Background Past studies have inconsistently identified factors associated with independent walking post-stroke. We investigated the relationship between pre-stroke factors and factors collected acutely after stroke and number of days to walking 50 m unassisted using data from A Very Early Rehabilitation Trial (AVERT).
Methods The outcome was recovery of 50 m independent walking, tested from 24 hours to 3 months post-stroke. A set of a priori defined factors (participant demographics: age, sex, handedness; pre-stroke: hypertension, ischaemic heart disease, hypercholesterolaemia, diabetes mellitus, atrial fibrillation; stroke-related: stroke severity, stroke type, ischaemic stroke location, stroke hemisphere, thrombolysis) were investigated for association with independent walking using a cause-specific competing risk Cox proportional hazards model. Respective effect sizes are reported as cause-specific adjusted HR (caHR) adjusted for age, stroke severity and AVERT intervention.
Results A total of 2100 participants (median age 73 years, National Institutes of Health Stroke Scale 7, <1% missing data) with stroke were included. The median time to walking 50 m unassisted was 6 days (IQR 2–63) and 75% achieved independent walking by 3 months. Adjusted Cox regression indicated that slower return to independent walking was associated with older age (caHR 0.651, 95% CI 0.569 to 0.746), diabetes (caHR 0.836, 95% CI 0.740 to 0.945), severe stroke (caHR 0.094, 95% CI 0.072 to 0.122), haemorrhagic stroke (caHR 0.790, 95% CI 0.675 to 0.925) and right hemisphere stroke (caHR 0.796, 95% CI 0.714 to 0.887).
Conclusion Our analysis provides robust evidence for important factors associated with independent walking recovery. These findings highlight the need for tailored mobilisation programmes that target subgroups, in particular people with haemorrhagic and severe stroke.
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Contributors JB, LC, JMC, FE and GAD contributed to major role in the acquisition of data. CK, LC and KSH designed and conceptualised study. CK, LC and KSH analysed and interpreted the data. JB interpreted the data. CK, LC and KSH drafted the manuscript for intellectual content. JB, JMC, FE, LBC, VR and GAD revised the manuscript for intellectual content.
Funding AVERT was funded by National Health and Medical Research Council (NHMRC) of Australia (386201, 1041401); Chest Heart and Stroke Scotland (Res08/A114); Northern Ireland Chest Heart and Stroke (AVERT-NI 2008); Singapore Health (SHF/FG401P/2008); The Stroke Association, UK (TSA2009/09) and National Institute of Health Research, UK (HTA Project 12/01/16). NHMRC fellowship funding was provided to KH (1088449) and JB (1058635, 1154904). JB also received fellowship funding from Australian Research Council (0991086) and the National Heart Foundation.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethics approval for AVERT was obtained from institutional review boards at all participating sites. Additional ethics approval for this analysis was received from Austin Health Human Research Ethics Committee (HREC), reference number LNR/19/Austin/15. AVERT was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12606000185561), US National Institutes of Health (ISRCTN98129255) and UK Clinical Trials Gateway (ISRCTN98129255).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request to AVERT Executive Committee.
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