What is the probability of patients who are nonambulatory after stroke regaining independent walking? A systematic review.

Patients after stroke who are nonambulatory require resources, and independent walking becomes a major determinant of the ability to participate in activities of daily living. Our objective was to determine the probability of walking for patients who are nonambulatory in the first month after stroke. We performed a systematic review and meta-analysis of consecutive, prospective studies of nonambulatory patients within the first month after stroke in rehabilitation and acute units. The outcomes were the probability of achieving independent walking at three-, six- and 12 months after stroke. Twenty-six studies were included in the review. Seventeen studies comprising 2856 participants were entered into meta-analyses. For initially nonambulatory stroke patients managed in a rehabilitation unit, the probability of independent walking was 0.60 (95% CI 0.47-0.74, 1373 participants) at three-months, 0.65 (95% CI 0.53-0.77, 444 participants) at six-months and 0.91 (95% CI 0.81-1.00, 24 participants) at 12 months. For patients managed in an acute unit, the probability of independent walking was 0.39 (95% CI 0.27-0.52, 634 participants) at three-months, 0.69 (95% CI 0.46-0.92, 405 participants) at six-months and 0.74 (95% CI 0.59-0.88, 34 participants) at 12 months. 60% of patients managed in a rehabilitation unit who are nonambulatory in the first month after stroke will regain independent walking compared with 39% of those managed in an acute unit. This information can be used clinically to make decisions about allocation of rehabilitation resources, education of patients and carers, and for discharge planning.