Predictors of favorable modified Rankin Scale outcome during inpatient rehabilitation for subacute stroke: a secondary analysis of the Walk 'n Watch trial.

Abstract

To investigate admission characteristics associated with favourable outcome during inpatient rehabilitation for early subacute stroke, and determine whether rehabilitation intensity has a role in predicting outcomes. This secondary analysis of Walk 'n Watch (WnW) cluster randomised trial included a total of 267 participants (mean age 67.9 years; 39% female; 82% ischaemic stroke) who received either usual care (<i>n</i> = 139) or WnW protocol (<i>n</i> = 128). Usual care consisted of 30-60 min of daily physical therapy. WnW followed a similar schedule with higher-intensity walking-related activity (e.g., treadmill, stairs) at 40-60% heart rate reserve. The outcome was favourable modified Rankin Scale (mRS <math xmlns="http://www.w3.org/1998/Math/MathML"><mo>≤</mo><mn>2</mn><mo>)</mo></math>. Baseline characteristics included age, sex, time since stroke, stroke type, admission mRS, depression, cognition, and walking endurance. Multivariable logistic regression examined associations, stratified by rehabilitation intensity. After inpatient rehabilitation, 40% of usual care and 44% of WnW participants achieved a favourable mRS outcome. Shorter time since stroke, haemorrhagic stroke, and lower baseline mRS were associated with favourable outcome in usual care. Higher cognition was associated with favourable mRS in WnW; males and those with greater walking endurance showed more favourable outcomes, though not statistically significant. Admission characteristics associated with favourable mRS outcome differed by rehabilitation intensity.