Gait and Sitting Balance Scores on the Mobility Scale for Acute Stroke Predict Discharge Home.

Research Report
Population: Adult

Marianne Beninato, PT, DPT, PhD, Associate Professor, MGH Institute of Health Professions

Megan Tinl, PT, DPT, NCS, Clinical Specialist, Brigham and Women’s Hospital, Department of Rehabilitation

Keywords: Prediction, Stroke, Discharge, Function

Background: The Mobility Scale for Acute Stroke (MSAS) is a standardized outcome measure comprised of six items that measure functional mobility. The MSAS is used to predict discharge disposition after acute stroke. In a sample of patients with acute stroke, a MSAS total score of 26 was previously identified as an accurate predictor of discharge home, independent of age or length of stay. Individual initial MSAS items, however, have not been analyzed relative to their contribution to predicting discharge home.
Purpose/Hypothesis: To evaluate the predictive validity of initial MSAS item scores in determining discharge destination (home vs not) after acute stroke
Subjects: 223 adults admitted to a tertiary care hospital with first time ischemic or hemorrhagic acute stroke
Materials/Methods: Data from initial physical therapy exams were retrieved from 223 medical records. Descriptive statistics were generated and Mann Whitney U tests were conducted to determine if there were significant differences in MSAS item scores between those patients who were discharged home vs those who were not. Logistic regression was conducted with Home vs Not Home as the criterion variable. Individual initial MSAS item scores (Bridging, Supine to Sit, Sitting Balance, Sit to Stand, Standing Balance and Gait) were entered into the regression model as independent variables individually, then systematically in various combinations in a stepwise method to generate the most parsimonious model. MSAS items were scored 1-6, ranging from 1 = maximum assist of two people to 6 = independent.
Results: Subjects’ mean age was 65.5 years +/- 14.8 and they were 51.6% male. 83% (N=185) of patients had ischemic stroke, 50.7% (N=113) had right hemispheric strokes and 35.9% (N=80) were discharged home from acute care. There were significant differences in scores on all six MSAS items between patients who were discharged home vs those who were not (P<0.000). The most parsimonious regression model (Chi Sq = 187.78, P<0.000) included two MSAS items: Gait and Sitting Balance. The odds of going home vs not home increased with increasing initial Gait (OR=2.60; 95% C.I.= 1.72-3.93; P<0.000), and Sitting Balance (OR=3.45; 95% C.I.=1.39-8.57; P=0.008) scores.
Conclusion: Of the six MSAS items, initial scores on the Gait and Sitting Balance items were predictive of discharge to home vs other settings.
Clinical Relevance: Discharge home after stroke typically requires certain abilities on the part of the patient. The current findings suggest that there may be two factors identified on initial examination, each related to a different level of ability, that are predictive of discharge home. Further investigation into the role of initial sitting balance scores in predicting recovery of other aspects of mobility may be indicated. In addition, including data on care giver assist availability and other home supports, might further inform the model predicting discharge home.

Beninato, Marianne , PT, DPT, PhD; Tinl, Megan , PT, DPT, NCS. Gait and Sitting Balance Scores on the Mobility Scale for Acute Stroke Predict Discharge Home.. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online.