Predictive discriminative accuracy of walking abilities at discharge for community ambulation levels at 6 months post-discharge among inpatients with subacute stroke

Abstract

[Purpose] This study aimed to compare the predictive accuracy of walking ability at discharge among subacute stroke inpatients at 6 months post-discharge in terms of community ambulation level and establish optimal cut-off values. [Participants and Methods] This prospective observational study included 78 patients who completed follow-up assessments. Patients were classified into three groups based on the Modified Functional Walking Category (household/most limited community walkers, least limited community walkers, and unlimited community walkers) obtained by telephone survey at 6 months post-discharge. Predictive accuracy and cut-off values for discriminating among groups were calculated from 6-minute walking distance and comfortable walking speed measured at the time of discharge using receiver operating characteristic curves. [Results] Between household/most limited and least limited community walkers, 6-minute walking distance and comfortable walking speed offered similar predictive accuracy (area under the curve, 0.6–0.7), with cut-off values of 195 m and 0.56 m/s, respectively. Between least limited and unlimited community walkers, the areas under the curve were 0.896 for 6-minute walking distance and 0.844 for comfortable walking speed, with cut-off values of 299 m and 0.94 m/s, respectively. [Conclusion] Walking endurance and walking speed among inpatients with subacute stroke provided superior predictive accuracy for unlimited community walkers at 6 months post-discharge.

Cutoff values of motor and cognitive measures for predicting and discriminating levels of activities of daily living after stroke: a scoping review

“…Inability to walk independently and receiving robot-assisted walking training Independent walking >10 m Inoue et al [27]. First-ever stroke and FIM walking ≤4 at admission Performance-oriented mobility assessment 0 vs. 1 Igarashi et al [28].…”

“…(2) Predictive factors and cutoff values based on longitudinal study There were 5 acute phase studies [19][20][21][22][23] and 10 subacute phase studies [6,[24][25][26][27][28][29][30][31][32] (Table 4). While the variables used varied widely, a significant number of studies used various trunk assessments [e.g.…”

“…FIM ≥ 6, mFAC ≥ 6): TIS Fujiwara version score of 12 [19] and Modified Rivermead Mobility Index (mRMI) score of 18.5 [20] at 2-3 days poststroke, as well as a BBS score of 12-13 [24,31] at 3 weeks to 1-month poststroke. The cutoff values for predicting limited community walkers (mFWT = 5, comfortable walking speed: 0.4-0.8 m/s) were as follows: distance of 195 m in the 6-min walk test [28] and comfortable speed of 0.56 m/s in the 10-m walk test at 3 weeks poststroke, as well as completion of the feet side-by-side position test in 5 s and semi-tandem position test in 1 s [30] of the Short Physical Performance Battery at 2 months poststroke. Lastly, the cutoff values for predicting unlimited community walkers (e.g.…”

Assessment indicators for determining walking independence

“…Furthermore, walking endurance and velocity are good predictors of whether subacute stroke patients will reach community walking levels at 6-month post-discharge. The cut-off values are 195 m and 0.56 m/s, respectively [27]. The 10MWT and 6MWT have different cut-off values depending on which level of walking independence is targeted, so the meaning of the measured times and distances should be interpreted according to the needs of the individual patient.…”

“…6-minute walk test (6MWT) [27] In subacute stroke patients, the cut-off value for predicting whether the community walking level will be reached at 6 months after discharge from the hospital is 195 m.…”