Trunk Control Test as a Main Predictor of the Modified Barthel Index Score at Discharge From Intensive Post-acute Stroke Rehabilitation: Results From a Multicenter Italian Study

Abstract

Objectives: To verify whether trunk control test (TCT) upon admission to intensive inpatient post-stroke rehabilitation, combined with other confounding variables, is independently associated with discharge mBI.

Design: Multicentric retrospective observational cohort study.

Setting: Two Italian inpatient rehabilitation units.

Participants: A total of 220 post-stroke adult patients, within 30 days from the acute event, were consecutively enrolled.

Interventions: Not applicable.

Main outcome measure: The outcome measure considered was the modified Barthel Index (mBI), one of the most widely recommended tools for assessing stroke rehabilitation functional outcomes.

Results: All variables collected at admission and significantly associated with mBI at discharge in the univariate analysis (TCT, mBI at admission, pre-stroke modified Rankin Scale [mRS], sex, age, communication ability, time from the event, Cumulative Illness Rating Scale, bladder catheter, and pressure ulcers) entered the multivariate analysis. TCT, mBI at admission, premorbid disability (mRS), communication ability and pressure ulcers (P<.001) independently predicted discharge mBI (adjusted R²=68.5%). Concerning the role of TCT, the model with all covariates and without TCT presented an R² of 65.1%. On the other side, the model with the TCT only presented an R² of 53.1%. Finally, with the inclusion of both TCT and all covariates, the model showed an R² increase up to 68.5%.

Conclusions: TCT, with other features suggesting functional/clinical complexity, collected upon admission to post-acute intensive inpatient stroke rehabilitation, independently predicted discharge mBI.

Keywords: Modified Barthel Index; Predictors; Rehabilitation; Rehabilitation outcome; Stroke; Trunk control.