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ORIGINAL ARTICLE   Free accessfree

European Journal of Physical and Rehabilitation Medicine 2019 August;55(4):433-41

DOI: 10.23736/S1973-9087.18.05489-8


lingua: Inglese

Community ambulation of stroke survivors at 6 months follow-up: an observational study on sociodemographic and sub-acute clinical indicators

Sanaz POURNAJAF 1 , Michela GOFFREDO 1, Maurizio AGOSTI 2, Maurizio MASSUCCI 3, Salvatore FERRO 4, Marco FRANCESCHINI 1, 5, the Italian Study Group on Implementation of Stroke Care (ISC Study) 

1 Department of Neurorehabilitation, San Raffaele Pisana Institute of Research and Care, Rome, Italy; 2 Department of Rehabilitation, Parma University Hospital, Parma, Italy; 3 Unit of Rehabilitation, Passignano sul Trasimeno Hospital, Perugia, Italy; 4 Hospital Care Service, Bologna, Italy; 5 San Raffaele University, Rome, Italy

BACKGROUND: Despite the importance of walking recovery in real life contexts, only 7% of stroke survivors at discharge from neuro-rehabilitation units recover independent walking in the community. However, studies on outcome indicators of walking ability restoration following stroke rarely regard the community ambulation.
AIM: The aim of the study is to investigate how sociodemographic and sub-acute clinical characteristics of stroke survivors at admission and at discharge may predict a good participation in community walking activity 6 months post-stroke.
DESIGN: Retrospective observational study.
SETTING: Inpatient neuro-rehabilitation centers.
POPULATION: Three-hundred-ten stroke survivors.
METHODS: A secondary analysis were performed on collected sociodemographic and clinical data of subjects after first-ever stroke within 72 hours of admission to acute care facilities (T1), at discharge (T2), and subsequently after 6-months post-stroke (T3). The regression analysis between every independent variable at T1 and T2 and Walking Handicap Scale-WHS (negative: 1-3; positive: 4-6) assessed at T3 were performed to identify the most important early predictors.
RESULTS: At T1, being younger, having a good ability to walk, early mobilization out of bed, not having TACI, and being female are significant positive indicators while, clinical complications are significantly negative for a WHS:4-6 at T3. No correlation was found between WHS and gender, etiology, the side of lesion, the presence of aphasia, and the presence of risk factors. The combination of risk factors indicates a negative WHS at T3.
CONCLUSIONS: The presence of risk factors and clinical complications delay significantly the walking ability restoration and return to social life. Such status consistently with the patient’s compliance must not postpone the rehabilitation relatively, rehabilitation must be facilitated with targeted programs taking care particularly of people with negative indicators for recovery of community ambulation 6 months post-stroke.
CLINICAL REHABILITATION IMPACT: Early indicators are considerable in order to predict a targeted prognosis and better provide a tailored rehabilitation program.

KEY WORDS: Stroke; Neurological rehabilitation; Walking; Prevention and control

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