Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand.
Neurorehabil Neural Repair. 2024 Oct;38(10):742-751. doi: 10.1177/15459683241270055. Epub 2024 Aug 20.
The use of prediction tools in stroke rehabilitation research and clinical practice is increasing, but it is not clear whether these prediction tools out-perform clinician predictions.
This study aimed to compare physiotherapist predictions for independent walking with the Time to Walking Independently after STroke (TWIST) prediction tool.
Adults with new lower limb weakness and unable to walk independently (Functional Ambulation Category [FAC] < 4) were recruited. At 1 week post-stroke, the treating physiotherapist was asked to predict whether their patient would achieve independent walking by 4, 6, 9, 12, 16, or 26 weeks, or remain dependent. Predictions were also made using the TWIST prediction tool, but not shared. Binary logistic regressions were conducted with the time independent walking was achieved as the dependent variable and independent variables were the physiotherapist and TWIST predictions.
Ninety-one participants were included (median age 71 years, 36 [40%] female). Most participants (67 [74%]) were non-ambulatory (FAC = 0) at 1-week post-stroke. Thirty-seven physiotherapists were recruited. Physiotherapists made accurate predictions for time taken to achieve independent walking for 39 participants (43%). Prediction accuracy was not related to physiotherapist confidence or years of stroke-specific experience. TWIST out-performed physiotherapist predictions (Physiotherapists 76%-77%, TWIST 86%-88% accurate) for participants who achieved independent walking by 4, 6, and 9 weeks post-stroke. Accuracy of physiotherapist and TWIST predictions was similar for 16 and 26 weeks post-stroke.
The TWIST prediction tool is more accurate than physiotherapists at predicting whether a patient will achieve independent walking by 4, 6, or 9 weeks post-stroke, but not for 16 or 26 weeks post-stroke. TWIST may be useful to inform early rehabilitation and discharge planning. Clinical Trial Registration-URL: www.anzctr.org.au Unique Identifier: ACTRN12617001434381.
预测工具在中风康复研究和临床实践中的应用越来越多，但尚不清楚这些预测工具是否优于临床医生的预测。
本研究旨在比较物理治疗师对独立行走的预测与中风后独立行走时间（TWIST）预测工具。
招募新出现下肢无力且无法独立行走（功能步行分类[FAC] < 4）的成年人。在中风后 1 周，要求治疗师物理治疗师预测他们的患者在 4、6、9、12、16 或 26 周内是否能够独立行走，或保持依赖状态。还使用 TWIST 预测工具进行了预测，但不共享。以是否能够独立行走的时间为因变量，将物理治疗师和 TWIST 预测作为自变量进行二元逻辑回归。
共纳入 91 名参与者（中位数年龄 71 岁，36 [40%] 为女性）。大多数参与者（67 [74%]）在中风后 1 周时无法行走（FAC = 0）。共招募了 37 名物理治疗师。物理治疗师对 39 名参与者（43%）达到独立行走所需的时间做出了准确的预测。预测准确性与治疗师的信心或中风特定经验年限无关。TWIST 在预测 4、6 和 9 周内实现独立行走的参与者方面优于物理治疗师预测（物理治疗师 76%-77%，TWIST 86%-88%准确）。在 16 和 26 周后，物理治疗师和 TWIST 预测的准确性相似。
与物理治疗师相比，TWIST 预测工具在预测患者是否能在中风后 4、6 或 9 周内实现独立行走方面更准确，但在 16 或 26 周后则不然。TWIST 可能有助于为早期康复和出院计划提供信息。临床试验注册网址：www.anzctr.org.au。独特标识符：ACTRN12617001434381。
