stroke hemisphere, thrombolysis, and the correlation with independent walking were investigated by using the Cox proportional hazard model of specific cause competition risk.

The effect of the statistical results is the cause-specific adjusted HR (caHR) after adjusting for age, stroke severity and AVERT intervention.

They included a total of 2100 stroke participants (median age 73 years, NIHSS scale 7, <1% missing data).
The median time to walk 50 meters without assistance was 6 days (IQR 2-63), and 75% of people achieved independent walking 3 months ago.

The adjusted Cox regression showed that the recovery of independent walking was slower and older (caHR 0.
651, 95% CI 0.
569 to 0.
746), diabetes (caHR 0.
836, 95% CI 0.
740 to 0.
945), severe stroke (caHR 0.
094) , 95% CI 0.
072～0.
122), hemorrhagic stroke (caHR 0.
790, 95% CI 0.
675～0.
925) and right hemisphere stroke (caHR 0.
796, 95% CI 0.
714～0.
887).

The important significance of this study is that it has discovered important factors related to independent walking recovery and emphasized the necessity of tailor-made sports rehabilitation training programs for subgroups, especially patients with hemorrhagic and severe stroke.

Original Source: bmj.