Stroke impairment, balance, and cognitive status on admission predict walking independence up to 90 days post-stroke but their contributions change over time.

This study aimed to identify predictors of gait independence in three successive patient cohorts that received inpatient rehabilitation for at least 30 days, 60 days, or 90 days post-stroke. A total of 26 independent variables were collected within 3 days of stroke onset, including basic information (age, sex, stroke type), sensorimotor function (Stroke Impairment Assessment Set), gait function, balance function, and cognitive function. The dependent variable was walking independence (without assistance from another person) at 30, 60, or 90 days post-stroke. A decision tree was developed for predicting gait independence at each assessment time point. The predictors of walking independence differed among the cohorts that received inpatient rehabilitation for at least 30, 60, and 90 days post-stroke. Specifically, the Short Form Berg Balance Scale score was in the higher layer and was a strong predictor of gait at all time points. The cognitive Functional Independence Measure progressed to the higher layer at later time points. The lower extremity motor function was an additional predictor in the 30-day cohort. For later cohorts, the predictive value of balance and cognitive function declined whereas the contribution of the paralyzed grip strength and trunk function increased. These results suggest that sensorimotor and cognitive function within 3 days of stroke can predict walking independence between 1 and 3 months post-stroke; however, the prognostic value of predictors varies among the patients who receive inpatient rehabilitation for shorter versus longer time.

Efficacy of Knee-Ankle-Foot Orthosis on Functional Mobility and Activities of Daily Living in Patients with Stroke: A Systematic Review of Case Reports.

OBJECTIVE:  To synthesize available evidence from case reports regarding the efficacy of knee-ankle-foot orthosis (KAFO) on functional mobility and activities of daily living (ADL) in patients with stroke. METHODS:  The following databases were searched, based on the Population Intervention Comparison Outcome (PICO) model: PubMed, CINAHL, Sco- pus, Cochrane Central Register of Controlled Trials, PEDro, Web of Science, and Igaku Chuo Zassi (in Japanese). Methodological quality was assessed using the CARE checklist. RESULTS:  A total of 14 articles, including 15 cases, were selected. Clinically meaningful improvement in functional mobility was reported in 10 of 15 cases, measured using the Functional Ambulatory Category, Trunk Control Test, walking speed, and Berg Balance Scale. Clinically meaningful improvement in ADL was reported in 9 of 15 cases, measured using the Barthel Index and Functional Independent Measure. However, the methodological quality of the reviewed articles was low, with missing information on limitations of management, adverse events, and patient-reported outcomes. CONCLUSION:  This systematic review of case reports found a low level of evidence of the efficacy of KAFO in terms of improvement in functional mobility and ADL. Of value, this study revealed the optimal outcomes for measuring the efficacy of KAFO.