Structural Modeling of Early Ambulation Progression in Patients with Acute Stroke: A Covariance Structure Analysis Approach.

Abstract

This study used structural equation modeling (SEM) to elucidate the causal relationships between Functional Independence Measure (FIM) items and consciousness levels in patients with stroke and low consciousness levels 2 weeks after initiating occupational therapy (OT). This modeling sought to identify the factors influencing the number of days required to get out of bed. SEM was used for multifactorial simultaneous analysis in a study of 22 patients with a Japan Coma Scale score of 20 after stroke. The Glasgow Coma Scale was used to evaluate patients' consciousness level; FIMs were used to evaluate activities of daily living in the ward. Influencing factors, including "bed/chair transfers" and "toilet transfers," were defined as "transfer functions," while factors involving "social interactions," "comprehension," "memory," "problem solving," and "expression" were defined as "cognitive decline." After 2 weeks, standardized coefficients showed that "transfer functions" and "cognitive decline" had effects of -0.33 and -0.25, respectively, on "early ambulation days." Further analysis revealed that improvements in "consciousness level" impacted "early ambulation days," with coefficients of -0.35 for "transfer functions" and 0.14 for "cognitive decline." Through the "consciousness level" observation variable, the coefficients of indirect effects were -0.27 for "transfer function" on "days to get out of bed," 0.38 for "cognitive decline," and -0.06 for "self-care" on "early ambulation days." Improvement in transfer movements and cognitive decline influenced the number of days required to get out of bed without improving consciousness or affecting early ambulation.