R3-Walk and R6-Walk, Simple Clinical Equations to Accurately Predict Independent Walking at 3 and 6 Months After Stroke: A Prospective, Cohort Study

Abstract

ObjectiveTo investigate if independent walking at 3 and 6 months poststroke can be accurately predicted within the first 72 hours, based on simple clinical bedside tests. DesignProspective observational cohort study with 3-time measurements: immediately after stroke, and 3 and 6 months poststroke. SettingPublic hospital. ParticipantsAdults with first-ever stroke evaluated at 3 (N=263) and 6 (N=212) months poststroke. InterventionNot applicable. Main Outcome MeasuresThe outcome of interest was independent walking at 3 and 6 months after stroke. Predictors were age, walking ability, lower limb strength, motor recovery, spatial neglect, continence, and independence in activities of daily living. ResultsThe equation for predicting walking 3 months poststroke was 3.040 + (0.283 × FAC baseline) + (0.021 × Modified Barthel Index), and for predicting walking 6 months poststroke was 3.644 + (-0.014 × age) + (0.014 × Modified Barthel Index). For walking ability 3 months after stroke, sensitivity was classified as high (91%; 95% CI: 81–96), specificity was moderate (57%; 95% CI: 45–69), positive predictive value was high (76%; 95% CI: 64–86), and negative predictive value was high (80%; 95% CI: 60–93). For walking ability 6 months after stroke, sensitivity was classified as moderate (54%; 95% CI: 47–61), specificity was high (81%; 95% CI: 61–92), positive predictive value was high (87%; 95% CI: 70–96), and negative predictive value was low (42%; 95% CI: 50–73). ConclusionsThis study provided 2 simple equations that predict walking ability 3 and 6 months after stroke. This represents an important step to accurately identify individuals, who are at high risk of walking dependence early after stroke.