Berg Balance Scale score at admission can predict walking suitable for community ambulation at discharge from inpatient stroke rehabilitation
Dennis R. Louie, Janice J. Eng
Rehabilitation Research Program, GF Strong Rehabilitation Centre, University of British Columbia, Vancouver, Canada
Objective: This retrospective cohort study identified inpatient rehabilitation admission variables that predict walking ability at discharge and established Berg Balance Scale cut-off scores to predict the extent of improvement in walking.
Methods: Participants (n=123) were assessed for various cognitive and physical outcomes at admission to inpatient stroke rehabilitation. Multivariate logistic regression identified admission predictors of regaining community ambulation (gait speed ≥0.8 m/s) or unassisted ambulation (no physical assistance) after 4 weeks. Receiver operating characteristic curve analysis identified cut-off admission Berg Balance Scale scores.
Results: Mini-Mental State Examination (odds ratio (OR) 1.60, 95% confidence interval (95% CI) 1.19–2.14) was a significant predictor when coupled with admission walking speed for regaining community ambulation speed; stroke type (haemorrhagic/ischaemic) was a significant predictor (OR=0.19, 95% CI 0.05–0.77) when coupled with Berg Balance Scale (OR 1.14, 95% CI 1.09–1.20). Only Berg Balance Scale was a significant predictor of regaining unassisted ambulation (OR 1.11, 95% CI 1.05–1.17). A cut-off Berg Balance Scale score of 29 on admission predicts that an individual will go on to achieve community walking speed (n=123, area under the curve (AUC)=0.88, 95% CI 0.81–0.95); a cut-off score of 12 predicts a non-ambulator to regain unassisted ambulation (n=84, AUC 0.73, 95% CI 0.62–0.84).
Conclusion: The Berg Balance Scale can be used at rehabilitation admission to predict the degree of improvement in walking for patients with stroke.
Regaining mobility is the top rehabilitation goal set by patients with stroke and is an important determinant of whether a patient is able to return home. In this study we observed 123 participants over four weeks, from admission to stroke rehabilitation until discharge. We identified the characteristics of stroke patients when they are admitted that predict their walking ability after four weeks of rehabilitation. Early balance function was found to be able to predict whether a patient will go on to walk unassisted or at a speed suitable for the community. Other important variables to consider when a patient is admitted to rehabilitation are cognitive function and whether the stroke itself was the result of a clot or bleed.