Walking recovery after an acute stroke: assessment with a new functional classification and the Barthel Index

Enrique Viosca, Rubén Lafuente, José L Martínez, Pedro L Almagro, Antonio Gracia, Carmen González
Archives of Physical Medicine and Rehabilitation 2005, 86 (6): 1239-44

OBJECTIVES: To investigate walking recovery after an acute stroke by using both a new functional classification and the Barthel Index, and to identify factors associated with good recovery.

DESIGN: A 1-year inception cohort study.

SETTING: In- and outpatient setting in a district hospital.

PARTICIPANTS: Twenty-six patients with a prognosis of intermediate walking recovery.

INTERVENTION: Conventional physical rehabilitation under professional supervision.

MAIN OUTCOME MEASURES: Walking capacity was assessed with a new classification scale and the Barthel Index during 5 patient evolution stages (admission to the hospital, hospital and physiotherapy discharge, clinical review, end of study). We also assessed the severity of the paresis of the affected lower limb, the time lapse between the stroke until the recovery of the weight-bearing capacity of the affected leg, and finally the time until standing balance was regained.

RESULTS: We detected improvement in walking capacity throughout the follow-up process with our new classification scale, but not with the Barthel Index. Significant improvements were observed from the initial assessment, from 1 month onward, and from 3 to 12 months. The functional level of the final ambulation correlated negatively and significantly with the initial time to achieve weight-bearing capacity on the affected leg and also with the standing balance. There was also a significant correlation with the severity of lower-extremity paresis.

CONCLUSIONS: Patients experienced an improvement in walking recovery throughout the first year after their stroke. The early weight-bearing capacity of the affected leg and standing balance were associated with higher walking levels 1 year after the stroke.

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