EARLY FUNCTIONAL FACTORS FOR PREDICTING OUTCOME OF INDEPENDENCE IN DAILY LIVING AFTER STROKE: A DECISION TREE ANALYSIS

TL;DR

This study identifies early motor and cognitive functions that predict a stroke patient's ability to perform daily living tasks after rehabilitation.

Contribution

The study introduces decision tree models to predict post-stroke outcomes based on early functional assessments.

Findings

Higher 'sitting-to-standing' scores and Berg Balance Scale scores predict better daily living outcomes (92.4% accuracy).

Lower visuomotor organization and time orientation scores predict poorer outcomes (82.7% accuracy).

Early motor and cognitive assessments are crucial for predicting post-stroke independence.

Abstract

This study aimed to investigate the predictive functional factors influencing the acquisition of basic activities of daily living performance abilities during the early stages of stroke rehabilitation using classification and regression analysis trees.

The clinical data of 289 stroke patients who underwent rehabilitation during hospitalization (164 males; mean age: 62.2 ± 13.9 years) were retrospectively collected and analysed. The follow-up period between admission and discharge was approximately 6 weeks. Medical records, including demographic characteristics and various functional assessments with item scores, were extracted. The modified Barthel Index on discharge served as the target outcome for analysis. A “good outcome” was defined as a modified Barthel Index score ≥ 75 on discharge, while a modified Barthel Index score < 75 was classified as a “poor outcome.”

Two classification and regression analysis tree models were developed. The first model, predicting activities of daily living outcomes based on early motor functions, achieved an accuracy of 92.4%. Among patients with a “good outcome”, 70.9% exhibited (i) ≥ 4 points in the “sitting-to-standing” category in the motor assessment scale and (ii) 32 points on the Berg Balance Scale score. The second model, predicting activities of daily living outcome based on early cognitive functions, achieved an accuracy of 82.7%. Within the “poor outcome” group, 52.2% had (i) ≤ 21 points in the “visuomotor organization” category of Lowenstein Occupational Therapy Cognitive Assessment, (ii) ≤ 1 point in the “time orientation” category of the Mini Mental State Examination.

The ability to perform “sitting-to-standing” and visuomotor organization functions at the beginning of rehabilitation emerged as the most significant predictors for achieving successful basic activities of daily living on discharge after stroke.

LAY ABSTRACT

In stroke rehabilitation, the prediction of activities of daily living is crucial for establishing effective therapeutic goals. We analysed data from 289 patients undergoing rehabilitation, encompassing all measured functional assessments, including item scores. The target outcome was defined as the modified Barthel Index, an indicator of activities of daily living performance, at the point of discharge. Two models were developed. The first is based on early motor function, which revealed that higher scores in the “sitting-to-standing” category on the motor assessment scale, higher Berg Balance Scale scores, and younger age were predictive of more favourable activities of daily living outcomes (92.4% accuracy). The second model, based on early cognitive function, demonstrated that lower scores in the “visuomotor organization” category of the Lowenstein Occupational Cognitive Assessment and a lower “time orientation” scores in the Mini Mental State Examination were indicative of suboptimal activities of daily living outcomes (82.7% accuracy). In conclusion, the ability to perform sitting-to-standing and exhibiting sound visuomotor organization stands out as crucial in predicting post-stroke activities of daily living outcomes. Clinicians can integrate these early functional assessments into their decision-making processes when establishing therapeutic goals.

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