Gait speed is a strong predictor of the ability to walk independently without wheelchair assistance in a facility setting for post-stroke patients

Abstract

The ability to walk independently without wheelchair assistance around a hospital ward or facility, i.e., practical ambulation, is not taken into account when assessing ambulation status of patients. To our knowledge, no study has adequately examined indicators of practical ambulation in stroke patients living in facilities. This study aimed to identify factors associated with practical ambulation in a facility setting based on prospective observational data from recovering stroke patients. Ninety-four stroke patients (mean age, 67.9 years) who received inpatient rehabilitation services at the Okinawa Rehabilitation Hospital from January 2011 to November 2016 were enrolled in this observational study. Exclusion criteria were dementia, orthopedic disease, or requiring assistance to walk 10 m. In addition to clinical characteristics, lower limb motor function on affected and unaffected sides (Stroke Impairment Assessment Set and leg strength, respectively) and comfortable gait speed (CGS) in a 10m-walk test were examined at the time when 10m-walking was acquired without assistance. Ambulation status was continuously assessed for up to 6 months after stroke onset. Cox proportional hazards regression was used to assess the contribution of clinical characteristics, lower limb motor function and CGS to practical ambulation ability, and receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic accuracy of these indicators. A total of 72 stroke patients acquired practical ambulation during the study period. Only CGS was associated with practical ambulation, and the hazard ratio of acquiring practical ambulation per 1 m/min increase in CGS was 1.03 [95% confidence interval (CI): 1.02–1.08; P < 0.001]. ROC curve analysis revealed the optimal cut-off point and diagnostic accuracy to be 19.9 m/min and 0.903, respectively (area under curve: 0.923; 95% CI: 0.814–0.970). These findings suggest that gait speed is a strong predictor of practical ambulation ability in a facility setting for recovering stroke patients.