Truncal impairment after stroke: clinical correlates, outcome and impact on ambulatory and functional outcomes after rehabilitation

Abstract

INTRODUCTION Good trunk performance is important for activities such as sitting and standing. In a cohort of patients with stroke, we sought to evaluate changes in trunk performance after stroke, establish factors correlated to trunk performance and assess the impact of trunk performance on discharge ambulatory and functional status. METHODS This was a retrospective review of the data of patients with stroke admitted to Tan Tock Seng Hospital rehabilitation centre, Singapore, over a two-year period. Data analysed included the National Institutes of Health Stroke Scale (NIHSS), Montreal Cognitive Assessment (MOCA), Fugl-Meyer Assessment (FMA) of limb motor impairment and Functional Independence Measure-motor (FIM-motor) scores, which measures self-care ability. Trunk performance was assessed on the Trunk Impairment Scale (TIS). RESULTS 577 patients with stroke (mean age 63.2 ± 11.8 years) were analysed. Truncal impairment was present in 96.4% of patients. Mean admission TIS score was 14.3 ± 6.1 and this improved to 17.2 ± 5.2 on discharge (p < 0.001). Admission TIS score was positively correlated with admission MOCA, FMA-upper limb and FMA-lower limb scores, and negatively correlated to NIHSS score and neglect. Admission TIS scores significantly predicted discharge FIM-motor scores (p < 0.001) and ambulatory status (p < 0.001). CONCLUSION Truncal impairment was common and improvements in trunk performance were seen after rehabilitation. Trunk performance was significantly correlated to stroke severity, upper and lower limb motor power, cognition and neglect. As admission trunk performance predicted discharge functional and ambulatory status, it is recommended that trunk performance be evaluated for all patients with stroke.