Prediction model for timing of independent walking on varied surface conditions in patients with early subacute stroke: A multicenter prospective study.

PURPOSE: This study aimed to develop and internally validate a model predicting when patients with early subacute stroke achieve independent walking on multiple types of surfaces.

METHODS

In this prospective multicenter observational study, adults admitted to rehabilitation wards for cerebral infarction or hemorrhage (April 2023-October 2025) were assessed. Walking independence was evaluated from 6 to 24 weeks after stroke onset using the Functional Ambulation Categories (FAC); FAC 5 indicated independent walking on multiple types of surfaces. A Cox proportional hazards model was developed using prespecified admission predictors: age, knee extension, Berg Balance Scale, Mini-Mental State Examination, visuospatial function, and continence. Missing data were multiply imputed. Internal validation used 200 bootstrap resamples.

RESULTS

Of 367 screened patients, 168 were analyzed (mean age 74.9 years). The cumulative achievement rate for FAC 5 plateaued at 51% by week 20. The model satisfied proportional hazards assumptions. Time-dependent area under the curve values ranged from 0.86 to 0.92. Calibration was favorable, with a slope of 0.92, expected/observed ratios of 1.00-1.03, and integrated calibration indices of 0.04-0.06.

CONCLUSIONS

A model based on routine assessments in the early subacute phase showed favorable internal performance in predicting the timing of independent walking across multiple surface conditions after stroke; however, external validation is required before clinical implementation.