R3-Walk and R6-Walk, simple clinical equations to accurately predict independent walking at 3 and 6 months after stroke: A prospective, cohort study

OBJECTIVE:To investigate if independent walking at 3 and 6 months poststroke can be accurately predicted within the first 72 hours, based on simple clinical bedside tests. DESIGN:Prospective observational cohort study with three-time measurements: immediately after stroke, and 3 and 6 months poststroke. SETTING:Public hospital. PARTICIPANTS:Adults with first-ever stroke. INTERVENTION:Not applicable. MAIN OUTCOME MEASURES:The outcome of interest was independent walking at 3 and 6 months after stroke. Predictors were age, walking ability, lower limb strength, motor recovery, spatial neglect, continence, and independence in activities of daily living. RESULTS:The equation for predicting walking 3 months poststroke was: 3.040 + (0.283 x FAC baseline) + (0.021 x Modified Barthel Index), and for predicting walking 6 months poststroke was: 3.644 + (-0.014 x age) + (0.014 x Modified Barthel Index). For walking ability 3 months after stroke, sensitivity was classified as high (91%; 95% CI: 81 to 96), specificity was moderate (57%; 95% CI: 45 to 69), positive predictive value was high (76%; 95% CI: 64 to 86), and negative predictive value was high (80%; 95% CI: 60 to 93). For walking ability 6 months after stroke, sensitivity was classified as moderate (54%; 95% CI: 47 to 61), specificity was high (81%; 95% CI: 61 to 92), positive predictive value was high (87%; 95% CI: 70 to 96), and negative predictive value was low (42%; 95% CI: 50 to 73). CONCLUSIONS:This study provided two simple equations that predict walking ability 3 and 6 months after stroke. This represents an important step to accurately identify individuals, who are at high risk of walking dependence early after stroke.