Melissa Bailey, MD
Being able to anticipate post-stroke prognosis is important in that it can allow patients to have a reasonable idea of what recovery they may have, can allow caregivers and patients to anticipate care needs, and can impact healthcare costs and patient placement after stroke. Recovery of walking after stroke can be especially important in returning to functional independence. A prior systematic review1 examined prognostic factors that would predict ability to walk 30 days after stroke regardless of if the patient was able to walk shortly after the stroke occurred, and factors such as age, leg strength, hemianopia, and size and location of stroke were found to be predictors. Preston and colleagues recently published a systematic review in which they examined prognostic factors for independent walking at 3, 6, and 12 months post-stroke in patients who were nonambulatory within one month after acute hemiplegic stroke.
The authors searched through multiple databases for cohort studies related to stroke prognostic factors measured within one month of acute stroke and the outcome of independent walking without the assistance of another person. 3074 articles were screened, and the authors performed meta-analyses on 15 articles that met inclusion criteria. Meta-analyses included, on average, 357 patients. Factors that were found to predict independent walking at 3 months after stroke were younger age (OR 3.4, P<0.001) (average age of 63 in those who returned to independent walking vs. average age of 71 in those who did not), an intact corticospinal tract (OR 8.3, P<0.01), good leg strength (OR 5.0, P<0.001), no cognitive impairment (OR 3.5, P<0.001), no neglect (OR 2.4, P<0.01), continence (OR 2.3, P=0.001), good sitting (OR, 7.9, P<0.001), and independence in activities of daily living (OR 10.5, P<0.001), whereas at 6 months younger age (OR, 2.1, P<0.001), continence (OR, 13.8, P<0.001), and good sitting (OR, 19.1, P<0.001) were predictors of independent walking, and at 12 months there was insufficient data. These findings could potentially help guide management in terms of intensity of therapy specifically aimed at walking, placement of patient post-hospital, and guidance for patient and caregiver in terms of expected outcomes.
Limitations of this study included a relatively low number of patients in the corticospinal tract analysis, only 2-4 studies were included per meta-analysis, and univariate analyses were performed, leaving open the possibility of confounders. Future investigations may analyze the role of interventions regarding modifiable prognostic factors, such as strength and outcomes related to rehabilitation interventions.
- Craig LE, Wu O, Gilmour H, Barber M, Langhorne P. Developing and validating a predictive model for stroke progression. Cerebrovasc Dis Extra. 2011;1:105–114. doi: 10.1159/000334473 14.