Early multidimensional mobility assessments for discriminating discharge-level ambulation and functional independence in subacute stroke inpatients: a retrospective cohort study

OBJECTIVE: To examine whether early multidimensional mobility assessments discriminate independent ambulation and functional independence on discharge in subacute stroke inpatients with supervised walking ability. DESIGN: Retrospective cohort study. SUBJECTS/PATIENTS: Fifty subacute stroke inpatients (≤ 5 months post-stroke). METHODS: Independent ambulation and functional independence were defined as Functional Ambulation Category ≥ 4 and Modified Barthel Index 75 on discharge, respectively. Discriminative ability of admission assessments was evaluated using univariate binary logistic regression and receiver operating characteristic curve analysis. RESULTS: The Berg Balance Scale and the modified Four Square Step Test demonstrated the highest discriminative performance. For independent ambulation, the Berg Balance Scale (≥ 40.5) yielded an area under the curve of 0.74 (95% confidence interval: 0.60-0.88) with 82% accuracy, and the modified Four Square Step Test (≤ 31.52 s) yielded an area under the curve of 0.78 (0.64-0.91) with 80% accuracy. For functional independence, the Berg Balance Scale (≥ 42.5) yielded an area under the curve of 0.74 (0.60-0.88) with 74% accuracy, and the modified Four Square Step Test (≤ 32.88 s) yielded an area under the curve of 0.71 (0.57-0.86) with 70% accuracy. CONCLUSION: Early balance and multidirectional stepping performance may be useful for screening to support goal-setting and discharge planning.