平野 哲

OBJECTIVES: We aimed to develop and validate a model to predict gait independence at discharge from inpatient rehabilitation in individuals with subacute hemiparetic stroke who have very severe gait disorder. METHODS: Overall, 298 individuals with subacute hemiparetic stroke and completely dependent gait were selected in one hospital as the training cohort. Seventy-seven individuals were selected in another hospital as the validation cohort. The prediction model was developed using multivariable logistic regression analysis, with individual characteristics selected based on a p-value threshold (<0.10) in the training cohort. Sensitivity, specificity, and area under the curve of the receiver operating characteristic curve were calculated in the training cohort, and external validation was conducted using the validation cohort. RESULTS: In total, 102 (34.2%) and 40 (52.0%) individuals in the training and validation cohorts achieved independent gait while hospitalized, respectively. The prediction model factors were age, days from onset to admission, stroke type, affected side, severity of paresis, unaffected side function, and cognitive function. The sensitivity, specificity, and area under the curve in the training cohort were 0.81, 0.80, and 0.88, respectively. Corresponding values in the validation cohort were 0.82, 0.70, and 0.83, respectively. CONCLUSIONS: A model combining age, days from onset to admission, stroke type, affected side, severity of paresis, unaffected side muscle strength, and cognitive function effectively predicted gait independence at discharge in individuals with very severe gait disorder due to subacute hemiparetic stroke.

ABSTRACT Radial extracorporeal shock wave therapy showed immediate spasticity reduction and sustained range of motion improvement in a patient with subacute stroke. However, twice‐weekly sessions were insufficient for lasting spasticity control, suggesting that more frequent treatments may be required. Further research is needed to optimize treatment protocols.

OBJECTIVE: This study aimed to examine the dose-response relationship between time spent in gait training and gait independence in individuals with non-ambulatory subacute hemiparetic stroke in a rehabilitation ward. DESIGN: Retrospective cohort study. SETTING: A rehabilitation ward in Japan. PARTICIPANTS: Non-ambulatory individuals with subacute hemiparetic stroke who were admitted and discharged from the ward between January 2018 and December 2021. INTERVENTIONS: Gait training using orthoses, canes, robotic technology, or manual assistance by the therapist as needed. MAIN OUTCOME MEASURE: Functional Independence Measure walk (FIM-walk) score. RESULTS: In total, 326 individuals (mean age [standard deviation (SD)], 70.4 years [14.7]; men, 205) were included in the study. The cumulative rates of achieving gait independence (FIM-walk score ≥ 6), estimated by the Kaplan-Meier method with total gait training time during hospitalization as the time scale, were 50.6% (95% confidence interval [CI]: 45.3-56.2), 61.7% (95% CI: 56.4-66.9), 65.0% (95% CI: 59.9-70.2), and 65.9% (95% CI: 60.5-70.8), at 2,000, 4,000, 6,000, and 8,000 min, respectively. When participants were categorized according to the severity of lower limb motor impairment assessed by the Stroke Impairment Assessment Set motor function in lower extremity total score at admission, the cumulative rates of gait independence were significantly different among the four groups, with complete paralysis being the lowest, followed by severe, moderate, and mild paralysis (p<0.001). Stratifying by gait training time per day, the higher the gait training time per day, the higher the cumulative rate of achieving gait independence in complete and severe cases, and the lower rate in mild cases (p<0.001). CONCLUSIONS: A dose-response relationship with a plateau relationship was found between gait training time and achieving gait independence for non-ambulatory individuals with subacute hemiparetic stroke. The relationships differ by the degree of severity of lower limb motor impairment and by training intensity.