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Background The prognosis of the walking ability of individuals with stroke affects the choice of rehabilitation program. Identifying patients who will need assistance with ambulation at discharge allows clinicians to deliver rehabilitation programs focused on educating caregivers and adjusting the patient’s environment to allow safe transfer within the home. The primary objective of this study was to develop and internally validate a prediction model of walking dependence for patients with stroke admitted to a rehabilitation facility. The secondary objective was to establish a prediction model of restricted walking speed. Methods This retrospective cohort study included 476 individuals with subacute stroke who were admitted to a rehabilitation facility. Model 1 was developed to predict the probability of walking dependence. Model 2 was developed to predict restricted walking speed. Walking dependence was defined as a functional independence measure walk score of 5 or less. Restricted walking speed was defined as the ability to walk at 0.93 m/s or less. Potential predictors, including age, leg strength of the affected side, sitting balance, cognitive function, and urinary function, were selected based on the literature and analyzed using logistic regression analysis. Models were internally validated using the bootstrap method. Model performance was assessed by discrimination (area under the receiver operating characteristic curve (AUC)) and calibration (Hosmer–Lemeshow (H–L) goodness-of-fit test and calibration plots). Results A total of 236 patients (49.6%) walked dependently at discharge. Of the 240 individuals who achieved walking independence, 121 (50.4%) had restricted walking speed. In model 1, older age, poor leg strength, sitting balance, cognitive function, and urinary incontinence were significantly associated with walking dependence at discharge. The AUCs of models 1 and 2 were 0.93 (95% confidence interval (CI) = .90–.95) and 0.69 (95%CI = .62–.76), respectively. Both models had good calibration confirmed by the H-L test. Conclusions The internally validated prediction model of walking dependence had good discrimination and calibration, while the prediction model of restricted walking speed had poor discrimination. The prediction model for walking dependence developed in this study may be useful for planning rehabilitation strategies and setting realistic goals for patients.
Background The prognosis of the walking ability of individuals with stroke affects the choice of rehabilitation program. Identifying patients who will need assistance with ambulation at discharge allows clinicians to deliver rehabilitation programs focused on educating caregivers and adjusting the patient’s environment to allow safe transfer within the home. The primary objective of this study was to develop and internally validate a prediction model of walking dependence for patients with stroke admitted to a rehabilitation facility. The secondary objective was to establish a prediction model of restricted walking speed. Methods This retrospective cohort study included 476 individuals with subacute stroke who were admitted to a rehabilitation facility. Model 1 was developed to predict the probability of walking dependence. Model 2 was developed to predict restricted walking speed. Walking dependence was defined as a functional independence measure walk score of 5 or less. Restricted walking speed was defined as the ability to walk at 0.93 m/s or less. Potential predictors, including age, leg strength of the affected side, sitting balance, cognitive function, and urinary function, were selected based on the literature and analyzed using logistic regression analysis. Models were internally validated using the bootstrap method. Model performance was assessed by discrimination (area under the receiver operating characteristic curve (AUC)) and calibration (Hosmer–Lemeshow (H–L) goodness-of-fit test and calibration plots). Results A total of 236 patients (49.6%) walked dependently at discharge. Of the 240 individuals who achieved walking independence, 121 (50.4%) had restricted walking speed. In model 1, older age, poor leg strength, sitting balance, cognitive function, and urinary incontinence were significantly associated with walking dependence at discharge. The AUCs of models 1 and 2 were 0.93 (95% confidence interval (CI) = .90–.95) and 0.69 (95%CI = .62–.76), respectively. Both models had good calibration confirmed by the H-L test. Conclusions The internally validated prediction model of walking dependence had good discrimination and calibration, while the prediction model of restricted walking speed had poor discrimination. The prediction model for walking dependence developed in this study may be useful for planning rehabilitation strategies and setting realistic goals for patients.
IntroductionThe incidence of hemiplegia caused by stroke is high. In particular, lower limb dysfunction affects the daily activities of patients, and lower limb robotic devices have been proposed to provide rehabilitation therapy to improve balance function in this patient population.ObjectiveTo assess the effectiveness of the LiteStepper® unilateral lower limb exoskeleton (ULLE) combined with conventional treatment for balance function training in patients with post-stroke hemiplegia.MethodsThis multicenter randomized controlled trial, conducted in the convalescent rehabilitation ward of four hospitals, involved 92 patients in their post-stroke phase. Participants were randomized into an experimental group (EG) or a conventional group (CG). The EG adopted the LiteStepper® ULLE combined with conventional treatment for 21 days. The CG underwent a standard daily rehabilitation routine for 21 days. The Berg Balance Scale (BBS), Functional Ambulation Category scale (FAC), 6-min walk test (6MWT), and Barthel Index (Barthel) were used for evaluations before and after 21 days of rehabilitative training.ResultsThe BBS scores in EG was significantly elevated compared to CG, exhibiting a profound statistical difference (P< 0.0001). Notably, these disparities persisted at both day 21 (P < 0.0001) and day 14 (P < 0.0047) post-intervention, underscoring the efficacy of the treatment in the EG. The EG demonstrated a markedly greater improvement in BBS scores from pre-rehabilitation to 21 days post-training, significantly outperforming the CG. Furthermore, at both day 14 and day 21, functional assessments including the FAC, 6MWT, and Barthel revealed improvements in both groups. However, the improvements in the EG were statistically significant compared to the CG at both time points: day 14 (FAC, P = 0.0377; 6MWT, P = 0.0494; Barthel, P = 0.0225) and day 21 (FAC, P = 0.0015; 6MWT, P = 0.0005; Barthel, P = 0.0004). These findings highlight the superiority of the intervention in the EG in enhancing functional outcomes. Regarding safety, the analysis revealed a solitary adverse event (AEs) related to the LiteStepper®ULLE device during the study period, affirming the combination therapy’s safety profile when administered alongside conventional balance training in post-stroke hemiplegic patients. This underscores the feasibility and potential of incorporating LiteStepper®ULLE into rehabilitation protocols for this patient population.Discussion and significanceThe LiteStepper® ULLE combined with conventional treatment is effective and safe for balance function training in patients with post-stroke hemiplegia.
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