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Predicting longitudinal progression in functional mobility after stroke: A prospective cohort study

Stroke, ISSN: 1524-4628, Vol: 51, Issue: 7, Page: 2179-2187
2020
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BACKGROUND AND PURPOSE: A majority of people with stroke remain impaired in their functional mobility. The aim of the study was to determine longitudinal changes in functional mobility after stroke. METHODS: The study was of a longitudinal and prospective design. The functional mobility was assessed using the Timed Upand- Go test on 5 different occasions: 5 days after onset, within 24 hours after discharge, 1 month after discharge, 3 months, and 1 year poststroke. Stroke severity was stratified based on impairments and activity limitations using a baseline cluster analysis. A multilevel model was developed to predict longitudinal progression in functional mobility based on stroke severity. RESULTS: One-hundred-thirty-five patients were included at baseline. Two distinct subgroups (moderate stroke [52%] and mild stroke [48%]) were identified based on impairments and activity limitations using clustering. Ninety-one patients were included in the longitudinal analysis. After controlling for age and cognition, significant improvements in functional mobility were found in the moderate stroke group between baseline and 1 year poststroke (mean difference in Timed Up-and-Go test time, -6.4 s, adjusted P<0.001). Patients with moderate stroke had a maximum rate of improvement in functional mobility during the first 3 months poststroke and then declined significantly at 1 year (12% increase in Timed Up-and-Go test time, adjusted P=0.025). Younger patients had better functional mobility. Although there was also a slight improvement in the mild stroke group, it was not statistically significant. CONCLUSIONS: The recovery of functional mobility differs between mild and moderate stroke. Patients with moderate stroke improved their functional mobility during the first 3 months, after which it decreased significantly. These findings suggest that long-term rehabilitation is desirable to maintain and perhaps increase the gained functional mobility. Older patients and those with moderate impairments and activity limitations have particular needs.

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