Prediction of gait independence using the Trunk Impairment Scale in patients with acute stroke

Masahiro Ishiwatari; Mami Tani; Reina Isayama; Kaoru Honaga; Masato Hayakawa; Tomokazu Takakura; Akira Tanuma; Akihiro Kurosu; Kozo Hatori; Futoshi Wada; Toshiyuki Fujiwara

doi:10.1177/17562864221140180

Prediction of gait independence using the Trunk Impairment Scale in patients with acute stroke

Ther Adv Neurol Disord. 2022 Dec 6:15:17562864221140180. doi: 10.1177/17562864221140180. eCollection 2022.

Authors

Affiliations

¹ Department of Rehabilitation Medicine, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo, Tokyo 113-8421, Japan.
² Department of Rehabilitation, Kiminomori Rehabilitation Hospital, Chiba, Japan.
³ Department of Rehabilitation Medicine, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
⁴ Shioda Medical Corporation, Chiba, Japan.
⁵ Department of Physical Therapy, Faculty of Health Science, Juntendo University, Tokyo, Japan.

Abstract

Background: Gait recovery is one of the primary goals of stroke rehabilitation. Gait independence is a key functional component of independent activities in daily living and social participation. Therefore, early prediction of gait independence is essential for stroke rehabilitation. Trunk function is important for recovery of gait, balance, and lower extremity function. The Trunk Impairment Scale (TIS) was developed to assess trunk impairment in patients with stroke.

Objective: To evaluate the predictive validity of the TIS for gait independence in patients with acute stroke.

Methods: A total of 102 patients with acute stroke participated in this study. Every participant was assessed using the TIS, Stroke Impairment Assessment Set (SIAS), and Functional Independence Measure (FIM) within 48 h of stroke onset and at discharge. Gait independence was defined as FIM gait scores of 6 and 7. Multiple regression analysis was used to predict the FIM gait score, and multiple logistic regression analysis was used to predict gait independence. Cut-off values were determined using receiver operating characteristic (ROC) curves for variables considered significant in the multiple logistic regression analysis. In addition, the area under the curve (AUC), sensitivity, and specificity were calculated.

Results: For the prediction of the FIM gait score at discharge, the TIS at admission showed a good-fitting adjusted coefficient of determination (R ² = 0.672, p < 0.001). The TIS and age were selected as predictors of gait independence. The ROC curve had a TIS cut-off value of 12 points (sensitivity: 81.4%, specificity: 79.7%) and an AUC of 0.911. The cut-off value for age was 75 years (sensitivity: 74.6%, specificity: 65.1%), and the AUC was 0.709.

Conclusion: The TIS is a useful early predictor of gait ability in patients with acute stroke.

Keywords: Trunk Impairment Scale (TIS); acute stroke; gait; predictive validity; prognostic prediction.