Article

Early prognosis, adequate goal setting, and referral are important
for stroke management. OBJECTIVE: To investigate if independent gait 6 months
poststroke can be accurately predicted within the first 72 hours poststroke,
based on simple clinical bedside tests. Reassessment on days 5 and 9 was used to
check whether accuracy changed over time. METHODS: In 154 first-ever ischemic
stroke patients unable to walk independently, 19 demographic and clinical
variables were assessed within 72 hours and again on days 5 and 9 poststroke.
Multivariable logistic modeling was applied to identify early prognostic factors
for regaining independent gait, defined as >/=4 points on the Functional
Ambulation Categories. RESULTS: . Multivariable modeling showed that patients
with an independent sitting balance (Trunk Control Test-sitting; 30 seconds) and
strength of the hemiparetic leg (Motricity Index leg; eg, visible contraction for
all 3 items, or movement against resistance but weaker for 1 item) on day 2
poststroke had a 98% probability of achieving independent gait at 6 months.
Absence of these features in the first 72 hours was associated with a probability
of 27%, declining to 10% by day 9. CONCLUSIONS: Accurate prediction of
independent gait performance can be made soon after stroke, using 2 simple
bedside tests: "sitting balance" and "strength of the hemiparetic leg." This
knowledge is useful for making early clinical decisions regarding treatment goals
and discharge planning at hospital stroke units.

Langue : ANGLAIS