Maximum walking speed at discharge could be a prognostic factor for vascular events in patients with mild stroke: A cohort study

Publication date: Available online 26 June 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Hiroyuki Kawajiri, Hiromi Mishina, Sho Asano, Yuji Kono, Hironori Hayashi, Jun-ichi Niwa, Manabu Doyu, Shinya Kimura, Sumio Yamada
ObjectiveTo identify the prognostic value of physical activity-related factors as well as known vascular risk factors for vascular events in mild ischemic stroke.DesignSingle-center prospective cohort study.SettingUniversity hospital.ParticipantsConsecutive patients with acute ischemic stroke and transient ischemic attack with modified Rankin scale scores ranging from 0 to 2 were enrolled in this study.InterventionsNot applicable.Main Outcome MeasuresEnrolled patients were followed up for composite vascular events as primary outcomes up to three years post discharge. Primary outcomes included stroke and cardiovascular death, hospitalization due to stroke or TIA recurrence, cardiovascular disease, and peripheral artery disease. During hospitalization, known vascular risk factors such as previous history of vascular events, stroke subtype, white matter lesions, and ankle-brachial index were assessed. Moreover, at the time of discharge, physical activity-related factors such as maximum walking speed, handgrip strength, knee extensor isometric muscle strength, anxiety, and depression were assessed as potential predictors.ResultsA total of 255 patients (175 men, median age 70.0 years) were enrolled in this study. The Kaplan-Meier estimates of cumulative risk of composite vascular events at one-, two-, and three-years were 9.6%, 14.4%, and 15.2%, respectively. After multivariate analysis, cerebral white matter lesions of periventricular hyperintensity (grade=3; hazard ratio: 2.904; 95% confidence interval: 1.160 to 7.266; p=0.023) and maximum walking speed (<1.45m/s; hazard ratio: 2.232; 95% confidence interval: 1.010 to 4.933; p=0.047) were identified as significant independent predictors of composite vascular events.ConclusionsThe results of this study indicate that maximum walking speed could be an independent prognostic factor for composite vascular events in mild ischemic stroke.



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